1 00:00:43,455 --> 00:00:48,056 Rebecca Morrison: If my doctor said you need to be on this, I 2 00:00:48,163 --> 00:00:54,369 would get on it. My doctor has not said that. I do need to 3 00:00:54,476 --> 00:01:00,789 probably lose some weight. I keep saying that, but my blood 4 00:01:00,896 --> 00:01:07,531 work is good. I'm more or less healthy. My stats are positive. 5 00:01:07,638 --> 00:01:14,379 I've gone to a cardiologist to make sure I don't have a risk of 6 00:01:14,486 --> 00:01:21,228 heart disease. I don't. So many women are in this middle place. 7 00:01:21,335 --> 00:01:28,183 We are not obese in the way that is dangerous for our health. We 8 00:01:28,290 --> 00:01:34,710 are just visually bigger than the ideal that is portrayed in 9 00:01:34,817 --> 00:01:38,670 the media. How do we deal with that? 10 00:01:38,780 --> 00:01:41,660 Lauren Arora Hutchinson: That's Rebecca Morrison. Like so many 11 00:01:41,660 --> 00:01:45,530 people today, she is struggling with a decision about a new 12 00:01:45,530 --> 00:01:50,330 class of weight loss medications called GLP-1s. 13 00:01:50,330 --> 00:01:53,570 Rebecca Morrison: I mean, I'm just a person that is trying to 14 00:01:53,570 --> 00:01:58,610 determine something for my own health. What is the responsible 15 00:01:58,610 --> 00:02:04,235 thing to do as a human being, as a woman, as a mother, as a wife, 16 00:02:04,235 --> 00:02:10,625 as a daughter, as a person. Should I do it? Do I need to do 17 00:02:10,625 --> 00:02:16,355 it? Do I have to do it? 18 00:02:16,355 --> 00:02:18,425 Lauren Arora Hutchinson: Rebecca's question isn't just 19 00:02:18,425 --> 00:02:22,445 about medication, it's about something many people are 20 00:02:22,445 --> 00:02:28,580 quietly wondering right now. When a medical intervention is 21 00:02:28,580 --> 00:02:32,690 promoted as both a public health revolution and a way to achieve 22 00:02:32,690 --> 00:02:37,400 a cultural ideal, how does that shape the choices we make about 23 00:02:37,400 --> 00:02:45,470 our bodies? I'm Lauren Arora Hutchinson. I'm the director of 24 00:02:45,470 --> 00:02:48,725 the iDeas Lab at the Johns Hopkins Berman Institute of 25 00:02:48,725 --> 00:02:52,835 Bioethics. I've spent years working on stories where 26 00:02:52,835 --> 00:02:57,815 medicine and science show up in people's everyday lives, and in 27 00:02:57,815 --> 00:03:05,075 this episode we're looking at GLP-1s. This is playing god? 28 00:03:05,075 --> 00:03:14,840 Rebecca Morrison: Being in my 50s now, and having children of 29 00:03:14,840 --> 00:03:19,820 my own, I understand my mother's story much better than I did 30 00:03:19,820 --> 00:03:27,620 when I was 13-14. She thought, at the time, that being thin 31 00:03:27,620 --> 00:03:34,115 equaled being beautiful equaled having power, having worth as a 32 00:03:34,115 --> 00:03:41,795 woman. This came from her own experiences in Iran, where 33 00:03:41,795 --> 00:03:46,865 before the revolution, Iran was very Western. We were seeing the 34 00:03:46,865 --> 00:03:50,465 fashion of the world and European fashion, American 35 00:03:50,465 --> 00:03:55,385 fashion, and maybe culturally that beauty of a woman was very 36 00:03:55,385 --> 00:04:01,160 important. It determined a lot about how her life was going to 37 00:04:01,160 --> 00:04:04,730 end up, what kind of husband she would get, what kind of 38 00:04:04,730 --> 00:04:14,420 attention and respect she would get. So she comes to America. 