Body image and weight loss drugs

0:00This BBC podcast is supported by ads outside the UK. America is changing. And so is the world. But what's happening in America isn't just a cause of global upheaval. It's also a symptom of disruption that's happening everywhere. I'm Asma Khalid in Washington, D.C. I'm Tristan Redman in London. And this is The Global Story. Every weekday, we'll bring you a story from this intersection, where the world and America meet. Listen on BBC.com or wherever you get your podcasts. I want to put all the issues on the table that keep me up at night. The interview brings you conversations with the people shaping our world.

0:43From global leaders. I've much more than fulfilled the promises that I've made. To cultural icons. I'm just interested in how it feels to be playing songs that are 50 odd years old. Songs are like children. They're with you forever. The interview from the BBC World Service. Listen now wherever you get your BBC podcasts.

1:10Hello, I'm James Reynolds. Welcome to the documentary from the BBC World Service. In BBC Conversations, we bring people together to share their experiences. And this time, our guests share their experiences of body image and weight loss drugs. The Super Bowl in the US is rarely just about football. This year, President Trump described Bad Bunny's halftime show as terrible. Kim Kardashian and Lewis Hamilton made their first major public appearance together. And there was also controversy surrounding one of the adverts. In the ad, tennis champion Serena Williams promotes a weight loss injection, saying that she is healthier thanks to the product.

1:54Her words have led to quite the backlash on social media. Fans are disappointed that a woman for so long associated with strength and body positivity is now selling being thinner as the ideal. In our conversations, then, we wanted to discuss the cultural pressure to lose weight now that these drugs, known as GLP-1s, are available. Later on, two men shared their experiences of weight loss jabs. Firstly, though, my colleague Luke Jones brought together four women who were all plus size. Jordan in New York and Virgie in California, with Emilia from Ireland and Paige, who's here in the UK. I am a plus size woman.

2:35I'm size 18-20. And yeah, I've always had a bit of a complex relationship with my weight and food. But in the last sort of few years, I've really done a lot of work to unlearn diet culture and detach myself from that way of thinking and behaving when it comes to food and dieting. And yeah, I'm in a much better place like mentally, even like health wise now. than I've ever been physically. Like I'm doing a lot more exercise and walking because I enjoy it and like dancing because I want to go dancing. Like it's not a punishment. So I'm more able to do that and feel good about it. So then it's like a cycle that continues.

3:09I really relate to Paige's story. Oh, I mean, I didn't, I didn't learn fat phobia or body shame at home. I learned it in school. And so I had, you know, this first five years of my life that were so beautiful. And then And I got kind of thrown into a lot of teasing, a lot of name calling. I mean, I learned the word fat and I learned that that was a really bad word. That was the worst thing you could be. And that's what I was. But I really internalized this message. I really hated my body. I thought every single thing wrong with my life was because of my body. This is something that people who haven't experienced fat phobia don't really understand is that it's like a type of brainwashing and you can't kind of opt out of it.

3:53And in this brainwashing, we're taught every single thing that's bad in your life is because you are fat, because you eat wrong. And can you give me an example of that? I get your point that it is a whole suite of things. What is one example? Like if I go into a date and doesn't go well, my first thought is I should lose weight. My first thought isn't, you know, did I even like that person? Or are we compatible? Like, you know, did we have a good time? my thought is if there's not a callback it's because something's very wrong with my body and then I take that forward and it just keeps multiplying and multiplying and multiplying and as someone who came to like therapy later in life I'm like oh my goodness I had so many things that I was doing that were so bananas and so clearly signaling that I wasn't ready for a relationship but none of that got dealt with because I was just dealing with everything through trying to lose weight.

4:44My story is very different to protein pHs. I have always been plus size. I've always been fat. I'm not afraid to use that word now, but there definitely was a time when I was. And I have kind of been around the block in terms of ways to address this. I also had disordered eating. I had bulimia. I struggled greatly with all the fad diets, the keto diet, the 5-2 diet. I tried everything that I could get my hands on that I thought would fix it because I had been fat all my life. It was something that I felt haunted me and it drove my mental health to such a bad place that I did try and take my own life when I was 16 and I was put into a mental health facility for a few months.

5:31Looking back on it, so much of that was to do with the way I regarded my own body. And the fact that I felt, no, it's a story that so many people actually face or they know somebody that struggles with. When you accept that, as Virgie says, being fat is so wrong, it is the worst thing that can happen to you and you try everything to fix it and you can't fix it. From a mental health side, it's a very slippery slope. I've worked hard in therapy. I'm sure that's like a common theme among people here today to try and break down everything that I had built up in my head. And now I work as a body positivity advocate.

