Fatness and the Abnormal
Kristin Rodier
Presentation to Philosophy, Disability and Social Change 5, December 13, 2024
I want to thank Shelley Tremain and the conference organizers for inviting me to share my work. Learning about what everyone has been working on has become a highlight of my year. In keeping with Shelley’s advocacy within the discipline of philosophy, inviting my work on fat specifically helps elevate my claim that fat is a philosophically interesting study area.
I locate my work within critical disability studies, not just because of how my fat disabled body is taken up socially, medically, and interpersonally, but because of how I understand fat and disability theoretically, which is not merely analogically or intersectionally, but as part of a larger apparatus of the production of abnormality through pathologization, social exclusions, and violence. For me, it is important to describe fat oppression always while clarifying when and how fatness triggers specific forms of medical management, healthcare injustices, social exclusions, violence and other disparities. My understanding of the abnormal analyses how bodies are not only in terms of “normal” or “abnormal” but “How normal is this body; how amenable is it to normative enhancements or optimization?” (Puar, as cited in McGuire and Fritsch 2019, 92). My paper locates Ozempic within constellations of techniques to manage abnormality, identifying its functions through the apparatus of ableism, making fat people “healthier” and thus more normal.
I am narrowing in on the role of norms of rationality that construct and maintain fat agency as compromised and abnormal, outlining how Ozempic complicates a thorny choice landscape for perspectives as diverse as fat resistance politics, so-called progressive body positivity, and mainstream medical and weight loss positions. We are in a time when everyone who is losing weight is going to be accused of using Ozempic, and responses to this give us insight into theories of the subject, rationality, and agency within ableist racialized fatphobia. The release of Ozempic and its use for the medical management of weight loss offers an opportunity to demonstrate good neoliberal consumption habits and rational forms of bodily management for some, when at the same time it mobilizes ableist racialized fatphobia to deepen constraints on fat agency.
Fatness and the Abnormal: Disciplining Bodies in the Age of Ozempic
Fat Studies scholarship outlines various medical turns in understanding obesity that developed and maintained fat stigma, none more important and recent than when, in 1998, “overweight” and “obesity” cut-offs reclassified millions of Americans from “normal weight” to “overweight,” and from “overweight” to “obese,” changing medical management, surgical and insurance cut-offs and baptizing the “obesity epidemic.” Sander Gilman (2010), in his history of obesity, argues that it is the “most recent version of an obsession with bodily control in society and the promise of universal health through all forms of medicine” (xiv).
This paper works within the scholarly literature framing the obesity epidemic as a biopolitical mechanism, normalizing bodies and selves to function optimally for power, and deploying biopolitical mechanisms that isolate, measure, and attempt to eradicate bodily differences (Snyder and Mitchell 2006). The BMI functions as a technology of biopower, administering life through creating and using a statistical measure of a population. Examples of this are BMI cut-offs for hip replacements, in vitro fertilization, and various life-saving treatments and surgeries are denied on this basis. While weight loss itself is almost universally praised, since the advent of Ozempic and other GLP-1 inhibitors, renewed and concentrated attention is being paid to the method by which one has lost weight.
Ozempic appears against narratives where one earns their seat at the thin table through the right kind of hard work. Given that fat people are shamed for almost anything they eat, and they are mocked and excluded from exercise spaces, even if they work hard, there doesn’t seem to be a right way to lose weight. Ozempic, however, is an interesting contrast given its framing as both a personal and smart choice. Talia Welsh (2022) identifies a pervasive assumption operating, she labels the “good health imperative”: “It is both rational and moral to better one’s health when one can” (viii). Weight loss, insofar as it is understood to be necessarily health-improving is then compelled by the good health imperative. The widespread use of Ozempic by people of almost any size, and their reports of it as significantly improving their lives, demonstrates a form of biopower “from below” (Tremain 2017).
