Program: Has Ozempic killed body inclusivity?

Yumi: Hey ladies, we're planning a mini series on mental health and here at ladies HQ, we'd love to know what you're hungry to learn more about. Maybe it's something like how to better manage your stress, or cheap and realistic ways to stay on top of your mental health. Supporting someone through a dark time. Postnatal depression. Also, if you have a mental health story to tell, we would love to hear it. You can send a voice memo or an email to the ladies at ABC.

Evie: Everyone's talking about weight loss drugs. Everyone feels like they've got the right to talk about bodies, fat bodies in particular. My decision to go on it was an unbelievably personal decision without actually thinking about anyone else or anyone else's opinion.

Yumi: Even though I'm giving this whole weight loss drug, public scrutiny, oxygen in a way that's harmful. But if we are going to have this conversation, I think we just need to have this conversation better.

Nat: I've got an eight year old daughter, and it's something that preys on my mind a lot, because I don't want her ever, ever feeling the way about her body like I have about mine. You either go on the drugs and people judge you because you're taking the easy way out, or you don't go on the drugs and there's something wrong with you. You can't win as a fat person in this world.

Yumi: Cast your mind back to before and other GLP one drugs were mainstream. There were signs that body inclusivity might actually be replacing the interminable fetishisation of painful thinness. For example, musician Lizzo was being celebrated for leading with fat. Yes, she was talented, loud, funny, sexy and fat and fat didn't seem to be a thing she cared to hide, apologise for or wish to change. Bigger models were strutting down catwalks, filling our feeds, modelling our underwear, and it seemed like it was more acceptable to exist at any size than it had been in living memory. Then ding dong GLP one agonist weight loss drugs arrived. At first they existed in the distant domain of the rich and famous. But now more and more of us your friends, your mum, your sister, yourself are on them. For some people, the drugs have been transformative. Others have had to stop taking them because of the side effects. Others still just don't want to be on them. But beyond what they've done to individual bodies, these drugs have also derailed the conversation around body inclusivity, and fat bodies are once again up for public debate. I'm Yumi Stynes, ladies, we need to talk about osmotic and body inclusivity. To have this conversation, I've gathered together a panel of three brilliant women. They've all experienced enough judgement about their bodies throughout their lives to honestly make you real.

Emma: Generally, it's hard to stop me from talking.So that's really good.

Yumi: This excellent talker is Doctor Emma Beckett. Emma is a food and nutrition scientist at the University of New South Wales, and she writes and broadcasts a lot about health and nutrition. If you spot Emma in the world, she'll no doubt be wearing a food themed outfit on the day we meet. She's in a fabulous doughnut print dress that's kind of making me hungry. We also have Nat Atkinson, that's 43 and a working mum of three.

Nat: I think I'm down like 16 kilos since I started.

Yumi: Nat lives in regional New South Wales and started taking Wigan, one particular brand of weight loss drug, four months ago.

Nat: It's been a kilo a week.

Yumi: And also joining us is Evie Gardiner, who's 29 and lives in Queensland.

Evie: I am back in Sydney for work. I work at the National Eating Disorders Collaboration.

Yumi: Evie's currently doing a PhD on size inclusivity. The crowd's gone wild and we're welcoming to the stage Nat Atkinson, Evie Gardner, doctor Emma Becker. So good to have you here. So we're talking about bodies. We're talking about weight loss drugs. I wanted to put it to you first, and I don't know who wants to start, so I'm just going to look down, no meaningful eye contact, and just ask you, how have you felt about your bodies throughout your lives?

Nat: Uh, I'm happy to start. Horrific.

Yumi: So we've got Na, and you felt horrific.

Nat: Horrific. Some of my earliest memories are comments from friends, dads that weren't particularly nice.

Yumi: Can you quote them? What did they say?

Nat: He used to just call me the fat friend. Um, but he had twin daughters. And both of them, they were really slim. Slim girls. Gorgeous girls. Mhm. So I was the fat friend. But I mean I'm from a family of curves. And yeah that' yeah.

