Ozempic — one of 2024’s most controversial phenomena — may soon be in the home of every middle-class American. With Biden’s proposal to allow Medicare and Medicaid to cover weight-loss drugs like Ozempic, the drug could become accessible to millions. As its exclusivity dwindles, so may our societal beauty standards.
For centuries, royalty (and now celebrities) have dictated what is considered beautiful. In England circa 1700, a fuller figure and plump cheeks signified wealth and prosperity, reflecting an ability to afford abundant food and leisure. However, by the mid-18th century, the standard had shifted toward a slimmer silhouette, as exemplified by Queen Charlotte of Mecklenburg-Strelitz, wife of King George III. Her preference for tightly laced corsets and an emphasis on a narrow waist influenced the era’s fashion and beauty ideals, marking a stark departure from earlier notions of beauty tied to abundance and opulence.
With a pendulum of beauty standards swing, swing, swinging, will we soon see a decade where our admiration of thinness is slimmed down? From the early 2000s skinny chic to the 2010s body positivity movement, the legacy of the 2020s remains unwritten.
The Rise & Risks of Ozempic
Since its initial approval as a type 2 diabetes medication in 2017 and later approval for weight loss under the name Wegovy in 2021, Ozempic has become a revolutionary drug in the fight against obesity. Ozempic mimics the hormone GLP-1, suppressing appetite and cravings and offering weight-loss results comparable to bariatric surgery, with users in trials losing up to 15% of their body weight.
Sounds too good to be true, right? Well, naturally, this apparent ‘miracle’ drug is not without controversy. Currently, reports from the FDA link Ozempic and other diabetes-weight loss drugs to at least 162 deaths and 10,000 cases involving “serious” injuries, such as gastroparesis, stomach paralysis, and ileus.
Dr. Dina Peralta-Reich, a dual board-certified physician in Pediatrics and Obesity Medicine, emphasized the importance of understanding the risks associated with the drug. “One of the side effects of this medication when it is not used correctly is muscle loss,” she explained. She also highlighted a growing issue: “If you’re getting your medication from med spas or online suppliers, nobody’s monitoring body composition, which is a major cause of medication misuse.”
Critics argue that Ozempic’s popularity has sparked ethical concerns, particularly regarding access and availability. With its high demand, patients with diabetes — who rely on the drug to manage their condition — are finding it harder to fill prescriptions due to shortages. This issue raises questions about the emphasis on weight loss over chronic disease management.
Additionally, the high cost of Ozempic places it out of reach for many who might benefit most, thereby amplifying disparities in healthcare access.
Insurance Coverage & Legislative Challenges
Affordability remains a key barrier to Ozempic access in the U.S. “An Ozempic pen in the United States for somebody without insurance costs approximately $1,000. I could get the same pen in Latin America or Europe for less than $200,” Dr. Peralta-Reich noted.
However, access to Ozempic is poised to improve significantly due to recent policy developments. The Biden administration’s proposal could make these treatments accessible to over 7 million Americans by 2026, substantially reducing out-of-pocket expenses for eligible individuals.
Currently, Medicare and Medicaid cover these drugs only for conditions such as diabetes or heart disease. The proposed rule change would recognize obesity as a chronic health condition, allowing coverage specifically for weight loss. This policy shift aims to address the high costs that have previously limited access to these weight loss treatments.
Expanding insurance coverage for Ozempic could have a profound impact on the approximately 42.4% of U.S. adults living with obesity. This policy change has the potential to save over 40,000 lives annually by reducing obesity-related health complications. In the long term, broader access to effective weight-loss medications like Ozempic may alleviate the public health burden of obesity, leading to decreased healthcare costs and improved quality of life for millions of Americans.
However, the proposal is not set in stone. The Biden administration’s proposal to expand Medicare and Medicaid coverage to include anti-obesity medications like Ozempic faces significant legislative hurdles.
Historically, health policy reforms in the U.S. are marked by significant delays and challenges due to the complex legislative process and varying political priorities. For instance, the Affordable Care Act (ACA) underwent extensive debates and revisions before its enactment in 2010. Similarly, the American Health Care Act of 2017, intended to repeal and replace the ACA, faced substantial challenges and ultimately failed to pass.
The current proposal’s projected cost — estimated at $25 billion for Medicare and an additional $14.8 billion for federal and state Medicaid spending — raises concerns about its fiscal impact. Given these factors, the proposal is likely to encounter scrutiny and potential opposition in Congress, making its enactment uncertain.
Still, if it does pass, it could signal an entirely new era of beauty standards, unseen in many years.
The 2000s: growing up with Lohan & Hilton
“Nothing tastes as good as skinny feels.” The infamous words of Kate Moss still ring in the ears of teenage girls across the nation. For those of us who grew up in the 2000s and 2010s, the thinness ideal was omnipresent, reinforced by celebrities like Paris Hilton and Lindsay Lohan, whose small frames were celebrated on magazine covers and red carpets. This era saw the normalization of disordered eating, as tabloid culture openly praised drastic weight loss and shamed weight gain.
