Kat Rosenfield:

At the same time, to lose weight in other, easier ways — via liposuction or diet pills or, today, Ozempic — has long been viewed as not just unearned, not just cheating, but perhaps even a sort of devil’s bargain for which a harsh price will soon be paid. The history of scandals in the world of medically-assisted weight loss — the withdrawal of fen-phen from the market in the Nineties after research revealed that it could cause heart valve damage in up to a third of patients, or the rare but ghastly side effects of treatments like Coolsculpting — only serves to validate the moral superiority of the nay-sayers. We told you it couldn’t be that easy.

Of course, maybe this time it is that easy. Sure, there’s the occasional (albeit rare) horror story of Ozempic patients suffering stomach paralysis as a result of the drug — or the less ghastly, more quotidian concern that its appetite-suppressing effects cause the loss of not just fat but precious lean mass. But even if these apprehensions prove unfounded, the capacity of Ozempic to make weight loss not just effective but thoughtless is why it will almost certainly continue to occupy an important place in the medical consciousness, but a fraught place in our moral one.

Many years back, I spent a week in the hospital with what eventually turned out to be gallstones. I didn’t eat a bite for six days. Making the best of things, I thought, Well, maybe I’ll lose a little bit of stubborn fat, at least. Looking at myself in the mirror in the days after returning home, I was slightly disappointed to see that I looked pretty much the same from the waist up, even though I’d lost between 15-20 pounds in that week. Where did it come from? “Wow, your legs look really skinny,” the Lady of the House said. Indeed. When the body thinks there’s a famine, the quadriceps, the biggest muscles in the body, are the first department to suffer budget cuts. Thus did I learn a harsh lesson about how little people understand when they babble about “weight loss,” as if all pounds are created equal and can be sacrificed interchangeably.

If you’re an ordinary person with a moderate interest in being healthy, the number on the scale is a useful enough heuristic, but your ratio of fat mass to lean mass is far more important. How many of you know what your body fat percentage is? (Your digital scale is not very accurate on this measure, sorry to say.) Ideally, you should be less concerned with dropping pounds and more concerned with turning existing fat into muscle, regardless of what the scale says. Like sitting in a hospital bed for six days without eating, Ozempic sounds like a great way to achieve what’s known as “skinny-fat” — a high percentage of fat and low percentage of muscle despite having a “normal” BMI (another one of those heuristics that is useful on the level of the general population and useless for the individual). I have no problem predicting that this fad will end the same way that all attempted shortcuts end: in failure, unintended consequences, or both. You’d be better served by learning how to combine the best ratio of proteins, carbs and fats into ideal portion sizes. No drugs or asceticism required.