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Hey there everyone–
Have you all been following the coverage of the diabetes drug Ozempic? Ozempic is the brand name of semaglutide, one of a series of drugs in the category GLP-1 receptor agonists. The drug, which mimics a hormone, works by suppressing the body’s production of glucagon. Since glucagon cues the body to raise its blood sugar, when it’s suppressed, insulin is better regulated and insulin resistance can be prevented. Ozempic sets off the cascade that signals the brain to tell the body it’s “full.”
The drug received approval for people with type 2 diabetes and/or obesity, to help them eat less and control their weight and blood sugar. Because Ozempic and other drugs, like Wegovy, that use the same chemical, not only produce the feeling of fullness, but also slow down the actual emptying of the stomach, people who take the drug report not only consuming less food, but also not suffering from cravings. Several people who have taken the drug have written in online forums that they feel like a “skinny person” because their brains can now tell them to stop eating. They say that something that was always broken is now fixed.
As one might imagine, the side effects of the drug are quite unpleasant. People suffer from diarrhea, vomiting, constipation, dizziness and nausea. They can also experience hair loss and a gaunt look in their faces, more consequences of rapid weight loss than the drug itself.
It is not surprising that a drug like this—so powerful and so quickly effective—would generate interest among those whose careers and financial prospects depend on them maintaining a certain weight and appearance. Rich people, too, have found ways around the limitations of the drug’s target population, paying compounding pharmacies to give them the drug, or an off copy of it (semaglutide sodium, which some say is not the same thing at all) if a doctor won’t prescribe it to them, off-label.
In the last few months, both the New Yorker and New York Magazine have devoted space to profiling the drug; Oxchitl Gonzalez, author of the Atlantic’s newsletter Brooklyn, Everywhere, wrote a beautiful meditation this week on exercise and Ozempic, and there are countless other news stories and catty posts speculating about who is on it and lying about it, and who is actually “earning” their weight loss through other means. Speculation reached a frenzy when Kim Kardashian showed up at the Met Gala wearing a dress that was worn by Marilyn Monroe. Her famous ass appeared to have significantly diminished, though she denies being on the drug. There are memes about “Ozempic face” and it’s already being referred to in the press as a “celebrity weight loss drug” rather than a treatment for diabetes.
Here’s the thing I’ve been wondering about, though. For all the press this drug received over the last six months, all the excellent discussions of whether Ozempic is the death knell to the body positivity movement, and a restoration of white thinness as the beauty ideal associated with the rich, there’s a question I’ve yet to see someone raise: what happens to a person’s ability to access their emotions when they are taking a drug that suppresses their appetite?
That is, is there a link between loss of “appetite”—the literal hunger for food—and the loss of connection with desire itself, with feeling itself? One thing I know as a therapist is that our feelings exist on a spectrum and along a continuum of intensity. We cannot suppress grief and terror and still have access to joy and excitement. We cannot dull the level of intensity of one feeling and still have access to the high intensity of another. Most people who are moving from a state of numbness or dissociation to instead feeling their emotions in real time, for example, cannot access their joy without first feeling and processing their suppressed grief.
When I’m working with clients who are trying to get in touch with their feelings, I start, as most of us do, with the somatic. Before we can identify the subtle differences between anger and contempt, or aversion and fear, we can start with physical sensation. If anger is recognized in part by tuning in to tightness in the gut, and anxiety recognized when we feel our shallow breaths, above the diaphragm and our quickened heartbeats, it’s clear that to be emotionally attuned, we have to attune to the signals coming from our corporeal being.
Would it follow, then, that the reverse is also true? That suppressing appetite would perhaps unwittingly suppress emotion? There’s an eerie, unanticipated side effect of Ozempic. It stops people from engaging in other behaviors that produce dopamine. It stops people from shopping in an addictive fashion; it’s been said to stop alcoholics from craving drinks. If this is a drug that stops people from seeking dopamine hits altogether, then what kind of person does one become, when access to pleasure is no longer available, or even sought after?
I’m not in any way dismissing the incredible possibility and hope that Ozempic might provide to all of those whose lives are impacted by addiction. Rather, I’m wondering about the unintended consequences of only focusing on this drug’s power to induce weight loss. Because pretty much the only other thing I see people talking about, after they’re done gnashing their teeth at the Kardashians, is how much money is about to be made off the obesity drug revolution. Consider this newsletter your stock tip about which pharmaceutical companies you should invest in over the next ten years.