39 00:04:14,420 --> 00:04:18,290 She thought I was very beautiful when I was young. I was tall for 40 00:04:18,290 --> 00:04:25,865 my age. I could be a model, or I was this statuesque woman, and I 41 00:04:25,865 --> 00:04:32,615 hit puberty, and I was eating, and she was shocked by the 42 00:04:32,615 --> 00:04:40,775 change in my body. In her mind, that dream of hers for me was 43 00:04:40,775 --> 00:04:47,060 shattered, and the more she fought to get me back to that 44 00:04:47,060 --> 00:04:55,010 thin ideal, the more I fought against it. Maybe it's just who 45 00:04:55,010 --> 00:05:01,490 I am, maybe it's genetics of my body. After 13-14, I never got 46 00:05:01,490 --> 00:05:10,205 back to my pre-puberty body. I was never thin again. So, 47 00:05:10,205 --> 00:05:17,735 binging for me was always this feeling of freedom, along with 48 00:05:17,735 --> 00:05:26,855 the sensation of all these foods that I wasn't allowed to eat. I 49 00:05:26,855 --> 00:05:33,620 was bulimic for decades into my 40s, so that's, you know, that's 50 00:05:33,620 --> 00:05:38,810 a long time of keeping a secret, of closing the bathroom door and 51 00:05:38,810 --> 00:05:46,820 putting on the shower, so nobody can hear you. I felt like I was 52 00:05:47,420 --> 00:05:54,815 so broken or wrong, and I would not be loved. I would not be 53 00:05:54,815 --> 00:06:00,485 accepted if I didn't try to lose weight, and those were the times 54 00:06:00,485 --> 00:06:06,575 where I really fell into the eating disorder. 55 00:06:06,575 --> 00:06:09,725 Lauren Arora Hutchinson: For Rebecca, food and body size were 56 00:06:09,725 --> 00:06:14,255 never just about health; they were tied up with identity, 57 00:06:14,300 --> 00:06:20,360 emotions, expectations, family, and what it meant to be valued. 58 00:06:20,360 --> 00:06:23,660 Rebecca Morrison: When I got married, that helped, because it 59 00:06:23,660 --> 00:06:29,420 was a man who I loved and respected enormously. It 60 00:06:29,420 --> 00:06:34,640 confirmed all my beliefs, all my fight, my whole life, that I am 61 00:06:34,640 --> 00:06:41,405 worthy of everything that anyone else is at a different size. I'm 62 00:06:41,405 --> 00:06:47,225 really proud that in my 40s I was able to look at myself in 63 00:06:47,225 --> 00:06:57,815 the mirror and say, never again. I'm not going to hurt my body 64 00:06:57,815 --> 00:07:10,460 for that reason. I settled into an average American-sized body. 65 00:07:10,460 --> 00:07:14,450 I think I had read a couple times throughout the years that 66 00:07:14,450 --> 00:07:18,770 the average American body was maybe size 14 or 12 or 67 00:07:18,770 --> 00:07:20,960 something. 68 00:07:20,960 --> 00:07:22,940 Lauren Arora Hutchinson: But as Rebecca worked to rebuild her 69 00:07:22,940 --> 00:07:27,425 relationship with food, unbeknownst to her, to most of 70 00:07:27,425 --> 00:07:31,745 us, there was a medical revolution occurring. 71 00:07:31,775 --> 00:07:35,795 Mara Gordon: My name is Dr. Mara Gordon. I am a very busy primary 72 00:07:35,795 --> 00:07:38,975 care doctor. The vast majority of my patients are publicly 73 00:07:38,975 --> 00:07:42,365 insured, meaning Medicaid or Medicare, and I have prescribed 74 00:07:42,365 --> 00:07:46,655 GLP-1 agonists since I graduated medical school in 2015. They're 75 00:07:46,655 --> 00:07:51,740 not new medications, I've used them for years. We had a couple, 76 00:07:51,740 --> 00:07:54,920 I believe, versions of GLP-1 agonists that were used 77 00:07:54,920 --> 00:07:59,090 exclusively in patients who had a diagnosis of diabetes, and 78 00:07:59,090 --> 00:08:02,930 they were really helpful medicines. I mean, I pretty 79 00:08:02,930 --> 00:08:05,510 proactively recommend them for people who have a diagnosis of 80 00:08:05,510 --> 00:08:09,020 diabetes, heart disease, metabolic dysfunction associated 81 00:08:09,020 --> 00:08:12,905 steatotic liver disease, sleep apnea, they can all be useful 82 00:08:12,905 --> 00:08:16,985 for. So, I'm so grateful for their existence. They really, 83 00:08:16,985 --> 00:08:19,055 really helped my patients. 