A new stigma for obese people: when medication becomes the ‘shortcut’ to losing weight

Rivers of ink have been spilled on the stigma surrounding people with obesity. But that is not the end of the story. The arrival of incretin-based medicines (GLP-1 and similar) is bringing to light, ever more clearly, a new manifestation of this prejudice, which, paradoxically, is growing in tandem with the resounding success of these medicines. In fact, incretin-based medicines are increasingly being labelled as ‘shortcuts’ to weight loss, and the finger is being pointed at the lack of commitment and willpower of those who use them. This growing social condemnation, experts warn, could end up undermining the drugs’ effectiveness, just as millions of people are starting to use them. And this is not merely the classic stigma associated with being overweight, the one that has always affected these people. It is something different and, according to a new analysis published in the International Journal of Obesity , potentially more insidious: it is a specific stigma, directed at those who lose weight with the help of medication, rather than through ‘willpower’ alone.

The scope of this issue is outlined by Stacy M. Post, who, in a recent article in the International Journal of Obesity, calls for conceptual clarity and describes a phenomenon that is now difficult to ignore: the widespread perception, even within the medical community, that losing weight through semaglutide, tirzepatide and similar molecules amounts to ‘taking a shortcut’ compared to the traditional methods of diet and exercise. This narrative draws on an idea that is as old as it is deeply rooted in Western culture, namely that the value of an outcome depends on the ‘effort’ made to achieve it. And which, in the case of weight loss, now clashes with the effectiveness of a class of drugs that, within a matter of weeks, produce results that decades of behavioural recommendations had never managed to guarantee on a large scale.

And it is the figures that tell the story of the success of these long-awaited drugs: it is estimated that around one in four Americans has used them at least once and that over 100 million people in the United States alone would be eligible to start treatment. Yet, according to a survey cited in the article, as many as 76 per cent of those who use them report having experienced some form of stigma first-hand, linked specifically to their choice to use them, rather than to their weight itself.

An experimental study published in the same journal and authored by Erin C. Standen, Sean M. Phelan and A. Janet Tomiyama also addresses the prejudice surrounding these drugs. The researchers asked hundreds of participants to evaluate fictional characters who had lost weight using a GLP-1 drug, through diet and exercise, or who had remained the same weight. The results speak for themselves: those who lost weight using the drug were judged more harshly and considered less ‘attractive’ as potential partners than those who had achieved the same result through traditional methods, and even compared to those who had not lost weight at all. A second experiment, focusing on those who stopped treatment and regained the weight they had lost, showed that in such cases the stigma affects both those who had used the drug and those who had lost weight through diet and exercise in the same way; both groups were also rated more poorly than those who had managed to maintain their weight loss.

The point raised by the Post is that this form of prejudice does not merely undermine the self-esteem of those who experience it, but can have significant clinical implications. “This complex form of stigma,” writes the author, “can exacerbate the negative effects on physical and mental health and affect adherence to GLP-1 treatment to a greater extent than weight-related stigma alone, potentially creating new barriers to the effective treatment of obesity.”