Will Obesity Be Legal After Ozempic?
A provocation
Preface
A few years ago, as part of a project that still hasn’t come to fruition (I’m stealing some time from it to write this up, in fact), we surveyed some Americans about what they thought made countries high or low status in international politics. This wasn’t scientific or extensive—it was a genuine pilot—but nevertheless pilots can be informative if your goal is to get low-resolution images of public opinion and you’re not sampling on something that’s clearly biasing your results. I mention this to preface a result I might later walk away from but suspect is true: respondents really thought fat countries were low-status.
By whatever name, obesity is notable by its absence in political science. Taboos operate at the level of not naming or discussing an issue, and they are most obvious when there’s a gap between what is acceptable to discuss and what is unmentioned in polite company.
Social scientists are usually, despite their pretensions, very interested in being part of polite society, and refrain from addressing many subjects because of a sense that those subjects just aren’t fit for study—or that addressing them will associate the researchers with some trait. There is, in other words, a strong desire to associate yourself with high-status topics, regardless of scientific interest. I’m going to exaggerate here for rhetorical effect but I am definitely kidding on the square. Every researcher worth their salt is defined in a vector space of topics associated with them; do you want your personal keywords to be “money, power, status” or “drugs, laziness, obesity”? Market positionality is real, especially when you’re fighting for one of the last planks on the raft of the Medusa-style job market in academia. If there’s no cluster of researchers working on something, then it’s awfully sus to be interested in something deviant—what, do you think that science isn’t faddish or cliquish or prudish? And so many topics that, to a Martian, might seem equally deserving of study go unaddressed in favor of contextually-desirable discussions. (This is one reason why the tastes of a handful of researchers at top institutions can be influential: they can signal high-status interest in topics and create clusters of interest around given topics, and often they even deploy this power in responsible, scientific ways!) I’m not immune: I haven’t done anything with that enlightening point from the pilot, after all.
All of this is context-loading for why there isn’t really much political-science discussion of obesity, even though obesity would seem to merit discussion. (There is some but this isn’t the post to do a literature review.)
The Argument
Obesity is a defining fact of contemporary American life. There are politics around obesity, including submerged conflicts in every doctor’s office where someone with a suboptimal BMI presents with an unrelated condition, sotto voce discussions about class and government assistance, discussions around policymaking and elections in which the attractive win more often, and much more overt manifestations over the politics of bodies themselves. There’s a reason why r/fatpeoplehate was banned and there’s a reason why it was popular. On university campuses in the United States, radical pro-fat scholars share territory with facilities dedicated to making the body as fit as scientifically possible. The body is political and thus so is obesity. The fat-acceptance people, then, are right that the personal is political, even if—as I suggest below—they might not actually like what could come of making obesity an overtly political topic.
Indeed, public interest in obesity is high. I went to the Roper database of polls and grabbed some representative data; on a skim of earlier surveys, it looks like the USA is approaching something like Peak Obesity Worries. When you ask Americans what the biggest health care problems the country faces, obesity always comes up, and usually (post-Covid) leads other things that look like “health” issues as opposed to “health access” issues. For instance, a 2025 Gallup poll on the most urgent health problem puts obesity at #3:
A different measure from Axios puts obesity at number one (and this seems about representative in similar lists that don’t mix policy and health issues, at least in the past several years):
And the public is latently sympathetic to the idea that adults with a weight-related condition, like obesity, can use weight-loss drugs like Ozempic—but not those without a weight-related condition1. (In survey results not shown here, there’s a lot of opposition to teens and children using them, too.)
There is also a substantial reservoir of support, if not an overwhelming degree, of sympathy for the position that the government should pay for Ozempic etc through Medicare and Medicaid:
What does this point to? Well, it suggests that there’s at least latent sympathy not only for viewing the use of Ozempic and other drugs in the GLP-1 class as acceptable for treating weight-loss but also that the public is at least public policy-curious on this issue. That might reflect some self-interest, by the way; at least 37% of Americans are obese or overweight (and you can find estimates that are much higher), so if you ask Americans if someone else should pay for medicines they are likely to want to take, well, of course you should expect to find some support.
Once something becomes defined as a political subject—that is, something that you can subject to governmental action, that is no longer “private”—then it becomes possible to imagine governmental action. This gets tricky, however, because making something “political” may not always lead to the results that activists want it to have. For instance, asserting that bodies are political might indeed put body size on the agenda—but once something is on the agenda, deliberation and the piercing of the veil separating private actions from public ones might lead to other outcomes. That can especially be the case if other circumstances change.
