The Hunger Switch

On the drug that quiets food noise and destroys the moral story we’ve told about appetite and control

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Photo by Diana Polekhina on Unsplash

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The first time I heard about Ozempic — the most recognised of the GLP-1 weight loss drugs originally used as a medication for diabetics — was around five years ago at a press dinner for beauty editors in London. At these events, socially connected women who care about aesthetics and embody the minimalist ideal of ‘quiet luxury’ share news with one another. I was a beauty editor for a decade, and we are always cheating on the current thing with the next thing. Knowing what people are going to want before they want it is the job.

Often, tips for this or that cosmetic doctor, who’s especially good at a particular ‘tweakment’, will flitter across the table. Or maybe the facialist who can utterly erase the puffy, greyish evidence of a week of abject stress from your face in a ninety-minute session so you can look how you wish you felt. Perhaps this is exactly the setting in which you’d expect talk of a new weight loss drug to disseminate. A table on which fresh bread sits in expensive dishes, generally uneaten because weight has always been, in aesthetic terms, a moral issue. There are plenty of contexts in which the worst thing you can be is fat, and an industry based on aesthetics tends to be one of them. I say this as someone who has struggled with weight for most of my life.

One long-established beauty editor friend leaned in and asked me quietly if I’d ‘ever go on Ozempic’. ‘On what?’ I asked, presuming it was a skin supplement or the latest tortuous London exercise class led by some exiguous blonde girl named Milly or Dilly or Tilly with a double-barrelled surname and the impossible physique of a ballerina.

‘It’s an injectable weight loss drug’, my friend replied. ‘For diabetics, but people are using it off label for weight loss. It’s incredibly effective but so expensive. A lot of my friends are frantic to get it. Some are on it already. Anyone you see who’s suddenly skinny, especially if they’ve always been bigger? They’re on Ozempic.’

Five years later, GLP-1s are everywhere. Emily Sundberg published an interesting reader survey on them this week. There’s much conversation about the long-term impact of these drugs. I’m not particularly interested in that debate here. I’m interested in what our attitude to GLP-1s tells us about ourselves and one another, what we value, and how these drugs have not changed the moral lens through which we view weight by default, but probably should change it.

We generally tend to assume that overweight people have an emotionally or psychologically indulgent approach to food — that there’s a disconnect between what their body signals they physically need and what they desire. At least, that is how we’ve talked to and about fat people for the entirety of my lifespan — we simply presume that food overconsumption is a moral issue.

‘Just eat a salad and stop when you feel full’.

We think that there are two wolves inside us, one of whom really loves pasta. And look, everyone loves pasta, right? So the people who just eat a little bit of it and then go about their day with their BMI in the healthy range and their mind not thinking relentlessly about pasta? They must be morally better people. Less weak. We’re dualists about mind and body when we think about food — it’s commonly assumed that the difference between eating at caloric maintenance (to stay at a particular weight) is just a matter of willpower, habits and discipline. Exercise! Don’t consume more energy than the body can use! Simple!

Not simple, of course. This presumption ignores the complexity of individual bodies and the ways that our health and genetics influence both how our bodies are capable of functioning and what they look like on the outside. That too is a minefield into which I frankly can’t be arsed to wade. It tends to be full of people with the veins popping out of their necks claiming that PCOS isn’t real or we all have the same twenty-four hours in the day (we don’t, Brian — we just all have twenty-four of them. How we spend them is impacted by our widely varying income, health, culture, environment and responsibilities — not just our preferences). These are people who truly believe that their health and fitness makes them morally superior to someone less healthy or less fit. They tend to forget that it’s perfectly possible to have a butt like marble and be able to turn down a bowl of pasta but still have the moral character of a complete and utter twat.

The common criticism of people taking these drugs is a fascinating window into the things we feel threatened by, or seek to protect. ‘It’s a shortcut’ — I don’t think it is unless you’re abusing it, which is quite dangerous. GLP-1s can result in muscle loss and other serious issues if not accompanied with regular weight-based workouts and high protein intake. They can have side-effects and require a high level of commitment around nutrition and exercise. The ‘it’s a shortcut’ critique is factually incorrect, but it also hinges on the presumption that being fat is the result of poor will power. If this were the case, GLP-1s wouldn’t work — they don’t create willpower.

This sort of critique would be better directed toward people minding their own business in a very literal sense. Why are you angry about someone else’s body? Doesn’t that strike you as inappropriate? Does it maybe seem like projection? Just a smidge? The thin people who feel their status is threatened by the increasing accessibility of their sacred (skinny) cow are in the same boat. So are the fat people angered by others losing weight and thereby proving it is possible to lose weight. Everyone is threatened. Everyone is angry. Everyone is made insecure about themselves.

-‘Are you okay?’

-‘No! I’m FURIOUS about Michael’s stomach. He took Wegovy and now it’s smaller than it used to be!’

-‘… what?’

Ultimately, if a drug can switch excessive appetite (an appetite that signals a person to eat more calories than they need) off overnight (or at least in a short period of time) — as GLP-1s seem to do — then this poses a challenge to the theory that fat people just don’t know when to stop, or that they simply lack willpower. Even with the disregulation that can result from long-term overconsumption of food (like impaired satiety signals, whereby someone’s sense of ‘I’m full!’ arrives later, or not at all), these drugs do work for countless people.

Suddenly, those who have been plagued by ‘food noise’ — an obsessive tendency to think constantly about food eaten, food yet to eat, or the self-loathing metamonologue of ‘don’t eat that!’ — go internally quiet. A relationship to food that has been an enormous drain and distraction for a person with long-term weight issues or concerns changes. The signal to eat too much, and too much of the wrong things, which we widely consider a moral failing — a personal psychological weakness rather than a biological imperative — stop coming.

But any dualist will tell you that you cannot turn off metaphysics through physicality. Immaterial things don’t have a material ‘off’ switch. If a drug can eliminate what we widely think of (and judge people on the basis of) as a moral failing — very much an immaterial thing — then it must not be a moral failing. It might be a physical process which differs between individuals, but it isn’t about willpower, or moral fibre. It is embodied.

You don’t need willpower to turn down food when you’re not hungry.

My book, Some of Our Parts: Why We Are More Than the Labels We Live By is out now!