Given this, is there a way for fat people to lose weight that could recuperate normative rationality? And, since proper bodily governance through reason is linked to genetic superiority and ableist white supremacy, what does this tell us about how fat figures into the differential distribution of bodily value more generally? Philosophers such as Kate Manne (2024) argue it is wrong to obligate fat people to lose weight since weight loss doesn’t work. She also offers other ways out of the moral requirement, but these don’t achieve much since it’s quite clear that Ozempic and other GLP-1 inhibitors seem to work. With the existence of a clear path out of the crosshairs of fatphobia, what happens to the claims that we can’t obligate someone to do something that isn’t possible? I can think of no better place to start to get a handle on these issues than with Oprah.
Oprah’s Ozempic Special
In March of 2024, just a few short months after calling weight loss drugs like Ozempic “the easy way out”, media-mogul and former long-time board member of Weight Watchers Oprah Winfrey hosted a “full circle” moment called “An Oprah Special: Shame, Blame and the Weight Loss Revolution” (ABC News, 2024). The panelists included doctors who consult with drug companies that make the GLP-1 inhibitors, the CEO of Weightwatchers (Sima Sistani) and Amy Kane, an influencer who lost over a hundred pounds using these drugs. Winfrey’s weight has been central in media coverage and bullying of her, as well as to her public disclosures, relatability, and wealth portfolio. Her goal for this special was to end the stigma and shaming of being overweight, but also to stop shaming and stigmatizing the method by which someone loses weight.
These two claims are tenuously held together in a medical paradigm. To put it in Winfrey’s words: “It’s a disease and it’s in the brain.” Winfrey, an emblem of upward mobility, said she always blamed herself for her weight, but that she only now—in 2024—understands it is not a characterological flaw: “When I tell you how many times I have blamed myself because you think, ‘I’m smart enough to figure this out,’ and then you hear all along, it’s you fighting your brain.” Getting emotional, Winfrey ended her special by addressing the audience on weight and self-esteem, “for the people who think that this [drug] could be the relief and support and freedom…that you’ve been looking for your whole life, bless you because there is space for all points of view” ([my emphasis]2024).
Branding Ozempic as “freeing” fat people from physical and mental limitations operates almost too explicitly as a form of ableist neoliberal governmentality since, as Tremain argues, “power operates most effectively when subjects are enabled to act” (2017, 185). One of the most powerful claims of Ozempic as a technique of freedom is that it quiets “food noise” making food less desirable or interesting—that is, you don’t think about it. This is what Susan Bordo talks about in Unbearable Weight (1998) as a norm of Enlightenment rationality – mind-body separation, and not only a mastery of desire but a freedom from it altogether—freedom from the flesh, thus offering fat people a clear path to improved rationality.
Tressie McMillan Cottom (2024) describes Winfrey’s special as a “harbinger of how the weight-loss industry is rebranding: Obesity is a disease, and – for the first time – it’s not your fault.” Classifying obesity as a disease officially in 2013 hasn’t reduced stigma, so why would Ozempic be the missing piece that removes fault from the individual? One speculation comes directly from what Winfrey mentioned – that the method shouldn’t be stigmatized; it should instead be seen as an individual’s personal choice—which is also consistent with mainstream body positivity advocates who assert bodily privacy to resist fatphobia. Popular calls to destigmatize Ozempic use might be just because slender people are using it. This highlights how, despite Winfrey’s claims, the stigma is tied to fatness, not the method per se, making destigmatizing unlikely to succeed. Indeed, it may lead to the reverse, an increase of ableist racialized fat stigma since the existence of Ozempic now creates a widespread belief that it is a “silver bullet” leaving fat people “no excuses” not to get thin. This is the reversal of the charge that Ozempic is the “easy way out.” In discussing this with Cindy Baker, she said, “fat people can’t win for losing.” Weight watchers has taken an “if you can’t beat them, join them” approach, purchasing a GLP-1 inhibitor provider and designing subscription programs specific to their use.