Yumi: So that's how you felt.

Nat: That's how I felt.

Yumi: About your body throughout your life?

Nat: Yes. Yeah.

Yumi: Yeah. Horrific. How about you, Evie?

Evie: Well, just building on that. The comments really stick with you. And you. Me? The question really? I just had that question from my psychologist. How's your relationship with your body? And it got me thinking about one of the comments that's really stuck with me in school is I was on school camp, and I overheard these two kids in my year talking about me, and they said, Evie so fat, she's going to poke a hole in the ozone layer, and I don't even know what that means. Not great. But I remember as a kid thinking, oh my God, I feel horrible, I feel ashamed, and I just wanted to hide, I wanted. I actually never went on a school camp again after that.

Yumi: Oh, no.

Evie: So that was year eight camp, and I never went to year nine or year ten because I was so worried about comments about my body, because a lot of those camp trips, you know, you're doing activities where you're being physical and you're in teams. And I just remember thinking, no one wants me on their team because of my body. So I think just wanted to yeah. Comment on on what Nat said about comments. They really stick with you. And I think that build a relationship with my body that hasn't been super positive, but I feel really lucky that I have a much better relationship with it now.

Yumi: Emma?

Emma: I'll start with positive right now. In this moment, I have a good relationship with my body. It's where my brain lives. It's what lifts my weights. It's what gets me through the day. And I think I'm very lucky to have arrived at that place because I have been the butt of those jokes. And I've been at the end of those comments, and I'm actually an identical twin myself. I went to a tiny little primary school where people didn't tease you about your weight. Everyone was just who they were. I got to high school, I met diet culture, I met fat phobia, and people literally would say, are you the fat twin or the thin twin? And that created this idea in me that I needed to be the Thin Twin, because otherwise I didn't know how to answer that question. And it was just stuff like that all the time. And as a twin, people naturally want to compare you. But I'm really glad that my twin sister and I have arrived at a place in our lives now where we can champion each other's lives and each other's bodies, and not be in competition with each other.

Yumi: You've all pointed to the ways that people talking about your bodies has really mucked with your thinking around it. Are we okay even having this conversation, doctor Emma, I know you were like, I hate this conversation. I hate people talking about weight loss, drugs and also I hate skinny people sharing their opinions about whether or not people should take weight loss drugs. So how can we have this conversation in a safe, respectful, and productive way?

Emma: For a second, I thought you were going to stop it. I hate thin people. And no. Part of me wishes we didn't need to have this conversation. Part of me wishes that we could be at a place where we don't do this anymore. But we're not. And so even though I'm, like, giving this whole weight loss drug, public scrutiny oxygen, I think in a way that's harmful. But if we are going to have this conversation, I think we just need to have this conversation better. And I think that's putting the kindness in and taking the judgement out and remembering that we're talking about people. I think a lot when we talk about fatness, we forget we're fat people. We're not numbers on the scale where humans as well, and how we feel about this definitely matters in these conversations.

Yumi: What has changed since Wegovy since all these drugs became mainstream in the world as a fat person. What's your immediate reaction to that?

Emma: I think we're more fat phobic than ever, because it's created this space where people's right to change their bodies or not, has become public property. And it's almost for me, like you're damned if you do and you're damned if you don't.

Evie: I agree, I think it's, it's kind of burst that bubble for me where I've had this sort of like safety net bubble of people around me who were supportive and understand and don't comment on my body. And now that bubble kind of feels like it's burst because everyone's talking about weight loss drugs. Everyone feels like they've got the right to talk about bodies again. Fat bodies in particular. You either go on the drugs and people judge you because you're taking the easy way out, or you don't go on the drugs and there's something wrong with you, because why wouldn't you? If there's this option that helps you to lose weight quickly or easily, as they say, then why wouldn't you do that? So really, it really feels like you. You can't win as a fat person in this world.

Yumi: Evie has Ozempic chat filtered down to say, weekend barbecues in your world. And what has been the emotional impact of those conversations for you?

