The "obligation" of "health"

The Question

Hi Casey!

Sorry, I feel like you must be getting questions about Ozempic constantly. But I need some advice. I’m in recovery (a year ago I would have said “recovered”) from anorexia. My girlfriend was prescribed Ozempic last summer for weight loss. She has a BMI over 30. She took it for three months and, yes, lost weight — at least in part because she was throwing up nearly every day. She stopped taking it because the side effects (nausea/vomiting, severe dehydration because she had lost her appetite for water, fevers) were too much to handle.

Now she wants to go back on it. Her family treats her horribly because of her weight, and she thinks that another couple months on Ozempic would make her lose enough weight that they would treat her better. She doesn’t have any “obesity-related comorbidities,” and she’s a fairly serious athlete (muay thai! very cool!), but she’s also anxious about the risk of diabetes, high blood pressure, etc. (It doesn’t help that her parents took her to a weight-loss clinic where the doctor said she would die of diabetes in her thirties if she didn’t lose weight, despite her totally normal blood sugar/A1C.)

I feel so angry every time I see Ozempic in the news (so, all the time). It’s, for lack of a better word, triggering to see people describing themselves as experiencing a “normal” appetite for the first time, and then elaborating that they can barely force themselves to eat a single meal a day. It’s even worse to see a package of Ozempic pens every time I open my fridge, knowing exactly how awful my girlfriend’s experience has been. Maybe worst of all is the crash course in medical and familial fatphobia I’ve gotten over the past year.

I have two basic questions. First, how can I support my girlfriend as she does something that I know makes her miserable and I worry is causing her long-term harm, for reasons that I find completely sympathetic but also horrible? And second, how can I support her without destroying my own honestly pretty fragile relationship with food and my body?

Sorry this is so much text! Thanks for any advice! --L

The Answer

A few years ago, in the first Swole Woman era (of The Hairpin, may she rest) I received the question “How do I set goals and still like who I am now?” At the time, I wrote that the key was not defining “who you are” by “what it is that you do.” I still think that’s right. But I think about it often, the tension that exists between “accepting who you are” and “wanting yourself to be different in some way,” and between “the intoxicating power of believing yourself (or others believing in you) to be possible of transformation,” and how that belief can become pressure to always be transforming, for reasons we don't stop to examine.

It’s possible to track the rise of fitness content on social media almost one-to-one with the moment that Instagram added the ability to post videos, which happened in June 2013 (I know because I was there). One decade later, my Instagram is long overdue for a cleanup. What used to be a feed that amounted to a mood board of strong people that got me all wound up for my next gym session has become so much yelling of Health Tips, correction-dunking, screeching values-asserting. Whether that’s my bad follow choices or everyone responding to the whims of the algorithm is difficult to say, but it feels at least a bit like a little of column A, a little of column B.

But the vacuum of this stuff is not a recent problem. In all of 1980, political economist Robert Crawford wrote this:

The past few years have witnessed an exercise and running explosion, the emergence of a vocal and often aggressive anti-smoking ethic, the proliferation of popular health magazines, and the appearance with amazing frequency of health themes in newspapers, magazines, and advertisements for even the most remotely related products. Vitamins and other health aids are being consumed more and other items consumed less—all for health reasons. On numerous social occasions, and in spite of much professed rejection of concern or derisive amusement, personal health has become a favorite topic of conversation…

I have chosen the word healthism as a way to crystallize some important contradictions in the new health consciousness and movements… Briefly, healthism is defined here as the preoccupation with personal health as a primary—often the primary—focus of the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles, with or without therapeutic help. The etiology of disease may be seen as complex, but healthism treats individual behavior, attitudes, and emotions as the relevant symptoms needing attention.

Healthism is the idea that we are all not only uniquely responsible for our health, but that any failure of health is also a moral failing. Healthism is the undercurrent of “ick”, the “why can’t they just,” that shines through in commentary about public mental breakdowns, eating disorders, fatness. Even if we can grasp the intellectual problem with feeling this way towards others, we can struggle with not holding ourselves to a moral standard of health. We can feel duty-bound to subjecting ourselves to a constant onslaught of trends and tips to memorize and synthesize and enact: Girl, Wash Your Face, don’t eat “inflammatory” foods, don’t work out too hard before your period, try this new injection. Because we face social rejection over not maintaining a white-knuckled grip on our health (and, theoretically, lose our health, too), we feel compelled to pull every health lever that presents itself.

But how do we draw lines around this stuff, especially when we are doing some of the things we "should," but it feels like everyone agrees we are not doing enough?