The writer and attention economy provocateur Caroline Calloway has a new essay out in Byline — which bills itself as “The Paris Review but for people with 10 hours of screen time” — about taking Ozempic. She was not overweight when she started on the GLP-1 drug, and she describes wearing hidden ankle weights into a doctor’s office so that her body mass index qualified her “resoundingly” for an online prescription.
Calloway explains the way the drug curbs her appetites for food, alcohol, drugs and all-purpose “short-term gratification.” She is upfront about the unpleasant gastrointestinal side effects she experiences, and concludes: “It’s either this and being skinny, or a violent hangover, which feels the same, and being 15 pounds heavier.” She continues, “I don’t have the self-discipline to change my psyche or the life span to fix the patriarchy. I’ll run out of time and die before I see the world stop treating thin women with more reverence and gentleness than the averagely plump girl I once was.”
There was a predictable backlash to Calloway’s essay, and she defended herself in Instagram comments by saying that her healthy (not “plump” by any medical metric) starting weight was “BEYOND above the average BMI in downtown New York and I’ll die on that hill. We walk amongst models here.” While Calloway’s whole shtick is to agitate — her internet activity was once described in this paper as “viral shenanigans” — my sense is that she really feels this way. Her uncomfortable candor is a useful illustration of how the widespread availability of GLP-1s has further warped the way mainstream American culture views women’s weight.
Multiple things can be true about GLP-1s: They are truly miracles and may treat a whole range of conditions beyond obesity and diabetes. And they are often misused, partly because we have told women in multiple ways that being thin makes them valuable. As my colleague Tressie McMillan Cottom has written, our culture “makes being fat a woman’s burden, a means test for dignity, work, social status and moral citizenry.”
Two new studies show the complexity of the way these drugs affect their users. The first is a working paper for the National Bureau of Economic Research by the Harvard economist Rebecca Diamond, using data from the University of Southern California’s Understanding America Study. Diamond compared women ages 25 to 61 who started a GLP-1 for weight loss with women who wanted to start a GLP-1 but had not. The base line body mass index of these groups was around 35, which is at the low end of Class 2 obesity.
As Diamond notes, there is already a wealth of economic research that shows “heavier women earn less, work less and are less likely to marry or cohabit,” and her study adds to this literature:
Among women who are single when they start, the probability of being married or living with a partner rises 18 percentage points overall and 29 percentage points after six or more quarters. The gain builds gradually as weight comes off. Women not employed at base line also move into work. Their employment rate rises 13 percentage points overall and 27 percentage points after six or more quarters, and their weekly hours rise by nearly 10 hours at the longer horizon. Much of the employment gain is movement out of unemployment rather than out of retirement or disability.
Interestingly, for women who were already employed or partnered when they started taking a GLP-1, Diamond found that very little changed, suggesting that the “obesity penalty” for women is largely a first-impression prejudice. “The markets that respond are the ones where someone forms a fresh impression of a woman’s body weight: a prospective partner, or an employer considering an applicant who is not employed,” Diamond explains. If weight is just one piece of information balanced with other factors, it has less impact. (Men also face some economic penalties for obesity, but they are smaller than those that women face.)
A research letter recently published in JAMA Psychiatry outlines a study that estimates the prevalence of GLP-1 use among people with eating disorders. Nearly all of the study participants were female. Researchers found that the use and misuse of GLP-1s is higher among people with eating disorders than among the general population, and that some of them may be attempting to maintain their “eating disorder psychopathology through rapid restriction and weight loss.” They found that over 10 percent of participants with anorexia had tried GLP-1s.
Though GLP-1s may be a promising treatment for some kinds of disordered eating, like binge eating disorder, it appears much riskier for women with other kinds of diagnoses. In 2024, Bloomberg’s Madison Muller spoke with several eating disorder specialists who said that they’re “seeing an influx of patients who’ve relapsed after taking drugs like Ozempic. In other cases, people at risk of eating disorders develop what one doctor calls ‘GLP-1 induced’ anorexia after taking shots they never should’ve been prescribed.”
These findings bring me back to Calloway’s piece. She is subject to the same pressure to be thin that many — most — women in our culture feel, but for her, as an influencer, that pressure is undoubtedly ratcheted up to 11. Her livelihood is more dependent on how she looks, and because ultrathin is in, she clearly feels she must adhere to what’s in vogue.
Despite saying that Ozempic has made her life better because she’s skinny, Calloway also makes her mental and physical state sound kind of depressing. She talks about her bruised arms and bouts of vomiting, as well as her lifelong lack of sexual gratification. If you read between the lines, Calloway has done a service: She paints a picture of her battle against a sick culture, and in a roundabout way, lets us know that Ozempic really isn’t helping her win.
End Notes
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The New Yorker’s William Finnegan has an excellent piece about the trial of Thomas Plamberger, the Austrian man who was convicted of gross negligent manslaughter in the death of his girlfriend, Kerstin Gurtner, whose body was found near the peak of Grossglockner, Austria’s tallest mountain. I had heard about this case on social media, where the term “Alpine divorce” was coined to refer to Plamberger and other men who ditched their partners while hiking. The story Finnegan tells is far more complicated, and revealing about Austria’s cultural values of self-sufficiency and toughness. (Though for the record, Plamberger appears to have been absurdly, horrifically, borderline sociopathically negligent.)
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The post How GLP-1s Feed Our Sick Culture appeared first on New York Times.