84 00:08:19,055 --> 00:08:21,635 Lauren Arora Hutchinson: But also, Dr. Mara Gordon says... 85 00:08:21,635 --> 00:08:23,945 Mara Gordon: Patients often lost a little bit of weight on them, 86 00:08:23,945 --> 00:08:26,555 so I sort of thought of it as like a side effect of these 87 00:08:26,555 --> 00:08:30,425 medications, but over time researchers have started 88 00:08:30,425 --> 00:08:34,325 experimenting with using much higher doses, and they found 89 00:08:34,370 --> 00:08:37,850 that when you used much higher doses, often four times the dose 90 00:08:37,850 --> 00:08:41,540 that I was using in my patients to treat their diabetes a decade 91 00:08:41,540 --> 00:08:44,840 ago, people tended to lose weight, and often quite a lot of 92 00:08:44,840 --> 00:08:49,250 weight, 10 to 15, upwards of sometimes 20% of their body 93 00:08:49,250 --> 00:08:53,420 weight, and that was sort of the moment I pinpoint, like, ooh, 94 00:08:53,420 --> 00:08:56,270 everything's going to change. This is going to be a big deal. 95 00:08:56,315 --> 00:09:00,275 Somebody is going to get really rich off of this. 96 00:09:00,275 --> 00:09:01,895 Lauren Arora Hutchinson: Scientists are still learning 97 00:09:01,895 --> 00:09:05,555 about the full range of effects of these drugs designed to treat 98 00:09:05,555 --> 00:09:10,475 diabetes, but it appears that GLP-1s work on a number of our 99 00:09:10,475 --> 00:09:15,485 systems simultaneously. I asked Mara Gordon what a drug like 100 00:09:15,485 --> 00:09:16,865 this does... 101 00:09:16,865 --> 00:09:21,170 Mara Gordon: Basically, it regulates glucose. It causes 102 00:09:21,170 --> 00:09:25,430 weight loss through several mechanisms. The primary one is 103 00:09:25,430 --> 00:09:30,380 that it slows gastric emptying, so what that means is the 104 00:09:30,380 --> 00:09:33,830 stomach is basically fuller longer. It sort of empties at a 105 00:09:33,830 --> 00:09:36,230 slower pace. People, when they're taking these 106 00:09:36,230 --> 00:09:40,610 medications, have a sensation of satiety that lasts longer. It 107 00:09:40,610 --> 00:09:44,765 also enhances insulin secretion from the body, which can help 108 00:09:44,765 --> 00:09:48,335 with glucose levels in the bloodstream. They also promote 109 00:09:48,335 --> 00:09:51,575 satiety through the central nervous system, so they act 110 00:09:51,575 --> 00:09:55,625 centrally on the brain to sort of suppress appetite in ways 111 00:09:55,625 --> 00:09:59,585 that are not fully understood. 112 00:09:59,585 --> 00:10:01,625 Lauren Arora Hutchinson: But despite ongoing questions about 113 00:10:01,625 --> 00:10:05,015 short and long term effects, since this weight loss side 114 00:10:05,015 --> 00:10:09,140 effect became widely recognized, interest and demand for these 115 00:10:09,140 --> 00:10:12,140 GLP-1 drugs has been enormous. 116 00:10:12,140 --> 00:10:14,990 Mara Gordon: I would say people started asking about them, maybe 117 00:10:14,990 --> 00:10:20,330 in like end of 2021 beginning of 2022. It sort of started to 118 00:10:20,330 --> 00:10:24,470 enter the public consciousness, and I would have people sort of 119 00:10:24,470 --> 00:10:27,260 specifically coming in saying, "Hey, I heard about this weight 120 00:10:27,260 --> 00:10:32,435 loss medication, do you think I should try it?" It has just 121 00:10:32,435 --> 00:10:35,945 sort of reached a fever pitch. In my primary care clinic, I 122 00:10:35,945 --> 00:10:41,915 would say have conversations about GLP-1 agonists maybe five 123 00:10:41,915 --> 00:10:47,075 to seven times a day. Often patients who have no 124 00:10:47,075 --> 00:10:51,170 comorbidities, no diagnoses, often will say, "Hey, you know, 125 00:10:51,170 --> 00:10:56,390 I feel really fat, should I try Ozempic?" People are pretty 126 00:10:56,390 --> 00:10:57,410 desperate to lose weight. 