Evie: A lot of the people I surround myself with are pretty size inclusive, or at least are just, you know, they know not to not to make comments about people's bodies. But there are still instances where I might be at a family dinner with extended family or people that I don't really spend a lot of time with. And so, you know, they might bring up Ozempic or weight loss drugs because they've seen something in the in the news or they've seen something on their social media and it'll it'll kind of open a discussion about these drugs. And I think for me, my initial reaction when those conversations start is to kind of tighten up a bit because I start just anticipating the conversation, kind of going into discussions around morality and health. And if you're fat, you're not healthy and you're not moral. And if you're you're thin, you are.

Yumi: Emma, I've got a question for you. Did it feel like there was a moment in time when the world got more size inclusive for a bit, for a hot minute, and then it kind of has gone backwards?

Emma: Yeah. I think there was this moment pre weight loss drugs being released where it did feel like we were gaining some ground. And I think we had reached a really good place. But now I see those communities being divided. And we have part of the fat community saying anyone who is losing weight full stop, whether or not it's on these medications, is a traitor to the cause. I literally heard someone say, thin people have ruined dinner parties because people aren't eating anymore, and it's become so divisive and there's so many more factions now, and people are just saying so many unkind things and not thinking about how it lands with other people. We seem to have gone from liberate fat bodies and changed society and be positive about our bodies and be neutral about them, to suddenly everyone's body is public real estate and everyone's choices are public real estate. Now, can you tell us the story about how you decided to start taking the drugs?

Nat: My decision to go on it was unbelievably personal decision without actually thinking about anyone else or anyone else's opinion about me. I first heard about it at a couple of years ago. My auntie was on it because she had to have a stent put in, so she had to lose the weight for the surgery and she told me about it. She's like, it's the best. I lost weight really fast.

Yumi: Then Nat's sister and mum also went on wigs and lost weight easily. They could see that Nat was struggling, so last Christmas they pulled her aside.

Nat: They said, listen, we want to talk to you about something. We don't want you to get upset about it, but we just see you're really unhappy at the moment. You look really uncomfortable with yourself, and we'd like to help you if you want to go on it.

Yumi: So they grabbed you and sort of took you aside as like an intervention conversation where they'd obviously had a discussion about it beforehand. They said, we want to help you. And what was the next part of the sentence?

Nat: We know you can't afford it, so we can help you if you want. If you want us to. No pressure. If you want us to help you, we will help you. So I said yes straight away.

Yumi: They offered to pay.

Nat: They offered to pay, yeah. So probably without them it would be a stretch because it's not cheap.

Yumi: That's weight loss has been rapid.

Nat : It's it's been a kilo a week. Wow. And literally with like, I'm I'm not doing anything.

Yumi: The drugs have dramatically reduced her food noise.

Nat : It's sort of this really strange thing where where I used to be like, okay, do you know, what am I going to have for dinner? I'd start thinking quite early. It's gone that need to think about it all the time, and it's definitely silenced cravings for me.

Yumi: And Nat's experience of life in a new body is different.

Nat : So far for me, it's been a really positive experience. Sure. Yeah.

Yumi: Yeah.

Nat : Yeah. The chafing thing has been really good because I had to wear bike shorts all the time because I like wearing dresses and skirts and stuff, so that's feeling a bit better.

Yumi: It's been a life changer.

Nat : At the moment, yes.

Yumi: Evie and Dr Emma are not on GLP one drugs and have no plans to start. Nutritionist Doctor Emma says the conversations around these drugs are not comprehensive enough.

Emma: I would just love if we could take a step back and talk to people about health. If you have goals for health, then here's how we can reach them, regardless of our body size. Because simply shrinking bodies is not going to be the solution that we want it to be. And I think we also need to separate this conversation between are we losing weight on these medications for our health and to reduce our health risk, or are we using them to achieve a more privileged position in society? And if we're pursuing thinness because we want thin privilege to, then you're potentially becoming part of the problem rather than pushing back on what is thin privilege, and why do we let it happen to start with?