In the case of obesity and overweight, for instance, the advent of drugs that may make those conditions be seen as the result of personal choice could radically change what the “politics” of the body are. If there is a treatment that can radically reduce BMI, for instance—and there is, many of them, in fact—then the arguments around bodies will revolve not around the bodies but around the choices.
Which leads me to the question implicit in the title of this Substack essay: will obesity become illegal?
Yes, like all such questions in the headline, my answer is “no”. But let me sketch something:
Pressure for public subsidies for GLP-1s (or quasi-public, including health insurance) succeeds, widening access to the drugs even more (this could also take the form of negotiated discounts etc—don’t get hung up on the access mechanism)
GLP-1 adoption becomes even more widespread than it is now (a minimum of 12% of Americans are or have used GLP-1s)
The treatments work—indeed, it is likely that just as the AIs available to you are the least powerful AIs you will ever see, the GLP-1s available now are much less powerful than next or second-next generation treatments like reta.
Obesity becomes relatively less common and, because of wealth effects continuing to moderate access to GLP-1s, much more concentrated among lower-income (and hence lower-status) folks
Obesity doesn’t become illegal but it becomes triply stigmatized: not just as a condition on its own but one that is a condition of choice (symbolizing the rejection of mainstream views) and a marker of poverty/deprivation.
I think it is very possible that the United States is within 3 to 5 years of this tipping point. That might sound absurd to you but these drugs are falling in price and becoming far more potent—clinical results from trials put the power of reta, the next-generation Lilly drug, at essentially on par with bariatric surgery; many people appear to be dropping out of the clinical trials because the drug is too powerful and study participants are losing weight too fast.
This will appear like a revolution in body politics. It will, to be clear, have many undesirable side-effects: imagine the collision of body dysmorphia and anorexia etc with widespread pills that really do let you choose your own weight. But it will also fundamentally change the terms of engagement on this issue—even, perhaps, to much greater regulation than I have sketched here; if obesity leads to worse life outcomes and greater health problems, much like cigarettes, then there may be still greater political pressures to make treatments less than wholly voluntary.
There’s a wide world between banning a condition (requiring it to be treated) and coercing people to assent to treatments. You can imagine, for instance, that weight-loss treatments could become a part of welfare programs in a very coercive fashion; you might also imagine that corporations and other employers aggressively market this. And if there’s a physical attractiveness element to job-matching, and there is, then you can also imagine that the competitive pressures to reduce will be intense as others do the same. If the Cold War brought policies like the presidential fitness award and the British Empire brought “muscular Christianity” (and let’s not even mention the Turnverein), you can imagine that the optimization pressures of our current digital global order will similarly produce physical effects.
I want to make plain that with this my aim isn’t to herald or ward off the future; I’m a realist to the degree that I think that base social instincts ultimately condition politics, and the degree of literal hatred obesity attracts is a reflection of a pretty deep social drive (even if the precise ideal body type really has varied over time and with other factors). I know American society tolerably well, and I know that its deepest beliefs are not always welcoming—and that if there’s a pill to address a condition as despised as obesity is, then that will change society greatly.
I have doubts about this question wording, by the way, because it’s not clear if this is someone with anorexia or someone who is fat but not obese—to be Substack-blunt if not journal-specific about the wording. The question could have distinguished between these better.
A way to look at this is to ask why a government, especially an American government, would take an interest. There are two possibilities. One is what Aristotle called perfectionism: it is good for the state to help people, for their own good, realise their potential, lead the better life they could lead if they were not obese. The other is utilitarian: obesity is costly to society, and forcing the issue would pass a cost-benefit test.
We do something that has the appearance of perfectionism with limiting people on food stamps to not using them on junk food. But I think that’s just appearance; as the man said, the cruelty is the point.
An interesting comparison is mental health. There are people living on the street with serious mental health issues and who do not want treatment. This seems to me more dangerous to their own lives, and more costly to society, than obesity as a problem. Yet there is great resistance to action.
And for the requisite Canadian content: here’s an ad that any Canadian of a certain age will remember from the 1970s, with the federal-government funded Participation program. Damn Swedes.
https://youtu.be/PMD35tUh-Ek?si=epu4o6EGv9bFJZ5Q