127 00:10:57,410 --> 00:11:01,610 Lauren Arora Hutchinson: For decades, losing weight has been 128 00:11:01,610 --> 00:11:06,650 framed as a matter of willpower. Now, for the first time, that 129 00:11:06,650 --> 00:11:11,480 may not be true, and that shift has implications not just for 130 00:11:11,480 --> 00:11:15,305 health, but for how we understand responsibility, 131 00:11:15,305 --> 00:11:20,615 pressure, and choice. What happens when control comes from 132 00:11:20,615 --> 00:11:25,745 a medication instead of from within? 133 00:11:25,745 --> 00:11:28,205 Alex Brewis: I'm Alex Brewis. I'm a social scientist at 134 00:11:28,205 --> 00:11:30,635 Arizona State University. 135 00:11:30,635 --> 00:11:32,855 Lauren Arora Hutchinson: Professor Alex Brewis describes 136 00:11:32,855 --> 00:11:36,365 herself as a bio-cultural anthropologist. Her work 137 00:11:36,365 --> 00:11:40,430 combines social science and human biology, and she studies 138 00:11:40,430 --> 00:11:43,010 body image across different cultures. 139 00:11:43,000 --> 00:11:46,375 Alex Brewis: I have been working for a number of years, since 140 00:11:46,445 --> 00:11:50,594 about 2007 on cross-cultural views of body image, and we've 141 00:11:50,664 --> 00:11:54,954 now worked in many different countries, and we've established 142 00:11:55,024 --> 00:11:59,525 that negative attitudes towards fat have been expanding and have 143 00:11:59,595 --> 00:12:03,322 become really a globalized phenomenon. We have these 144 00:12:03,392 --> 00:12:07,752 clinical definitions that were set up actually in the 1930s or 145 00:12:07,822 --> 00:12:12,112 so for what constitutes obesity? There's just a single number 146 00:12:12,182 --> 00:12:15,909 that's height by weight that gets used a lot. You are 147 00:12:15,979 --> 00:12:20,409 so-called normal weight at 24.5 body mass index, and then at 25 148 00:12:20,480 --> 00:12:24,277 you become technically overweight, or at 30 you become 149 00:12:24,347 --> 00:12:28,848 technically obese. People hate those labels because they are so 150 00:12:28,918 --> 00:12:32,715 laden with all sorts of feelings of judgment, and they 151 00:12:32,786 --> 00:12:36,512 re-categorize you within society. You feel now like a 152 00:12:36,583 --> 00:12:40,661 kind of a different person because you've had these labels 153 00:12:40,732 --> 00:12:44,599 applied. These are arbitrary labels, in the sense that 154 00:12:44,669 --> 00:12:48,889 there's plenty of people that have as technically overweight 155 00:12:48,959 --> 00:12:53,319 or obese body mass index that have great metabolic health, and 156 00:12:53,389 --> 00:12:57,608 there's plenty of people that have so-called normal or ideal 157 00:12:57,679 --> 00:13:01,195 body mass that have all sorts of metabolic issues. 158 00:13:01,195 --> 00:13:03,685 Lauren Arora Hutchinson: Taken together, the messages people 159 00:13:03,685 --> 00:13:08,635 receive from medicine, from media, from culture all point in 160 00:13:08,635 --> 00:13:15,460 the same direction: lose weight. And now, there's a drug that 161 00:13:15,460 --> 00:13:17,920 makes it feel possible. 