There’s a beautiful passage by Uruguayan journalist, writer and novelist Eduardo Galeano from his series called “Windows.” This one is called “Window on the Body”:
The church says: The body is a sin.
Science says: The body is a machine.
Advertising says: The body is a business.
The body says: I am a fiesta.
When science—the pharmaceutical companies Novo Nordisk and Eli Lilly & Company—sees the body as a machine, then Ozempic looks like a miracle. Suppress hormone A with chemical B; trick the brain into engendering the satiety response, and diabetes and obesity, heart disease and sleep apnea, cancer and liver disease all decline.
But the body isn’t a machine. It’s a feedback loop. We are the ones who impose the metaphor of machine onto the body, to help us tame and study it, specialize in its systems, tweak its engine, bang on its hood. In reality, any intervention we make into one aspect of being will impact other aspects, often in ways we cannot anticipate.
When I was reading the NYMag Ozempic story, I was struck by the layout. The article, “Life After Food,” was accompanied by a photograph of a banquet table, covered with fake food. The table—its place settings, decorations, and platters laden with plastic turkeys and stuffed tomatoes, aspics and pomegranates—was covered with cobwebs. It conjured a world of people who had completely turned away from their own appetites. What other embodied awarenesses and information will be excluded from, or literally unavailable to consciousness, if we can no longer distinguish between hunger for food and hunger for connection, or between despair in the core of our being and the pit-in-the-stomach sensation that is the consequence of low blood sugar and too much focus and overwork?
Consider the following words:
Succulence
Appetite
Sensuality
Flesh
Taste
Desire
Pleasure
Each is a bridge between corporeal sensation and emotional expression, or even a kind of hybrid-fusion of the two. It is not a coincidence that the words listed above are associated with the “feminine” and the ways the feminine threatens a patriarchal world order that dominates and controls the female body, and all those whose bodies are feminized in relation to a rational, straight, white, able male-bodied ideal.
What happens when our dominant culture, which already encourages us to consume objects, people, drugs, and entertainment, in order to numb out and disconnect from that which terrifies us, is granted a drug so powerful that the numbing could be a kind of permanent state? What kind of capitalist productivity will be achieved by people who never need much to eat, and who can’t access the slowness, the pleasure, the rest that being truly full forces upon us, regardless of what our mind, or our boss, might demand of us?
What happens to our feelings of commonality and connection to others’ bodies, if our own body is unable to tell us what it wants and needs? Will Ozempic usher in a higher level of loneliness and numbness in its consumers? Or will they experience great happiness, looking at how beautiful they are in the mirror?
I wish I could end this post with recommendations of how to recognize and celebrate the fiesta, and not tame the body, objectify it, stuff its mouth with cloth. I wish I could say that when I look in the mirror I don’t check to see how much my stomach sticks out, and automatically think about what I could eat, or eliminate, to keep it as flat as possible. I wish I could tell you I remember what it was like to just inhabit myself, as a whole entity, and not think that “I” have a body and a mind, my property, divided from each other.
I wish I could tell you I don’t use food as a reward, earned after a sufficient period of denial, or after I’ve finished a certain amount of work. I’m writing this post in a coffee shop, trying steamed cold brew for the first time. It’s fluffy with bubbles; the barista told me it was creamy, but it’s actually just black coffee, no milk. My stomach’s twitching and growling but I won’t leave here until this is finished, until I’ve proven to myself that I can focus on my writing and not my lunch.
I’m writing this post to you, and to myself, as a reminder that the body’s hunger, its appetites, its beautiful and unruly nature is a kind of music, always playing, asking me, and us, not just to listen, but also to respond. I wonder what you do with your hungers and your terrors; if you’ve used the flat dullness of restriction to tame your moods, or if you’ve gloried in the music of your own embodiment and refused the siren song of transcendence that promises the ultimate escape from decay and death. I wonder if you know someone on Ozempic or if it’s coming up in your sessions when people talk about their bodies and desires. I wonder what you’re saying in return.
Take good care out there this week, and don’t forget your lunchbox.
xo
Rebecca
Is your body a machine or a fiesta?