Winfrey’s program aims also to dispel the idea that Ozempic for weight loss is an “off label” use. Bringing fat further into a disease management framework is touted as an innovation in obesity treatment, divorcing it from use for diabetes, cardiovascular disease and other issues, thus telling on themselves that the cure finds its disease. Those of us with decades of obesity under our belt are inherently suspicious of innovations in obesity management. Ozempic leaves glaring the unaddressed healthcare inequities, one of which is the significant cost associated with Ozempic, running upwards of 1500 USD a month. I said to Catherine Clune-Taylor recently that I thought fatties were supposed to be cheaper when we don’t get diabetes and her response to me was that “In this capitalist hellscape, if we cared about properly funding the healthcare system, we’d cap insulin prices.” On the flip side of this, in online discussion forums for slender Ozempic users, they lament the cost because they don’t meet the BMI cut-offs for prescription drug coverage—leading to even more strange bedfellows for fat activists who think the BMI is bullshit.
Amy Kane describes how people treat her better now that she is thinner, but they also treat her children better. Previous obesity epidemic rhetoric focused on responsiblizing parents for making fat kids, so-called second-hand obesity, but the special centres second-hand weight stigma, demonstrating that innocent children are harmed by mere proximity to parental fat. Her other point of advocacy was that Ozempic shouldn’t be thought of as “cheating” because it is hard work, demonstrating that fat agency continues to need recuperation even after one loses weight. Even though weight loss has retrieved her status as civilized and under control, her former fatness continues to mark her as more susceptible to overindulgence and overactive childlike desires.
This theme dominates diet and weight loss throughout the 20th and 21st century in terms of getting one’s “primitive” desires under control. This aligns with Anglo-American preoccupations with citizenship as well as Christian morality, where the body pulls us towards sin and the rational mind moderates desires. Lynn Gerber’s (2011) work on Christian weight loss and conversion therapies in Evangelical communities demonstrates how bodily desires for food and sex must be disciplined, including punishment for queer sex and indulgent eating. These come together in fat sex, which both demonstrates a lesser sexual desire and evokes fear of fat reproduction, which is neoeugenically discouraged on account of both nature and nurture, demonstrating how obesity as a disease offers convenient repackaging of ableism and racism.
Fat Subjects
Ozempic also complicates dieting subjectivity because there’s several uses, one of which is a so-called “vanity” use for slender, elite whites who use it to become more thin. These users have demonstrated considerable fragility about their Ozempic use, arguing they are making a private and personal choice. One by one, celebrities are being compelled to confess their use and the assertion of bodily privacy recalls Bordo’s figure of the dieting self who is “doing it (only) for themselves,” where “‘me’ is imagined as a pure and precious inner space, an ‘authentic’ and personal reference point untouched by external values and demands. A place where we live free and won’t be pushed around” (1993).
This defensive individualism contrasts with how invasive bodily questions are part of fat people’s everyday experiences. In another recent discussion with Catherine Clune-Taylor, she pointed out how on a recent podcast there was a white man who pridefully owned up to using Ozempic, claiming a kind of smartness in expediency that “owns” the “easy way out,” demonstrating the different subject positions available depending on whether one bears ableist racialized fat stigma. Almost any choice a fat person makes is going to be seen as the easy way out, even if that choice is bariatric surgery, which carries considerable risk and hard work to recover from and manage long term. In the background, the “right way” for a fat person to lose weight is always out of reach, and because smart rational choosing isn’t available to them (as evidenced by their body), whatever they choose is lesser, creating a feedback loop confirming their bad choices. Earning thinness is for the already normatively rational, through consumer choice and bodily management.
