Joe Biden’s well-intentioned Ozempic plan officially pathologizes fatness

A new rule the Biden administration has proposed that would let people with Medicare and Medicaid access Ozempic, Wegovy and other semaglutide or weight loss medications would help tens of millions gain access to drugs that cost about $1,000 a month. “It’s a game changer for Americans who can’t afford these drugs otherwise,” Health and Human Services Secretary Xavier Becerra told The Associated Press. 

Until now, Medicare, which covers more than 66 million people, has been prohibited from paying for such drugs unless patients have concurrent conditions such as diabetes or heart disease. The states have the power to decide whether their Medicaid exchanges cover the drugs, but only 13 states have.While Biden’s proposal would increase access for those who want, but can’t afford, weight loss drugs, the news of the plan, which involves directing the Department of Health and Human Services to reclassify these medications as treatment for a “chronic illness,” gets under my skin. Though some doctors and researchers have been trying for more than a decade to classify “obesity” — defined as having a body mass index over 30 — as a “chronic illness,” being fat and being chronically ill aren’t the same thing.

I would know. I’m a fat woman who has been living with left-ventricle cardiomyopathy (heart failure) and pulmonary hypertension (high blood pressure in the lungs) for more than five years. I didn’t develop either of these diseases because of my size. Instead, heart failure was a side effect of a medication I was prescribed, and pulmonary hypertension resulted from that heart failure. Both of these conditions could’ve been caught far sooner than they were, but my physician’s obsession with my weight prevented her from seeing and treating my actual symptoms until my heart was working at 16%.

So, however well-intended, Biden’s proposal would officially pathologize fatness and treat weight loss as the ultimate goal of this form of health care. “This proposal would allow Americans and their doctors to determine the best path forward so they can lead healthier lives, without worrying about their ability to cover these drugs out-of-pocket, and ultimately reduce health care costs to our nation,” the White House said in a statement.But that premise is faulty. Body mass index was never intended to be used to measure the healthiness of bodies, so it’s a mistake to solely rely on this system to measure “obesity.” Additionally, the American Medical Association’s decision to classify “obesity” as a disease was made against the advice of the committee that reviewed the scientific literature and concluded that fatness shouldn’t be categorized as a disease.

We also still have no idea what these drugs do to bodies in the long term, though the American Academy of Pediatrics still decided it was safe to prescribe them to children. There’s some research that shows long-term use can lead to thyroid tumors, pancreatitis, bowel obstruction, gallbladder disease and, in severe cases, kidney failure. And, at the same time, in order to maintain the weight loss these drugs promise, patients are required to remain on them — once they get off, many people begin gaining weight, ultimately regaining what they’ve lost.

When we consider what it would mean for our nation to be healthier we must ask ourselves: Why is losing weight treated as the inevitably singular conclusion?For more than a decade, I’ve been thinking and writing about what it means to exist in a fat body. Through that work — and through my own journey with weight loss, weight gain, heart failure and pulmonary hypertension — I’ve come to realize that America doesn’t actually care about the actual health of people who live here. For example, though we’re leading high-income nations in maternal mortality rates, too many Americans, especially pregnant Americans, don’t have access to health care and overall preventive care. So shouldn’t our first impulse be to increase access via, I don’t know, universal health care?

If America cared about the public’s health, we could address our food apartheid crisis, a term activist Karen Washington accurately coined in 2018 to name the “root causes of inequity in our food system based on race, class, and geography.” Thanks to our country’s long history of racial segregation and redlining, food that’s fresh and healthy tends to be more accessible in wealthier neighborhoods. That disparity contributes to a crisis in which impoverished people of color — who are already more likely to develop chronic illnesses, such as heart disease and diabetes — are forced to eat what’s available, food that doesn’t help them maintain a body weight the medical establishment considers “healthy.”

“The fact is the food system is racist, and access to food is based on the color of skin, how much money you have and where you live,” Washington told The Guardian. “Deserts are natural and have food, food deserts are manmade, not natural. Food is a human right. It’s not natural for people to be living this way and eating this way.” Prescribing medication to treat conditions that are inherited through systemic discrimination is the epitome of irony.Giving people on Medicare and Medicaid access to drugs like Ozempic would be another illustration that our government almost never addresses the root problems it has created or ignored.

If Robert F. Kennedy Jr. (a truly unserious man) becomes the next secretary of health and human services, this debate may be moot. His past statements suggest he wouldn’t support HHS’ reclassifying these drugs.

Kennedy is neither a physician nor a health expert but still feels comfortable saying that what is classified as “obesity” could be fixed with willpower. “If we ... [instead spend money on] giving good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight,” Kennedy told Fox News in October.Again, access to healthy foods is a great need, but Kennedy’s assertion flies in the face of science and disregards the fact that bodies simply have different makeups because they’re bodies.

Given that he’s likely to take the helm of HHS, maybe this argument is all for nothing, but if we are ever to live in a world that doesn’t treat thinness as the epitome of health and the ultimate moral reward, then we must stop describing weight loss drugs as either a miracle or a cure.