Opinion | Oprah, Ozempic and Us

Oprah Winfrey’s back, and she wants to talk about losing weight. Again. On Monday, Oprah’s ABC special, “Shame, Blame and the Weight Loss Revolution,” promised to answer some of the biggest questions around the new weight-loss drugs. The special was, as we call it in academia, a rich text. There were layers of history, with both Oprah and the intellectual history of bodies in pop culture. But, viewed at a distance and as a whole, the one-hour program was above all a harbinger of how the weight-loss industry is rebranding: Obesity is a disease, and — for the first time — it’s not your fault.

From the special’s outset, Oprah made the story about GLP-1 receptor agonists — Ozempic, Wegovy, Mounjaro — a retelling of her own struggle with weight. Of course, the public noticed last year when a remarkably thin Oprah emerged on red carpets. There was rampant speculation that she was on Ozempic. While Oprah never names which brand of GLP-1 she is taking, she confirmed again in this show that she is on a weight-loss drug.

That’s Oprah’s trademark: turning big political questions into a personal narrative of freedom and triumph. And it is this special’s raison d’être. Over and over again, deft production turns the thorny issue of weight-loss medicalization into (admittedly compelling) personal stories. But personal stories about prom dresses and self-esteem distract viewers from the inequality of obesity treatments that risk becoming luxury cosmeceuticals.

There is a war brewing between insurers and providers over who can get these drugs, and not even Oprah will be able to broker a resolution. True to her brand, she did not try.

What Oprah did try to do is finally write the ending to a story about bodies that she has been writing for almost 40 years. “The Oprah Winfrey Show” went into national syndication in 1986. I was 10 years old. That means I have been in a psychosocial relationship with Oprah’s weight-loss struggles for longer than I have been an adult.

In the 1980s, most of the Black women on television were either fair-skinned beauty queens like Vanessa Williams or darker-complexioned mother figures like Nell Carter. Oprah was not a thin beauty queen, but she also wasn’t the help. Engaging, articulate and utterly in control, Oprah embodied possibilities. Along the way, she also introduced a new language about bodies. They could be sites of struggle, and changing them could become a public ritual. The show’s 25-year run became a cultural textbook for remaking oneself as Oprah lost weight, gained weight, pivoted from “skinny” to “fit” and took us along for every part of the ride.

This special reminded audiences that Oprah is remarkably, almost preternaturally, good at making compelling television for a broadcast audience. It was her narrative storytelling that turned “The Oprah Winfrey Show,” a talk show, into something more like long-form narrative. Each episode had a topic. The topics had range: the best vacations, how to know if your husband had cheated on you, reconciling with your racist mother-in-law after you have a biracial baby.

But Oprah also created a meta-narrative in the ongoing story of her weight. Would this be the day, the week, the show, the year that Oprah loves or hates her body?

When Oprah ended her talk show in 2011, she had settled into her body. But settling is not love. In that way, she was, as she had become during her career, a stand-in for millions of Americans. Chained to our bodies, destined to be wed to them but never falling in love. We are at turns fat, not fit, overweight and obese. The acceptable terminology changes. It accommodates new fad diets — Atkins, Mediterranean, low-glycemic — and new morals around bodies. What has not changed is that weight loss is a booming business that seems to have no ceiling. Being fat can be hell. Selling to fat people is profitable.

Oprah knows this. She owned her title as the nation’s dieter in chief when she joined the board of WeightWatchers in 2015. Oprah-branded meals appeared in grocery stores. She even appeared in WeightWatchers commercials. The brand that pioneered meeting in strip mall storefronts and church banquet halls to be weighed in front of strangers may have felt a bit common for Oprah’s “live your best life” brand of almost-accessible luxury.

But in the end, WeightWatchers could have just been the safest co-branding opportunity; the least noxious of branded diets partnered with the warmest face of diet culture. And, as she said in the TV special, Oprah believed that WeightWatchers’ point-counting system was the best pathway to a smaller body. For a reported $221 million or so gained by trading WeightWatchers stock, why wouldn’t she want to share that with all of us, too?

Then the new drugs came. They work on multiple physiological levels to help some people lose a moderate to significant amount of weight. Expensive, hard to ignore, these new drugs promise us that weight loss can be more than a new diet. They promise to solve obesity.

