As some describe it, this is where the world is now heading owing to the discovery of weight-loss drugs. In three short years since America’s Federal Drug Administration approved these medications their use has exploded. Novo Nordisk, maker of Ozempic and Wegovy, has become Europe’s most valuable company. Eli Lilly, which manufactures Mounjaro, was one of America’s best performers last year. And celebrities including Oprah Winfrey and Kelly Clarkson have emerged, almost overnight, slimmed down and svelte.
Morgan Stanley, a bank, estimates that as many as 9% of Americans will take brand-name versions of weight-loss drugs by 2035. That is just the tip of the iceberg. Demand for versions of these medications is only growing. On the subway in New York, Ro, a health-care startup, advises riders to “skip the shortages” and get access to cheaper versions for as little as $99 a month. Instagram is plastered with advertisements from firms such as hers and eden, which target young people by using lower-case brand names and soothing colour schemes. In September Kourtney Kardashian, a socialite, began selling a capsule through lemme, her supplement firm, which also flogs vaginal probiotic gummies and anti-cellulite pills.
The most important consequence of the drugs’ discovery is well understood: they will improve the health and lives of most of those with access to them. But the understandable rejoicing at the health benefits has been tempered, in some quarters, by a fear that the drugs will encourage the worst of society’s aesthetic impulses: that they will bring about an even fiercer expectation that everyone should conform to contemporary beauty standards, a trend which may come with its own health burden in the form of mental-health conditions and disordered eating.
People clamour to get on weight-loss drugs for aesthetic reasons, as well as owing to health concerns. This is not mere vanity. Evidence of discrimination against fat people is widespread. In Sweden and Mexico, where including a photograph with a CV is common, researchers manipulated images to make identical fictitious job applicants seem fatter or obese. They found that they were significantly less likely to be offered interviews. Petter Lundborg of Lund University and John Cawley of Cornell University have compared the wages of thin and fat women, adjusted for education, experience and other factors, in Europe and America respectively, and found that women with obese bmis earn around 10% less than their peers. The implication of this is stark: for an obese woman earning, say, $80,000 the impact of getting on Ozempic could be more economically consequential than any eventual savings she might make on her health bills.
Will weight-loss drugs make discrimination worse? Tressie McMillan Cottom, a New York Times columnist, has argued against the notion that Ozempic will cure “the moral crisis of fat bodies that refuse to get and stay thin”. The implicit promise of the drug is that “it can fix what our culture has broken.” (Her preferred solution: rather than solving obesity with drugs, society should simply stop stigmatising fat people.) “Ozempic has won, body positivity has lost. And I want no part of it,” lamented Rachel Pick, a writer, in the Guardian.
Such concerns are fuelled by the fact that the “body positive” movement, which pushes back on the idea that everyone should strive to meet the same body ideal, had been gaining ground. Retailers offer more sizes. It has become common to see clothing displayed on bigger women when shopping online. John Galliano of Maison Margiela, a luxury fashion house, used models of all sizes at a show in Paris.
It is natural to think that, in the short term, prejudice against fat people might be reinforced by weight-loss drugs. So far they have mostly been available to the rich, notes Mr Cawley: “If being able to lose weight is something that is very correlated with a person’s income there is a risk that having obesity could be seen as signalling being lower-income.” But mass adoption is under way—and that will change things.
The signal and the scale
Early man first invented tools. Then he invented jewellery. Archeologists have discovered strings of shells, believed to have been necklaces or earrings, that are 150,000 years old—more ancient than the development of language. The urge to use your appearance to signal ways in which you are distinct from others is one of humanity’s oldest impulses.
People have sent different signals over time and across cultures. Sometimes the impulse for change is the discovery of a newer, shinier material: snail shells were replaced with gold beads and later diamonds. The high-status beauties of the Renaissance were the voluptuous ladies painted by Rubens. Then the industrial revolution made food more affordable for the masses and a leaner look became more desirable. Had Malthus—who in 1798 predicted populations would soon be imperilled by food constraints—been right, fatness would surely still be in vogue.
