It’s an ordinary Wednesday morning in early May. Kids dropped at nursery, high-protein breakfast consumed, and my husband and I are on our way to our PT session – except today is weigh-in day, and I already know what the scale will say before I see it.
Ten months of wall-to-wall gym sessions and calorie deficits, and nothing. Not one pound. I crumple into my husband’s arms, sobbing.
‘I can’t keep doing this,’ I say. ‘The deficits, the exercise, the mental effort – for nothing.’ He nods. ‘I think I have to try it again.’
He knows exactly what I mean by ‘it’: GLP-1 medication.
Days later, the parcel arrives, and I take my first injection. Within a month, I’ve lost weight for the first time in two years and, more importantly, I feel better than I have in ages.
On Monday, Wegovy (the brand name for Novo Nordisk’s GLP-1 medication) became available to buy in pill form for the first time in the UK. For those paying attention, it was a bit of a watershed moment that could have a huge impact on the accessibility of these medications – especially for those who didn’t like the idea of injecting the drugs.
I asked Dr Giles Yeo, a professor of molecular neuroendocrinology at the University of Cambridge and global expert in obesity, to explain why this moment matters for access to the drug: ‘At the moment, the vast majority of individuals accessing these drugs are doing it privately,’ he tells me.
‘The steep socioeconomic gradient to obesity [means that] those in the bottom quintile [are] more than twice as likely to end up with obesity as the top quintile [and] the drugs are currently not reaching those who need it most’.
The pills are going to be cheaper to manufacture, he says, because they won’t require a delivery device (such as a syringe) or refrigeration.
‘So when these drugs go off patent, there is a fighting chance the NHS will be able to substantially increase access to these drugs,’ he explains, which would be a game changer for many who could most benefit from them.
As always, depending on which corner of the internet you’re in, this is either exciting or terrifying (such is the nature of online discourse that there is no in-between, of course).
Why I changed my mind about GLP-1s
For me, though, it’s a much more nuanced conversation. Having spent many years living with obesity in a body that struggles to lose weight in the same way that some fortunate others seem to be able to, you could say I am the target audience of these drugs.
I’ve spent my life trying to lose weight and studying how to do so (mostly out of necessity). I have read everything, tried everything, gained it all and lost it all more than once. TLDR: no, I don’t just need to eat less and move more.
And so my decision to try to lose a specific amount of weight two years after having my second child was something I came to slowly and thoughtfully with the support of a network of both professionals and friends. It was not because I wanted to look a certain way, but because I don’t feel good in my body at this size, and have chronic back pain that I want to do something about.
When I first started hearing about these drugs, to be honest, I felt relief. Despite living within a culture that heavily promotes the idea that fat people are all lazy overeaters and that all thin people are virtuous and morally superior – I knew different. Because I knew that when I ate the same and moved the same amount as those around me, I gained and they didn’t. I wasn’t secretly eating or making it up – I was seeing that input and output weren’t quite as neatly tied together as everyone had thought.
I was also curious to try them, and so I did. Unfortunately for me, though, when I did, I was six months postpartum and had recently given up breastfeeding. My mental health took a steep dive (a known side effect of these meds), and I swore I’d never take them again – until a couple of months ago.
This time has been totally different; I have tapered my dose more gently and taken some really good advice on board about how to properly fuel myself and ensure I get all the nutrients I need with a smaller appetite.
The GLP-1 conversation has become more polarised
Interestingly, though, in the year between stopping and restarting the drugs, the conversation has become far more polarised. A new form of weight stigma has emerged: shaming people for using drugs to ‘cheat’ weight loss. As if the shame of being fat wasn’t enough, now there’s shame for trying to do something about it.
‘One of the common narratives about using these drugs is that you are “cheating” by taking them,’ Dr Yeo tells me.
‘However, these are modified versions of native hormones in our body,’ he explains, ‘you might even consider some people with obesity to be “deficient” in these hormones, which these drugs are now able to fix’.
Improving access comes with downsides too – making it easier for them to fall into the hands of people who might abuse them.
‘With greater access undoubtedly comes an increased risk of misuse,’ Dr Yeo says, ‘so we’ll need to be better at ensuring only those who need these pills get them’.
In practice, this means stricter qualifying criteria; not just a BMI threshold, but proper clinical assessment including mental health screening and medical history, as well as in-person clinician meetings and ongoing support for those taking them. Without all of this, the drug alone isn’t enough; I am speaking from experience.
I’ve noticed the majority of people who have the loudest opinions online about GLP-1s are people who are not living with clinical obesity. Those people are rightly objecting to the way that their presence in wider culture has directly fed a cultural return to extreme skinny worship that harms us all.
I totally agree with this, but I also think we are missing some important nuance in the public conversation about these drugs: for some people, such as myself, they can be genuinely game-changing.
I know because I have shared my own experiences online with a lot of carefully explained nuance and have been met with criticism (and a lot of lost followers).
At the same time, I have had over 100 messages from people on these drugs who feel bound to secrecy and ashamed because the public conversation isn’t fully capturing the whole story – including the very real benefits these drugs are bringing to those who genuinely need them.
Rather than demonising the drug entirely, we need to find a way to ensure that those who might abuse them are not able to access them. And we also need to allow space for positive stories as well as negative ones.
Medication can’t be the sole answer to the obesity crisis. It buys us time, but only if policymakers use that time to improve access to nutritious food and tackle the food environment that’s driving obesity in the first place. Otherwise, I fear it is going to be a missed opportunity.
A pill won’t end weight stigma
I keep wondering if the presence of the pills would have made a difference to my own journey to accepting help by starting treatment. The truth is, I don’t think so, but this whole conversation reminds me of when I was first prescribed antidepressants many years ago, and it was something I really struggled with because of the stigma and shame attached to them.
We have come a long way as a society on this issue, and mental health is no longer a conversation relegated to whispers and secrecy. There is even a campaign fronted by Love Island’s Dr Alex George urging people to post pictures of their mental health pills on social media to help those being supported by these life-changing drugs to let go of their embarrassment.
Could the pill form of GLP-1s be the first step in reducing the shame that obese people feel when accessing these drugs by normalising the experience? I would love that to be the case. But stigma around weight has never really been about the mechanics of how you lost it – it’s about the social hierarchies that depend on thinness meaning something. There are entire industries built on the idea that your body is a problem to be solved.
A pill doesn’t dismantle that; it just makes distracting ourselves from that reality a bit easier in the short term.
Rose Stokes is a 36-year-old writer living in Bath with her husband and toddler son. In a time of supercharged polarity – with much online discourse about raising kids dominated by stories of pure hardship or images of bucolic perfection – she’s here to tread the middle path with The Mumologues, WH’s new honest parenting column. From the (very real) challenges of modern mothering to the bliss of a tiny finger grabbing yours, she’ll discuss it all.