A Dietitian’s Thoughts on the Oprah Weight Loss Special

As a registered dietitian who hates diets but supports intentional weight loss, it’s hard to talk about Oprah and weight without being conflicted about whether she has been a victim or a perpetrator. Or quite possibly, both.

A victim of fat shaming, most definitely. When you’re a worldwide celebrity, body scrutiny seems to be part of the job, unfortunately. This is disgusting and sad and totally boring – why are we still so focused on other peoples’ bodies? 

Oprah has certainly struggled with her weight for what appears to be most of her adult life, and as viewers, we’ve been party to her merry-go-round of diets, most famously her little wagon filled with the fat she lost using a liquid diet (I never recommend that, obviously), her workouts with trainer Bob Greene, and most recently, her partnership with Weight Watchers. 

Oprah’s Favorite Thing used to be the best white t-shirt or the newest kitchen gadget. Now, it’s a pharmaceutical: The Oprah Special: Shame, Blame and the Weight Loss Revolution focused on her new favorite thing: GLP-1 agonist medications. 

GLP-1 agonists, which I’ve written about here, will most definitely save lives. I fully support their use for weight loss in people who qualify for them. Not for vanity weight, meaning that I don’t believe in their use to drop a few pounds. These medications are serious, and they have side effects (more on that in a second). They should be only prescribed by an ethical medical professional who will follow and continually assess for tolerance and effects.

It’s hard to argue with the research: these medications are effective for weight loss in most people. This is an oversimplification, but they work by reducing appetite. Less appetite, fewer calories consumed. Go off the medications, and you may gain the weight back. For many people, GLP-1 agonists are a lifelong commitment, or so it seems up to now.

And no, ‘natural’ GLP-1 agonists that are as effective as medications don’t exist. Read my review of them here.

I have some observations from this Oprah Special: Shame, Blame and the Weight Loss Revolution. Here they are:

Weight Watchers made a regrettable appearance.

That she featured Sima Sistani, CEO of Weight Watchers, as a guest, is absolutely horrible. Oprah has made a huge deal about announcing that she left the board of WW in order to do this special and not appear to have a conflict of interest.

I’m sorry, or maybe I’m not, for saying this: Weight Watchers is a boil on the butt of our society. It has maybe helped some people lose weight, but for what seems like far more of us, it seems to have had a profoundly negative effect on body image, eating habits, and chronic dieting. 

Sistani, for her part, did admit that in the past, Weight Watchers got it wrong by focusing only on behaviours, not biology. She qualified that with a plug for WW, saying, ‘We are the most clinically tested, evidence-based, science-backed behavior change program, but we were missing the third prong which was biology.’

Let me remind you that the research that she’s referring to here was done by WW and wasn’t all that remarkable. Read about it in my post, I’m a Dietitian. Here Are My Issues with Weight Watchers.

If Oprah wants to stop the shaming and blaming, she needs to take a big step away from Weight Watchers, with their weigh-ins, crazy-making points system, and sales pitch that their diet is all about ‘wellness’…because it isn’t. It’s about thinness and weight loss as their primary outcome measure. That’s not ‘holistic,’ it’s misleading. 

Weight Watcher’s shift to ‘modernizing the program’ by providing GLP-1 agonists is just another layer to that. After all of the theatrics around their alleged shift to  ‘wellness’ and not weight, it’s tough to trust WW has our best interests at heart versus looking to cash in on the GLP-1 med trend. 

After the show, an influencer named Katie Sturino called out Sistani for not acknowledging the harm that Weight Watchers has done over the years. Sistani took a mea culpa, giving an apology. Good for Sturino.

Oprah may still be submitting to diet culture, depending on how you look at it.

I’ve heard a couple of sides to this argument. One is that Oprah is allowed to do whatever she wants with her body to make herself feel good, and to be healthy. That she’s making it everyone’s business by putting herself on TV and praising GLP-1 agonists for weight loss shouldn’t factor into it.

The other side of the argument is that Oprah is yet again submitting to diet culture by taking these medications in order to reduce the size of her body. That for someone who has done so much work around promoting self-awareness and emotional health, she still can’t learn to love her body the way it is. That she should just ignore and forget all of the body shaming she has experienced, and own her size.

You’re probably wondering where, as a dietitian, I land on this. Here’s your answer:

I believe that it’s okay to want to lose weight. I think we don’t know the whole story behind Oprah’s struggles with her body, and that we should look at this through a lens of compassion. Just like Botox, hair color, personal trainers, and cosmetic procedures, we do things to our bodies to increase our confidence. Maybe Oprah’s size has prevented her from engaging in activities that she has wanted to do. Maybe she has health issues. Maybe she has food noise (thoughts of food – GLP-1 agonists take this away for many people, allowing them to feel ‘normal’ for the first time ever) every second of the day that’s distracting and horrible. Maybe she just doesn’t want to be this size anymore.