162 00:13:17,920 --> 00:13:21,220 Alex Brewis: People are being much more proactive than we 163 00:13:21,220 --> 00:13:23,860 normally see around weight. You're having people drive the 164 00:13:23,860 --> 00:13:27,610 conversations with doctors, so from a perspective of action 165 00:13:27,610 --> 00:13:29,800 orientation, people are definitely more, you know, 166 00:13:29,800 --> 00:13:33,430 they're using more agency around these drugs. So they're... they 167 00:13:33,430 --> 00:13:37,420 feel in some ways more in control of the ability to access 168 00:13:37,420 --> 00:13:39,835 tools to lose weight. 169 00:13:39,930 --> 00:13:42,180 Jeffrey Kahn: I think that's really important, actually, as a 170 00:13:42,180 --> 00:13:46,530 point in that these drugs are a tool that are empowering people 171 00:13:46,530 --> 00:13:49,680 to take charge of their health in a way that they may have 172 00:13:49,680 --> 00:13:53,490 wanted to, but it was very difficult before, but there are 173 00:13:53,490 --> 00:13:56,460 many examples of social pressures where people feel like 174 00:13:56,460 --> 00:14:01,050 they really need to do something to conform. That feels like 175 00:14:01,050 --> 00:14:03,480 what's happening with GLP-1s. 176 00:14:04,180 --> 00:14:06,250 Lauren Arora Hutchinson: Professor Jeffrey Kahn, our 177 00:14:06,250 --> 00:14:09,730 resident bioethicist and director of the Johns Hopkins 178 00:14:09,730 --> 00:14:12,730 Berman Institute of Bioethics. 179 00:14:12,730 --> 00:14:15,310 Jeffrey Kahn: At the same time, it's not just about, you know, 180 00:14:15,310 --> 00:14:19,180 people need to look a particular way. Public health experts have 181 00:14:19,180 --> 00:14:21,730 been messaging for a long time, and physicians have been 182 00:14:21,730 --> 00:14:25,345 messaging for a long time, that the proportion of Americans, in 183 00:14:25,345 --> 00:14:29,065 particular, but it's not true only in America, that are obese 184 00:14:29,065 --> 00:14:33,625 had been growing and was unhealthy. Unhealthy for the 185 00:14:33,625 --> 00:14:38,065 individuals, and it's unhealthy as a matter of public health, 186 00:14:38,065 --> 00:14:43,525 and so, the messaging has been people need to lose weight. So, 187 00:14:43,525 --> 00:14:46,015 it's a combination. This is what I think makes it a kind of 188 00:14:46,015 --> 00:14:50,770 unique moment. A combination of there's this health problem that 189 00:14:50,770 --> 00:14:55,660 we've had a very difficult time addressing over decades, and 190 00:14:55,660 --> 00:14:59,560 there's this ideal body image that are pulling in the same 191 00:14:59,560 --> 00:15:02,530 direction. 192 00:15:02,570 --> 00:15:06,620 Rebecca Morrison: So I am a curvy woman. I always have been. 193 00:15:06,620 --> 00:15:13,490 I've been size 12 to 14 most of my life, mostly 14. So I'm 194 00:15:13,490 --> 00:15:21,740 not... I'm medically obese for sure, but maybe on the street a 195 00:15:21,740 --> 00:15:24,920 person looking at me wouldn't say that I'm obese, but I'm 196 00:15:24,920 --> 00:15:29,075 overweight for sure, nobody would not say that. My face is 197 00:15:29,075 --> 00:15:32,525 not bad, you know, I've got a good face, I've got good hair, 198 00:15:32,525 --> 00:15:39,245 but I have a, you know, bigger body. But the pressure is 199 00:15:39,245 --> 00:15:45,605 enormous. I feel like, am I, am I irresponsible if I'm not 200 00:15:45,605 --> 00:15:49,895 taking this drug as an overweight person? Am I hurting 201 00:15:49,895 --> 00:15:54,500 my body by not taking a drug for the rest of my life that would 202 00:15:54,500 --> 00:15:55,430 make me thinner? 203 00:15:55,480 --> 00:16:00,745 Lauren Arora Hutchinson: How do you balance loving yourself and 204 00:16:00,745 --> 00:16:04,855 doing your best to be healthy all while not giving in to 205 00:16:04,855 --> 00:16:09,445 societal pressure? This is the question Rebecca finds herself 206 00:16:09,445 --> 00:16:14,395 grappling with. It's a question made all the more difficult by 207 00:16:14,395 --> 00:16:18,775 the marketing of these GLP-1 medications. 