Obesity is not merely about calories or self-control. It is about physiology and culture. This country has managed obesity as a moral failing because it will not solve the culture of inequality that makes it so easy for Americans to gain weight they would rather not have. The drugs’ price compounds obesity’s inequality problem. The people who might benefit from them the most are least likely to have medical access to them, culturally sensitive medical supervision to take them, the insurance approvals to subsidize their cost or the money to pay for them at full price when their insurance does not cover them. The new weight-loss drugs might help fight obesity, but only if people can afford them.

Even so, it is hard to overstate how much this has turned the fitness and weight-loss industries upside down. Self-help fitness gurus have long styled themselves priests in America’s Church of Fitness. They preach self-control, calorie deficits, supplements, cardio and strength training. But the truth is that the lithe, ultrafit bodies of people like Tracy Anderson, Jillian Michaels and Bob Harper have always not so tacitly been selling thinness. The structured programs based on discipline and shame become far less salable when clinical trials disprove their underlying thesis — diet and exercise alone do not work for everybody.

And then there is WeightWatchers. It is the corporate elder of the industry. After decades of convincing people that they could lose weight if they incorporated willpower and accountability, WeightWatchers is rebranding. It ended some in-person meetings, its mainstay, and purchased a GLP-1 provider. The new WeightWatchers also offers a GLP-1 program, a concession that it takes more than behavioral choices to lose weight.

Oprah says she donated her stake in WeightWatchers so she could produce this special without appearing to have a conflict of interest. Despite that, Sima Sistani, the chief executive of WeightWatchers, was a guest on the special. She pushed the new WeightWatchers story, which can be boiled down to: “It’s not your fault.” It seemed to me that companies like WeightWatchers that profited from the shame cycle of yo-yo dieting should start with, “I’m sorry.” But that’s the way of it when you are serving fat people. There is rarely an apology for serving them poorly.

Oprah herself used the “it’s not your fault” language to release individuals from the shame of fat bias. But it also does something else. It positions these GLP-1s as management drugs, like insulin for diabetics or hypertension medication for those with high blood pressure. Those are the kinds of drugs that insurance companies are compelled to subsidize.

It is hard to imagine a weight-loss revolution if Medicare continues to limit coverage. Currently the two brands of GLP-1 that are F.D.A. approved for only weight loss are underinsured. Two pharma reps who appeared on the special indicted insurance providers for denying drug coverage. Insurance providers will tell you that demand for the drugs and the prices that the pharma companies charge for them are unsustainable. The obesity crisis is a health financing crisis, just as much as anything else. We can’t solve one without solving the other.

But above all of this, the new weight-loss drugs offered something else to Oprah’s metanarrative. They offered the nation’s dieter in chief a chance to fulfill her show’s destiny — to finally create a body she can love. It was a payoff that some of her audience has perhaps waited 30 years to see. For others, it could be a letdown. A woman so successful that she redefined the term not just for women but specifically for Black women born to unglamorous means and expectations. If she cannot fall in love with her body at any size or shape, what hope is there for the rest of us?

In a way, it feels unfair to ask this of Oprah. She gave enough of herself in ushering us through our own national chaos about good bodies and bad bodies. It is unfair to blame her for popularizing diet culture. The Richard Simmonses, Suzanne Somerses, Jane Fondas and Susan Powters of the world deserve some credit. So, too, does the idea of a thin body as a moral body. It is an idea far older than Oprah. And it is an idea with a nasty racist and classist history. In some ways, it is a triumph of its own kind that a Black woman took a foundational idea of white supremacist thinking about aesthetic virtue and turned it into her own private fortune. I’m pretty sure there would have been a dieter in chief even if Oprah had never existed.

The ABC special doesn’t solve the pressing political issues of the weight-loss revolution. But, watching Oprah stand onstage, towering above the audience, wearing the kind of figure-hugging monochromatic jumpsuits she now favors, I realize that this may not be about us. This is about Oprah. You may find inspiration in her final weight-loss chapter. Even if you don’t, she clearly has found a way to love her body. It is hard to judge that.

Tressie McMillan Cottom (@tressiemcphd) became a New York Times Opinion columnist in 2022. She is an associate professor at the University of North Carolina at Chapel Hill School of Information and Library Science, the author of “Thick: And Other Essays” and a 2020 MacArthur fellow.

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