Thinness Has Never Been More Accessible—or More Costly

By: Jessica Jaeger, MS, RD, CEDS

The pursuit of thinness has taken on different flavors over the years – there was ‘90s supermodel skinny, 2000’s Tumblr skinny, and now there’s Ozempic skinny. Today’s flavor of thinness is more aggressive, more extreme, and perhaps most dangerously, more accessible. As a dietitian, I’ve had endless conversations with my clients about the drug. I sit with them as tears stream down their faces because their doctor recommended the injections just as they’ve finally started to make peace with their body. I sit with them, and we stare at one another, after I strongly encourage them to dispose of the shots they purchased from a friend, now hidden in the back of their refrigerator.  We sit together to strategize how they can consume enough calories and protein to at least mitigate the risk of their hair falling out and their bones weakening long before they may otherwise.

I’m a dietitian but you’d probably think I was a therapist if you knew how often clients cried in our sessions together. I hear people’s desperation to be free of judgment from parents, partners, strangers, and especially, from themselves. My clients share how they can’t look in the mirror, or how they can’t stop looking in the mirror. Some weigh themselves five times a day while others haven’t seen their weight in five years. Their mood depends on the number on the scale in the morning and how they think they look in a recently tagged Instagram photo. I could never blame them. Society critiques and shames larger bodies and this is often excused or justified under the guise of health.

I’ve had clients, and people in my personal life, roll their eyes and say, “It’s not natural,” or “Why don’t they just eat healthy?” But in my opinion, to criticize GLP-1s as “the easy way out” is missing the point. Most people I know who have chosen to take these drugs have struggled with their relationship to food and body image for years (and for some, this includes an eating disorder). In my experience, people who have chosen to begin these drugs have done so only after much deliberation – they grapple with “Do I finally give myself the relief of hating my body?” and “Is the cost of living in my current body higher than the cost of taking a GLP-1?”

I struggle in my stance on GLP-1s: I’ve seen people be hospitalized, develop gastroparesis, gallstones, and eating disorders, but I’ve also seen lowered blood glucose, cholesterol, and blood pressure- objective numbers that are difficult to dismiss. Patients and physicians alike are quick to recommend GLP-1s “for your health.” I consider the potential medical benefit, but then I think of the time a physician told me there's no such thing as losing weight too quickly on a GLP-1 and I am reminded how the line between the drive for health and the drive for thinness is blurred.

Whether you are outraged or amazed by the miracles or horrors of GLP-1s, their usage reinforces what we’ve all known all along: thinness is social currency and the price we’re collectively willing to pay keeps getting higher.

Disclaimer: This essay reflects my personal opinions and experiences as a Registered Dietitian and is intended for informational purposes only. It should not be interpreted as individualized medical or nutrition advice. To protect client confidentiality, all identifying details have been changed or omitted, and some clinical scenarios are composites inspired by multiple patient experiences rather than any one individual.