Weight-loss drugs will probably be responsible for the next big change, and it will not be the creation of Stepford dystopia. Thinness is desirable now because it sends a signal: that one has the time to work out, the money to afford healthy foods and the education to know what diet to follow. In low-income countries such as Malawi and Uganda, where food is scarce for poorer people, obesity is more desirable, as it was in the pre-industrial West. A study by Elisa Macchi of Brown University, carried out in these countries, manipulated images attached to loan applications, and found that applicants who appeared obese had better access to credit.
The economics of signalling was best articulated by Michael Spence, a Nobel prizewinner. In 1973 Mr Spence developed a simple model of how the labour market works. There are two kinds of job candidate: good, high-productivity ones and bad, lazy ones. Potential employers do not know which is which. Applicants can acquire a degree, but this is hard; bad candidates are unlikely to be able to do it. It is also costly for the good ones to acquire a degree; it takes time and money. In this model, even if there are no true benefits to education, good candidates will acquire degrees as a signalling device, to let employers know they are strong candidates.
Before Mr Spence’s paper, the thinking was that employers valued education because it improved productivity. Mr Spence showed that there might be more to it. Would you rather have gone to Harvard—to have studied, taken classes, made connections—and never be able to reveal it? Or would you prefer to have a piece of paper that says you went? A similar question gets to the truth about body types. Would you rather look slender and in shape? Or would you want to actually be healthy?
With their appearance, people are sending signals that have value in the job and marriage markets. But what if someone did not have to be rich or disciplined to be thin? A signal is useful only if it sends the right message. In Mr Spence’s model, the signal works only if a university education is difficult to attain and acquired only by strong candidates.
Consider another example to see how fast the value of a signal can be lost. When email was new it was clear that, if one addressed you by name in the subject line or the text, a real person was trying to catch your attention. They had, after all, crafted a message just for you. Then it became possible for senders to namecheck a long list of people with ease. For a time, email users were tricked: they clicked, expecting an important message, and instead received a generic ad. Yet they soon learned.
In gossipy corners of the internet a transformation in the perception of thin people is already under way. Posters on the “nyc influencer snark” subreddit, a forum dedicated to needling the poor taste of D-List TikTok stars and Instagram influencers, accuse any- and everyone of being on the jab. Often this is idle chatter, but sometimes they provide evidence (or “receipts”). Two months ago “Nycundercover”, a habitual poster, published a screenshot of Serena Kerrigan, who has 217,000 Instagram followers, standing in front of her fridge. “Not that any proof was needed, but she isn’t even bothering to hide her Ozempic use now,” they wrote, above an image annotated with a red arrow, pointing to the tell-tale cap of a GLP-1 pen.
As the medication must be kept cold to be effective, kitchen pictures and bruises on the abdomen (the typical injection site) have become the internet sleuths’ way of figuring out who is on the drugs. Perhaps unsurprisingly, these posters are not pointing this out to be nice or to flatter users of the drugs for their new figures. It is a gotcha moment. In the jargon of economics, they are revealing that the signal the person is sending with their body is a false one. They did not get thin the hard way.
Ozempic is not going to fix society and rid it of status games. Signalling that you are unique or better than others is hard-wired into human nature. However, the idea that it might become easy to be thin suggests that thinness will lose some of its grip on the popular psyche. Something else will doubtless replace it. Perhaps it will be a fixation on muscles, which are more difficult to feign. Or perhaps the truly elite will be those who signal that they are above it all, anyway, doing so with softer, middling body types.
In many ways, this could be a blessing. The pursuit of thinness, especially for young girls, has come at a great cost. Contrary to what many seem to think, by making it easy for almost anyone to be thin, Ozempic might not only fix America’s weight problems—it might also fix America’s problem with weight.
© 2024, The Economist Newspaper Limited. All rights reserved. From The Economist, published under licence. The original content can be found on www.economist.com