Yumi: Yeah. So just to repeat back what you just said because I'm going to fudge it. Are we losing weight? To try and improve our health outcomes? Or are we just trying to? This isn't what you said, but I'm going to say look better and accumulate some privilege in in the process.

Emma: I'm not like if you're using it for thin, privileged, pretty purposes, then you're a bad person. I'm definitely not saying that because society puts us in that place, and society puts us in a position where we can't find clothes that fit and we can't find other things that fit, and we do feel bad about ourselves. But I would love if we could do both at the same time. If people who wanted to and were in the position and were empowered by it can change their bodies. But let's not leave everyone else behind and lets you know when you acquire the thin privilege. Use that privilege to look back and say, well, what can I do with this privilege to help change society for my fat friends? Because fixing each of us individually so we don't feel bad. Often people think they're going to lose weight and they're going to feel better. Often they lose weight and then they go, oh no, it was never my weight that made me feel bad. It was society. It was my brain. And we're sold this kind of narrative that lose the weight, feel better. Then you can do the other things. But often we don't get there.

Yumi: Evie, I sense you want to react.

Evie: Can you comment on thin privilege for people listening who may not know what that is, or what that looks like? For someone who's fat? I'm a fat person. There's obviously different levels of fat and people are fatter than others. There's kind of this idea that the thinner you are, the more privilege you get. So as a what is kind of referred to as a small fat person. I still get thin privilege, but not not as much as a thin person would. So that privilege is sort of it's on a spectrum. It's it kind of shifts as your as your body weight shifts. So for me, I can Generally exists in my day to day life without significant barriers. So I can get on the train and get a seat and I can walk through doors and all of those things. But then there are still situations where I don't get the privilege to just exist.

Yumi: A couple of years ago, Evie was at her younger brother's 21st birthday party. It was at a go karting track.

Evie: And it just never occurred to me because I hadn't been go karting before, that there would be a weight limit for the go karts. We went to check in and they were like, okay, you have to put on what your weight is. And anyone who'd put their weight over 100 kilos was was kind of pulled up and they said, okay, well we need a way you on the scales over here because if you're over a certain limit, then you can't go on the go kart. They didn't pull us to the side. They didn't really do it very gently. And my whole family's there, my partner is there, and I'm feeling really Humiliated. And so they weigh me. And in front of everyone they said, you can't. You can't go go karting. I just remember feeling so embarrassed. And I as everyone went go karting for his 21st birthday, I sat in the car and cried.

Yumi: Aside from social exclusion, public humiliation and missing out on fun stuff from go karting to school camp, weight stigma can have other effects. A 2022 study from Monash University found that weight stigma, in part perpetuated by healthcare professionals, leads to negative impacts on a person's health and quality of life. Evie used to hate going to the doctor because of how she was treated, until she found a size inclusive GP, and Nat, who has a trusted regular GP, couldn't bring herself to talk about going on weight loss drugs with that doctor.

Nat : The thing that stopped me for so long. Going on it is the embarrassment and not wanting to be shamed by the doctor that I was going to go to.

Yumi: Nat went to a different doctor who was known to be proactive in prescribing Wegovy.

Nat : She's like, okay, jump on the scale I did. She went, oh, yep, you're obese. Okay. And the appointment went for probably less than ten minutes. I had the prescription and went and got on it straight away. Every time I go in there, she doesn't really remember who I am and she's like, what are you here for? I'm like, we're goby. So every time I just sort of prompt. And so her care isn't great. But I mean, the horrific thing is as well is that I'm not going to my normal doctor to get it. I have an amazing like woman doctor that.

Yumi: That cares about you.

Nat : That cares about me. And she's amazing. But I also know that she'd hate me being on it. So I go see one doctor for one thing. Once I'm ready, I'll go see my lovely doctor, who will then help me get to the point where I'm ready to move on.

Yumi: Can I just ask Nat? Your doctor gave you this would go over your prescription and has updated it as necessary. But doesn't even really know, you know. Did she give you like dietary advice or any sort of prompts to get you thinking about what would happen when you reached your so-called goal weight?