208 00:16:18,865 --> 00:16:26,410 Rebecca Morrison: You see it on social media all the time. I am 209 00:16:26,410 --> 00:16:29,320 bombarded with those commercials, Ozempic 210 00:16:29,350 --> 00:16:37,360 commercials. Maybe it's just me. Articles, magazines, doctors, 211 00:16:37,360 --> 00:16:40,390 it's everywhere. 212 00:16:40,390 --> 00:16:43,045 Alex Brewis: They are really playing on people's deepest 213 00:16:43,045 --> 00:16:46,165 anxieties and telling them, you know, if you feel these 214 00:16:46,165 --> 00:16:50,515 anxieties, then you need these drugs. So, what we're seeing 215 00:16:50,515 --> 00:16:54,835 very quickly is a shift into cosmetic use for people that 216 00:16:54,835 --> 00:17:00,385 don't have a medical sort of pathway in, and it's pushing a 217 00:17:00,385 --> 00:17:04,735 product that is making enormous profits for these telehealth 218 00:17:04,735 --> 00:17:05,455 companies. 219 00:17:06,385 --> 00:17:08,005 Lauren Arora Hutchinson: Pharmaceutical marketing is 220 00:17:08,050 --> 00:17:11,890 always fraught. It involves the uncomfortable coupling of 221 00:17:11,890 --> 00:17:14,980 science, which is slow, deliberate, and searching for 222 00:17:14,980 --> 00:17:19,510 the truth with salesmanship, an endeavor not known for any of 223 00:17:19,510 --> 00:17:23,950 the above. And in the case of these drugs, Jeffrey Kahn says 224 00:17:23,950 --> 00:17:27,220 the salesmanship seems especially out front. 225 00:17:28,230 --> 00:17:31,980 Jeffrey Kahn: The process of information and its delivery 226 00:17:31,980 --> 00:17:35,610 runs a continuum between, you know, here's just information 227 00:17:35,610 --> 00:17:38,550 you decide at one end of a spectrum to something that's 228 00:17:38,550 --> 00:17:43,920 more like persuasion all the way through to coercion. So, if you 229 00:17:43,920 --> 00:17:48,510 don't do this, I will harm you. And then, when you're going from 230 00:17:48,510 --> 00:17:51,075 persuasion on the way to coercion, there's an in between, 231 00:17:51,075 --> 00:17:55,035 which is manipulation. The individual's weaknesses are 232 00:17:55,035 --> 00:17:58,725 being taken advantage of by the person who has power or 233 00:17:58,725 --> 00:18:03,585 influence or information, and is using that weakness in a way 234 00:18:03,585 --> 00:18:07,845 that gets them to make a decision that the individual 235 00:18:07,845 --> 00:18:11,415 who's got the power wants them to make, so that's that's less 236 00:18:11,415 --> 00:18:15,090 of a free decision than just being given information and 237 00:18:15,090 --> 00:18:20,550 having the individual decide for him or herself. It sort of 238 00:18:20,550 --> 00:18:23,610 feels like what's happening in the context of GLP-1s is the 239 00:18:23,610 --> 00:18:27,330 inundation of advertisements, often by very well-known 240 00:18:27,330 --> 00:18:31,020 celebrities who are very fit people who are saying, I use 241 00:18:31,020 --> 00:18:34,770 this, so should you. It's a kind of manipulation, right? You want 242 00:18:34,770 --> 00:18:38,505 to look and be like me, doesn't everybody want to look and be 243 00:18:38,505 --> 00:18:43,755 like that person? And if you do, then it's easy for you to do so. 244 00:18:43,755 --> 00:18:48,435 Just call this number or go to this website, and we're standing 245 00:18:48,435 --> 00:18:54,135 by to provide you this drug. When what's being marketed is 246 00:18:54,135 --> 00:18:59,430 ideal body image, it's, it's harder for us to resist, and in 247 00:18:59,430 --> 00:19:04,230 the context of something