In fat studies and activism, there is a helpful distinction between the “good fatty” and the “bad fatty.” These terms relate to techniques of garnering political recognition and destigmatization based on how fat people demonstrate health. Arising from fat-o-sphere blogger Kate Harding, this marks the distinction of one group who is doing all of the “right things” or “wrong things” to manage health based on the same standards (Chastain 2016). Examples of “good fatties” are fathletes, former fatties, or a powerlifter who by no fault of their own has a obese BMI, or smaller fat people can be included but only if they can demonstrate an excellent diet, good bloodwork and glucose levels, and a healthy lifestyle. The bad fatty has bad habits making them fat, but importantly they don’t want to change—they have the wrong motivational profile. Good fatty performances have been criticized as healthist and divisive in fat politics, but they are also a credentialing move of rationality, offering up one’s techniques of bodily management as aligning with biopolitical forms of self-discipline even if that betrays bodily legibility—until now. Ozempic offers a broadening of good fatty recognition and practice, since they can now make the smart choice to medically manage their chronic disease.
Some of the smart choice v. easy way-out framing is related to public health-style arguments that pre-date Ozempic. Many who previously made careers from stigmatizing obesity (for our own good) are now fighting weight stigma (for our own good), or what I like to call, the system becoming aware of itself. Public-health approaches consider fat subjects to be determined by environmental factors, which contrasts with Ozempic use, which foregrounds individual management. Consider arguments for what Anna Kirkland (2011) has dubbed, the “environmental approach to obesity.” This progressive and sometimes feminist argument locates the primary causal factors for fatness in so-called obesogenic environments. This account highlights the role of food availability, transportation, and civil engineering. The second step in the environmental account is to emphasize the role of demographics in “obesogenic” environments, perhaps even taking a feminist approach, advocating for poor, minority women, and children.
Together these steps lead to policy measures aimed at optimizing the economic, physical, and food environments of disadvantaged peoples so they are less at risk of being fat and perhaps so that they become smaller (466). Kirkland notes, that this approach aims to shift the background environments in which people make their choices by trying to make poorer environments more like elite environments. Despite occupying a lot of the same spaces, thin elites are figured as capable of choosing outside of the obesogenic factors in their environment, whereas fat people are determined by them, overwhelming their wills. Kirkland writes, “The environmental account of obesity depends on an account of political subjects as duped by capitalist forces (Big Food), on the one hand, and entirely self-determining (thin because of healthy eating), on the other hand, and neither is satisfactory” (467). This double standard shows up in media coverage on obesity, which is more “likely to highlight bad food choices and sedentary lifestyle as causes for obesity when discussing minorities and poor people than when those groups were not discussed. The turn to the environment and away from personal choice is supposed to be a way to avoid that kind of racialized stigma” (Saguey and Almeling (2008) as cited in Kirkland 474).
Note that now Ozempic proponents seem to be thin people advocating for the right to make their personal choices to enhance their bodies, whereas fat people are taking the easy way out. The environmental account should point us to collective responses to social problems, but instead tries to engineer individual choice. Once again, obesity management is again aligned with individual “proper” consumption habits, one choice of which is Ozempic.
Conclusion
Many of these double standards and misrecognitions of agency can be linked back to how Talia Welsh’s analysis understands the good health imperative as a contemporary way of making us into certain kinds of selves, shaping essentially existential problems such as “birth, development, suffering, and death” (34) into problems of individual body management (151). This makes sense too considering one of the BMI’s primary functions is to predict life expectancy and life insurance is extremely difficult to obtain and exorbitantly expensive over a BMI of 30. BMI also regulates what is considered a high-risk pregnancy, triggering considerable medical interventions that one must undergo to remain a compliant patient. Higher weight is also, as I’ve argued elsewhere, a way of excusing forms of violence, including killing (Rodier 2022). Ozempic offers another way of thinking about the widespread acceptance and mundanity of these forms of violence, especially considering that compliance with its use is now being used to gate-keep other procedures, revealing again that for slender, able-bodied people, Ozempic is a freeing and rational choice, but for many fat, racialized, and disabled people, it is at the same time a paternalistic, expensive, and invasive intervention that is then violently framed as for their own freedom.
References
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BIOPOLITICAL PHILOSOPHY 