Nat : No. So she did ask, which I perhaps is what they're told to ask. Have you tried losing weight in any other way?

Yumi: Okay.

Nat : So I said yes because I have. And then she said, okay, well, this is an effective way of doing it. Here you go. Is will go be the one you want to go on?

Evie: Sure.

Yumi: This is why it's the Wild west out there. Dr Emma, what do you think about this?

Emma: It's concerning. The expectation most people would have for the medical profession is if they go to see one practitioner, they would get the same advice as if they went to see another practitioner. And so if I went to see one doctor about my blood pressure. I would expect they'd have a pretty similar way of treating that as another doctor about my blood pressure. But we're in a situation where people feel like they need to avoid one doctor to get one thing, and then go back to the other doctor to get the other thing. That says to me, there's some gaps in the medical professional training around this. I think there's probably some biases that are sneaking in with the doctors, and it's not all just evidence based practice as it should be, but it's also a worry, because if you're taking multiple medications and the doctors giving you those medications don't know about them, that's a risk. That's a medical risk. And if the whole point of being on this medication is meant to be improving our health, then that could be counteracting to that.

Yumi: Would I be right in saying you're avoiding judgement Nat?

Nat : 100%.

Yumi: Yeah. Okay. So back to judgement.

Nat : Yeah, 100%.

Evie: And also the solution is not judging people who go on these medications.

Yumi: This is Evie again.

Evie: Totally correct me if I'm putting words in your mouth. Nut, but it sounds like you have an amazing women's health doctor who you didn't go to for these medications because you were worried about being judged about going on the medications as opposed to her judging you about your body.

Nat : Oh yeah, it was about going on the medication.

Evie: There's that flip side now where fat people were scared about being judged about being fat, and people assuming that because we're fat, we're inherently unhealthy. And now we're scared of the the great, amazing doctors who might judge us because of going on these medications. Because, again, as as Emma and I said earlier, we can't win.

Emma: No.

Evie: We lose when we get judged on either side.

Yumi: And is it the idea that you're cheating?

Nat : Yeah, 100%. It's that I'm cheating. I should be doing more exercise. And that's something I guilt myself over often, which is, you know, add it to the list of things I guess we'll guilt ourselves over. But I guess it's the situation for a lot of people where time poor and exhausted, and unfortunately, my needs are at the very bottom of the list. A lot of the time. So this has just been a really good way of just putting something that has been nagging at me forever. Just it's something that's just not that I don't have to think about at the moment. Yeah, sure. And for years, one of the first things my dad has said to me on the phone is, how's he wait? Which is something he's always said.

Yumi: He's said that for years?

Nat : Oh, yeah. Every time I talk him, how's your weight? I love my dad. He's great. But he himself has struggled with weight over the years, and he's really fit. Like he'll sprint for 40 minutes every day. But it's just something that's always at the forefront of his mind. How's your weight? So it's always on my mind then. My weight's not great. So now it's just something I don't have to think about.

Yumi: So much.

Nat : So much. Yeah.

Yumi: These sorts of interactions between parent and child about weight, like gnats, are really common. And Dr Emma says it's because parents often have their own hang ups.

Emma: Weight often runs in families because of genetics. And you know, because we learn to live and, you know, eat and do through what we see from our parents. And so a lot of it we carry together. And whether it's from a thin parent saying to a fat child, why can't you be thin like me? Or whether it's a fat parent saying to a fat child, hey, we can lose this weight together? I think this is where we can think about our generation, our children, our nieces and nephews. How do we do this conversation better so that we're not passing on that stigma? We're not passing on that trauma, because until we break out of that cycle, I think we're just going to do a different version of this over and over again until the end of time.

Yumi: Mum of three Nat is acutely aware of what impact she might have on her kids, and she's actively choosing to not talk to them about taking a weight loss drug.

Nat : I've got an eight year old daughter, and it's something that preys on my mind a lot because I don't want her ever, ever feeling the way about her body like I have about mine. So I never talk in front of her about any of this and never show her what I'm doing either.