that has been deemed a public health 248 00:19:04,230 --> 00:19:09,270 epidemic, and so GLP-1 feels like it's it's in that 249 00:19:09,270 --> 00:19:13,920 combination of advertising, so that you will want to look like 250 00:19:13,920 --> 00:19:18,300 the celebrity spokesperson, but also so that you will be 251 00:19:18,300 --> 00:19:22,080 healthier and fitter, and that's better for you and the public's 252 00:19:22,080 --> 00:19:27,945 health. So these are together very, very strong messages that 253 00:19:28,065 --> 00:19:30,135 make I think it hard to say no. 254 00:19:33,250 --> 00:19:35,890 Lauren Arora Hutchinson: When you put all this together, what 255 00:19:35,890 --> 00:19:41,800 will it mean? Not just for how we'll see ourselves, but how 256 00:19:41,800 --> 00:19:45,730 we'll see our neighbors, our family, our friends. 257 00:19:45,730 --> 00:19:50,635 Alex Brewis: I think the universal thought from all those 258 00:19:50,635 --> 00:19:53,305 teams that have talked to so many people in so many different 259 00:19:53,305 --> 00:19:56,095 places is that it's just going to make the stigma around weight 260 00:19:56,095 --> 00:20:04,225 worse, because now it's also a signal of failure to be able to 261 00:20:04,225 --> 00:20:08,515 afford or be able to access the solution. 262 00:20:08,515 --> 00:20:10,810 Jeffrey Kahn: When we say body image, it's not just how you 263 00:20:10,810 --> 00:20:16,120 feel and look, but how others perceive how you look. There's 264 00:20:16,120 --> 00:20:21,220 now a thought, how did that person lose weight, or if they 265 00:20:21,220 --> 00:20:27,490 aren't of ideal body size, why are they not taking advantage of 266 00:20:27,490 --> 00:20:31,270 this miracle drug? It's going in the direction that they're 267 00:20:31,270 --> 00:20:37,105 becoming more available, easier to administer, lower in price. 268 00:20:37,405 --> 00:20:40,555 So, in every respect, I think those kinds of issues are only 269 00:20:40,555 --> 00:20:45,595 going to get more pronounced. The stigma around people who are 270 00:20:45,595 --> 00:20:50,005 overweight in a, in an era when, like, why would anybody be 271 00:20:50,005 --> 00:20:57,340 overweight? Will people feel like they can resist, and sort 272 00:20:57,340 --> 00:21:00,280 of, how do we even think about, you know, what it means to 273 00:21:00,280 --> 00:21:03,100 resist? Like, I don't want to take drugs like that for the 274 00:21:03,100 --> 00:21:07,030 rest of my life. I shouldn't feel like I have to, and I don't 275 00:21:07,030 --> 00:21:10,660 feel like I should be shamed and stigmatized for what is a 276 00:21:10,660 --> 00:21:15,040 decision that I think is for my best interests, right? So, we 277 00:21:15,040 --> 00:21:18,070 don't want that to be the environment in which people are 278 00:21:18,070 --> 00:21:21,205 making healthcare decisions. That seems wrong. It seems to be 279 00:21:21,205 --> 00:21:26,485 against individual autonomous decision making, and so how do 280 00:21:26,485 --> 00:21:31,855 we create a space for people to say that's just not for me, and 281 00:21:31,855 --> 00:21:36,685 not have them feel like they're, you know, shamed and shunned as 282 00:21:36,685 --> 00:21:41,815 a result. 