Shows like America’s Next Top Model perpetuated harmful beauty ideals, with contestants relentlessly criticized for being “too big” at mid-sizes of 8-10. This brutal messaging planted the seeds of insecurity for a generation, making eating disorders not just a private struggle, but a cultural expectation tied to fame and desirability.
In these tumultuous years, womanhood became closely intertwined with the idea of starvation. “Beauty is pain” was interpreted as a motivation for hair loss, infertility, and chronic illness as a result of being underweight. Platforms such as Tumblr and Twitter further reinforced these ideas, with entire communities dedicated to tips for fasting. And while these spaces are now heavily regulated by social media platforms, they continue to thrive in the shadows of the internet, waiting for a new victim to slip into starvation.
This obsession with thinness has now led some individuals with eating disorders to turn to abusing GLP-1s for fast weight loss. Without proper diet and exercise, Ozempic could cause drastic, unhealthy weight loss in a short period of time. This is especially dangerous for adolescents, with Ozempic being FDA-approved for patients 12 years old and above. Dr. Peralta-Reich stressed that improper use of GLP-1 drugs in young patients could negatively impact growth, forever damaging their body’s development.
Built to fail
Furthermore, many of our institutions continue to promote unhealthy body image and eating habits, some being detrimental psychologically, and others physically.
Growing up in a NYC public school has meant an annual weigh-in in gym class since kindergarten, a procedure required by the DOE that is heavily criticized by mental health experts. In conjunction with social media and celebrity culture, it’s no surprise that so many children’s insecurities begin to fester as they age. “Social media is a blessing and a curse,” Dr. Peralta-Reich explained. “It depends on the patient’s personality, self-confidence, and environment. If you grew up in a household where weight was an obsession, that definitely makes an impact.”
Moreover, the presence of food deserts act as another institutional barrier to healthy living for adolescents and adults alike. A food desert is defined as a low-income area where people lack access to affordable and healthy food, making it virtually impossible for people living below the poverty line to ‘eat clean’, contributing to America’s place in the top 10 obesity rates in the world.
A New Standard?
Historically, exclusivity has often shaped beauty ideals, with the most unattainable traits becoming the most desirable. In a future where insurance coverage makes Ozempic readily available to millions, the allure of thinness may diminish.
This democratization of weight loss could redirect the focus to other markers of beauty — perhaps athletic builds, natural curves, or even entirely different physical characteristics that celebrate individuality and diversity. As the barriers to thinness are lowered, the pendulum may swing once again, emphasizing forms of beauty beyond the slim standard.
Before Ozempic, this trend already began to take root with body positivity movements led by influencers and celebrities. For example, Lizzo has gained significant traction by challenging traditional beauty norms. Her hit song “Truth Hurts” and unapologetically bold fashion statements have inspired millions to embrace body diversity.
In addition, social media campaigns like #EffYourBeautyStandards, initiated by activist Tess Holliday, have further amplified these messages, pushing for a broader acceptance of all body types in mainstream culture.
These movements lay the groundwork for a paradigm shift as accessibility to weight-loss drugs prompts a reevaluation of beauty ideals. However, there is a much darker possibility with the new accessibility.
The proliferation of thinness may just ultimately lead to another standard for the general population to strive for. If thinness becomes obsolete to the rich and famous, and a curvier/larger frame is celebrated, plastic surgery may surge once more.
Conclusion
As Ozempic and similar drugs become more widely accessible, the implications for health, society, and culture are undeniable. While these medications offer a groundbreaking solution to obesity, they concurrently prompt ethical and logistical questions about cost and prioritization. Moreover, GLP-1s hold the potential to entirely reshape beauty standards, a fact that I believe is being majorly overlooked.
If thinness loses its exclusivity, the definition of beauty may undergo a significant transformation, entirely ‘breaking away’ from what we’ve known.
Yet, true cultural change requires more than access to medication; it demands a collective reevaluation of values shaped by history, media, and societal pressures. Therefore, although I theorize a radical pendulum shift brought forth by Ozempic and other weight loss drugs, we may very well just see another decade of skinniness covering magazine covers and social media feeds.
As we move forward, instead of focusing on what body is currently trending, we should expand access to life-saving treatments and cultivate a culture that values health, authenticity, and the beauty of human diversity.
As Dr. Peralta-Reich put it, “We need to live in a less judgmental world and a more educated world. People should be allowed to make choices for themselves without the weight of societal scrutiny.” After all, as history has proven time and time again, wealth and beauty standards are eternally changing and all-powerful.
So next time you look in the mirror and your eyes dart to imperfections shamed in the media, and you begin to crave the perceived ‘quick-fix’ of Ozempic, take a breath and remember that while Ozempic may transform your body, your mind is yours to shape.
Dr. Dina Peralta-Reich, a dual board-certified physician in Pediatrics and Obesity Medicine, emphasized the importance of understanding the risks associated with the drug. “One of the side effects of this medication when it is not used correctly is muscle loss,” she explained. She also highlighted a growing issue: “If you’re getting your medication from med spas or online suppliers, nobody’s monitoring body composition, which is a major cause of medication misuse.”