Yumi: Dr Emma would love to see a future where we move away from the hateful baggage around weight and fatness, and see weight loss medications as just one tool for long term sustainable health. If we had someone with depression or anxiety and we put them on meds for that, we would add to that. That would be one tool to put someone in a better place. And then when they're there on the medication, you go through the cognitive behavioural therapy. As you go through the changes that you need in your life to be able to cope with those things that are triggering or exacerbating the depression and the anxiety. We need to be doing that with these medications too, because otherwise we're just shrinking people. We're not actually making them healthier on the way because we're not changing what they're actually eating. They're just eating less of it, and we don't give them an exit strategy. Doctor Emma says it's important we take into account that people are turning to these weight loss drugs, not simply to lose weight, but to shake off the judgement they feel is heaped upon them.

Emma: I think the judgement is a bigger picture problem that got us into this mess to start with, because the fact that fat people, when they go to the medical professionals that they do get that judgement, that they fear that judgement, we as fat people then get poor quality health care because of that, because we're avoiding the professionals, because the professionals are being mean to us and the solution cannot be. We all shrink our bodies so that we can get taken seriously, because that's not a solution.

Yumi: So what's Nat's plan with Wegovy in the long term?

Nat : I've probably got till the end of the year on this, and now I need to start addressing things like, how am I going to phase myself off this? Like I eat really quite well anyway. It is just for me. I think a lot of it's portion control and a lot of it as well was when I'm bored, I eat. So I guess I need to address those sort of things. And now that this side of things has been dealt with, hopefully now I'll have more mental capacity to deal with these other, other points.

Yumi: We had Aubrey Gordon on the podcast last season and freaking love her so hard, but I think she fits into the category of people who are not going to take these drugs. And I think there is a cohort of people that we can accept is going to sit in that category, while the rest of the world around them shrinks in size. First of all, do you agree that maybe larger bodies, fat people, are going to become even more of a minority than they were? And what can the rest of the world fat, thin? Listening to this podcast do to support them?

Emma: Can I firstly say fat bodies? We are not the minority. We're actually the majority. Like most people are overweight at this point, that we still get treated like a minority really demonstrates what thin privilege actually is. I don't think it's a question of will fatness become a minority, because there's going to be people who will not lose weight on these medications because of biology, and some people can't take the medication. Some people won't take it for ethical reasons. Some people can't afford it. So, you know, fat people are not going away. And society better get used to that. And, you know, start treating as well like people and designing things so that we can survive and thrive as well as other people.

Yumi: This is PhD student Evie again.

Evie: I would love the world to get to a place where we don't have to exist in this society, where it feels like bodies are being othered based on on weight and what we look like. I'd love to just get to a place in the world where I don't even have to say that someone is size inclusive. I just want to get to a place where bodies are bodies, a place where we have these different characteristics and they're not defining. They don't influence what we can access and what we can't access. They don't influence the privilege that we get or don't get I. And I think unfortunately, with these weight loss drugs, I don't think that they're going to contribute to that goal.

Nat : Yeah, I agree with all of the points that you both have said. If it wasn't for my mum and my sister, we'd be having a really different conversation right now. Because I wouldn't be on it, and I'd still feel like I was feeling six months ago.

Evie: We need to change society. We need to change the system rather than change individuals. Although they may be a wonderful solution for an individual, I don't think they're the answer for the population.

Yumi: And on that note, Dr Emma Beckett, Evie Gardiner, and Nat Atkinson, thank you so much for joining us today.

Nat : Thank you very much.

Emma: Thank you.

Evie: That was really, really fun today. 

Yumi: This podcast was produced on the lands of the Gundungurra and Gadigal peoples. Ladies, We Need to Talk is mixed by Ann Marie de Bettencor. This episode was produced by Elsa Silberstein and Gab Burke. Supervising producer is Tamar Cranswick and our executive producer is Alex Lollback. This series was created by Claudine Ryan.