Who are we to judge her reasons, especially because we know nothing about her except what we see in the media. 

It is not okay to demand that everyone to love and accept their body the way it is. That position, in my opinion, wrests bodily autonomy from them. It places our own expectations onto someone for who the nuances of their life we don’t know. It’s the equivalent of telling a traumatized person to ‘just get over it already.’

If Oprah feels amazing on GLP-1 agonists, I love that for her. Where I have an issue is that her ability to reach people is massive, and therefore, her responsibility in terms of her messaging is equally huge. If she’s going to go on TV and tell people how helpful these medications are, she needs to be sure that all sides are explored. The good, bad, and the ugly.

Weight loss is not about willpower.

I’m glad Oprah said this, and she got this right, along with her statement that obesity is a disease.

Willpower where weight loss is concerned, is the diet industry’s way of blaming us when their restrictive diets inevitably fail. We did it wrong. We weren’t motivated or dedicated enough. We just didn’t try hard. We’ll get it right the next time…on another diet.

Though controversy still exists in terms of this definition (and here), I agree that obesity is a disease, and this fact was amplified on the show by the medical professionals Dr. Amanda Velazquez from Cedars-Sinai and Dr. Scott Butsch from the Cleveland Clinic. (Side note: both these doctors are reportedly associated with companies that produce GLP-1 agonists). 

While some people will never get this – especially people who don’t struggle with their weight – it’s great that the world is waking up to the fact that for individuals are wired differently, and that they now have safe choices around how to manage food noise and hunger. 

There is tremendous inequality when it comes to accessing GLP-1 agonists.

These medications – Ozempic, Wegovy, and others – are extremely expensive. We’re talking up to thousands of dollars per month. Unfortunately, in the United States, many people who could benefit from them can’t access them because insurance won’t cover them. Those who don’t have insurance at all are in the same boat: they need to pay out of pocket.

In Canada, GLP-1s are covered by provincial health insurance in some provinces, but only for diabetes. The cost out of pocket is around $300 a month.

In general, insurance companies cover medications for diabetes, blood pressure, cancer, and high cholesterol. Ironically, these and other conditions are linked to obesity. Covering GLP-1 agonists for weight loss in people who qualify should, by any estimate, result in huge medical cost savings in the long-term. It’s simple math. 

So, why won’t many insurance companies cover medication for weight loss? 

The only answer I can think of is that they don’t believe that obesity is a disease. That, and they’re extremely short-sighted.

Low and middle income people are more likely to be overweight than people who are wealthy. Social determinants of health, including but not limited to, income and access to medical care, impact far more than weight: according to the research, they increase risk for all-cause mortality.

I wrote about social determinants of health in my post ‘No, We Don’t All Have the Same 24 Hours in a Day.’

Making GLP-1 agonists available to people who can’t afford to pay, along with systemic changes to improve access to food and healthcare, would probably go a long way in lowering disease rates and healthcare spending. 

The other side to this is that rich people get thinner, and the use of GLP-agonists for vanity weight loss may be causing or exacerbating shortages of the drugs. This directly impacts people who are taking them for legitimate reasons. 

Side effects can be brutal. 

One complaint about the show that I’m seeing a lot is that there wasn’t more of a comprehensive discussion around side effects, and that the topic appeared to be ‘brushed off’ by some of the doctors. One woman featured said that she vomited blood on the medication, only to be asked by Oprah if she’d try a different brand next time. Is it because representatives for GLP-1 agonist manufacturers were in the audience? To call a medication a ‘weight loss revolution,’ but not present all sides of the story, seems to be creating messaging that everyone should jump on the bandwagon for these drugs. That isn’t true.

Even though serious side effects may be uncommon, when you have so many people taking or wanting to take these meds, they should be properly briefed on what can occur on them. 

Even further, a warning around the inappropriateness of procuring and taking these drugs when someone has, has had, or has a predisposition to restrictive eating disorders would have been on point. At least, it would have been their due diligence. 

GLP-1 medications need to be combined with other lifestyle and diet changes.

Oprah uses these medications, follows a ‘healthy diet,’ (I think she said somewhere that it’s based on the WW diet), and is also an avid hiker. And she’s correct: although GLP-1 agonists are the closest thing to a ‘magic weight loss bullet’ that we’ve come to, for overall health, GLP-1 agonists shouldn’t be treated like they’re the only thing that matter.