283 00:21:41,815 --> 00:21:43,660 Lauren Arora Hutchinson: There's still a lot we're learning about 284 00:21:43,660 --> 00:21:48,160 these drugs, how their effects play out over time across large 285 00:21:48,160 --> 00:21:52,900 populations, and what happens when people stop taking them. 286 00:21:52,900 --> 00:21:56,260 One place those questions are starting to surface is around 287 00:21:56,260 --> 00:22:02,080 eating disorders. By suppressing appetite so effectively, GLP-1s 288 00:22:02,080 --> 00:22:05,845 can make it easier to restrict food in ways that resemble an 289 00:22:05,845 --> 00:22:10,765 eating disorder. There are concerns among some clinicians 290 00:22:10,765 --> 00:22:14,155 that in some cases people may develop new patterns of 291 00:22:14,155 --> 00:22:18,775 disordered eating, while in others, symptoms that have been 292 00:22:18,775 --> 00:22:23,215 under control for years might return, and because these drugs 293 00:22:23,215 --> 00:22:27,805 are often so easy to access, those risks may not always be 294 00:22:27,805 --> 00:22:35,140 recognized ahead of time. For Rebecca, it's one more layer in 295 00:22:35,140 --> 00:22:39,820 an already complicated decision. 296 00:22:39,820 --> 00:22:44,530 Rebecca Morrison: I've spent my entire life, first fighting 297 00:22:44,530 --> 00:22:49,390 against my mother's ideas, and then really fighting against 298 00:22:49,450 --> 00:22:54,685 society telling me that I'm anything other than worthwhile, 299 00:22:54,685 --> 00:23:02,395 lovable, and frankly beautiful. My goal is to live a healthy 300 00:23:02,395 --> 00:23:11,155 life and to live a long time. If my longevity is at risk because 301 00:23:11,155 --> 00:23:16,090 of my weight, I will consider GLP-1s, and I'm already 302 00:23:16,090 --> 00:23:19,240 considering them. That's the truth. I've talked to my doctor 303 00:23:19,240 --> 00:23:24,340 about it numerous times. I've thought, yes, no, yes, no, I 304 00:23:24,340 --> 00:23:30,640 don't know. I still am not 100% convinced that I have to take a 305 00:23:30,640 --> 00:23:39,265 drug for the rest of my life that I'm not sure supports my 306 00:23:39,265 --> 00:23:47,455 ideals as a woman of what it means to have worth and purpose 307 00:23:48,205 --> 00:23:49,045 the way I am. 308 00:23:49,045 --> 00:24:11,620 Lauren Arora Hutchinson: Coming up next week on playing god? 309 00:24:12,970 --> 00:24:15,820 Ashley Womble: The first doctor visit I had after I became 310 00:24:15,820 --> 00:24:18,790 pregnant... They were like, “Well, if that's what you think 311 00:24:18,790 --> 00:24:23,080 you should do.” Why isn't there any guidance around this? 312 00:24:23,650 --> 00:24:30,280 Ruth Faden: It's sort of like a mass social experiment. 313 00:24:30,310 --> 00:24:32,440 Lauren Arora Hutchinson: Many thanks to our guests in this 314 00:24:32,440 --> 00:24:37,660 episode—to Rebecca Morrison for sharing her story with us, and 315 00:24:37,660 --> 00:24:43,210 to Jeffrey Kahn, Alex Brewis, and Mara Gordon. playing god? 316 00:24:43,210 --> 00:24:46,615 is a production of the Dracopoulos-Bloomberg iDeas Lab 317 00:24:46,615 --> 00:24:51,115 at the Johns Hopkins Berman Institute of Bioethics, made 318 00:24:51,115 --> 00:24:56,155 association with Sea Salt and Mango Productions. This episode 319 00:24:56,155 --> 00:25:01,225 was produced by Lyric Bowditch, Irene Carter, and Redzi Bernard, 320 00:25:01,225 --> 00:25:06,805 with help from Brian Ricker. Our Executive Editor is Tony 321 00:25:06,805 --> 00:25:12,640 Phillips. Music and sound design by Alexander Overington. 322 00:25:12,640 --> 00:25:17,620 iDeas Lab Producer, Lyric Bowditch. Researcher, Brian 323 00:25:17,620 --> 00:25:23,710 Ricker. Story Editor, Simon Adler. Show art by Barry 324 00:25:23,710 --> 00:25:28,660 Pousman and Shawn Carney. Our Production Coordinators are Leah 325 00:25:28,660 --> 00:25:33,505 Lord and Susan Snead. Our Executive Producers are Jeffrey 326 00:25:33,505 --> 00:25:38,935 Kahn and Anna Mastroianni. I’m Lauren Arora Hutchinson, 327 00:25:38,935 --> 00:25:44,845 host and Managing Editor. Come back next week for more 328 00:25:44,845 --> 00:25:48,715 playing god?