6:12That's kind of become my own personal mission is just to be obnoxiously self-accepting and try and get everyone else to be obnoxiously self-accepting. Well put. Jordan, how about you? I can relate to so many things everybody else is saying. I have always been fat since I was a little kid. I grew up that way. I'm still that way. And of course, you know, I've had my experiences with fad diets. I grew up in the early 2000s. So there was certainly no shortage of quick fixes. And I was in Weight Watchers by the time I was in middle school and doing things like the Beyonce diet where you drink only lemonade with maple syrup and cayenne pepper when I was probably in elementary school.

6:50That sounds horrible. Yeah. But I was willing to do anything, of course, because when I was young, I also really learned and internalized that every aspect of my life would be better if I lost weight. And I think for me, the biggest source of learning that I was not good enough was really from the media. I've always been like a fashion girl. I love clothes. I love like doing my hair and seeing all these things when I was young, like just really reinforced that essentially that the kind of person that I wanted to be required that I be thin. And really, no matter what kind of person you want to be, you should be thin.

7:23But when I was in my, I guess, like early 20s, probably, I feel really lucky that I was able to work through that in a way that like, It sort of just clicked for me. And there seem to be so many different but also similar themes in what you've all described there in terms of growing up. But now, of course, we have something which you will all be confronting and facing, which is the popularization of these weight loss jabs. Has that changed the way that you see yourselves and the way that society sees people who are plus size? Or is it just another thing in the same way that various diets have been or other trends?

7:58What do you think about that, Virgie? I think the shame is very old. It's tapping into a shame that I learned as a child. So there's that. But right coming out of the era of body positivity, body liberation, whatever you want to call it, for me, it was very jarring to watch the kind of the 180 overnight was really destabilizing to see people around me express for years to me values that I thought we shared. And then the moment that GLP once come on the scene, I'm like, wait, I really am your worst nightmare. I think it creates this kind of cascading effect that leads to gaslighting, the sense that you have your understanding of reality is no longer grounded in actual reality.

8:48And it's not just around that, you know, oh my goodness, my recovery around body image, around my relationship to food is at risk, but my sanity, my actual overall mental health is at risk. I think that I feel more than anything, this sort of exasperation that it's never going away, right? Which I knew. And it never did go away, even in the years of like the body positivity movement, like, obviously did incredible things for a lot of people. But so much of that from like a corporate perspective, a marketing perspective was this very like, you know, girl bossy, pink wash version, right? It's the marketing for me that's like you were all jumping on the trend of body positivity when it was in fashion to include these like inclusivity marketing campaigns.

9:34And now it's like, where's that energy gone? Like it was all just for sure. It was all just for capital gain. I have two cents to throw on for that one if you don't mind. Marketing kind of historically both follows and leads society, right? So as individuals care deeply about plus size representation, brands will scramble to integrate plus size representation. And the second that we suddenly go, oh, no, actually, I want everybody to be as thin as possible. Then all of a sudden brands throw it out the window. And I think that is so indicative, though, of like the fact that the diets, the GLP ones don't change anything.

10:12Right. It really just like is such a temporary fix. But for me, yeah, bondage. Right. And I think what I feel more so than anything is a sadness for people and a pity almost. Not for everybody, of course. Everything I'm going to say is not like a blanket statement for everybody who takes these drugs. But people who do it in search of transcending fat phobia of seeking a better life from a mental perspective because of the way you're treated, it just is so sad to me more than anything. but I do feel the exasperation that it just has created fat people in the eye of the public as something that needs to be solved more than ever.

10:50Yeah it did actually really affect me quite a lot when like I started seeing all the targeted ads like every time I went on social media I was getting another like paid advertisement for these weight loss drugs and I just think imagine if it was any other drug in the world that we were seeing like advertisements for like pushed to our social page or we were seeing ambassadors doing 20 % off a drug like it blows my mind that it's been so normalized and I did I did have moments where I was like should I be trying this and it was sort of like a pressure of an expectation it feels like there's not like a sort of an excuse of being fat I feel like there's no you know what I mean there's like a pressure of no excuse anymore like why aren't you taking this why aren't you trying this option so I think there's an additional layer with these where as a fat person you are darned if you do and darned if you don't in terms have taken these drugs and if you decide to take them you're faced with an additional issue do you tell people i have done this and i'm taking this and it's working for me and face accusations of you are promoting this you are taking the easy way out or do you turn around and go well i've been doing pilates and i've been taking green tea and i've been doing walks and then what happens is everyone looks at the other fat people and go what you can't take walks you know you can't drink green tea look this is working for her and that is where I have so much sympathy for the person that doesn't disclose this is what they're doing because ultimately it's no one else's business what you choose to take for your health and these are just substances they themselves cannot induce fat phobia and they can do so much good for people with diabetes that genuinely need them or people that really really really need them and yeah they themselves are not evil but I wonder if perhaps as a society we are not ready for them my biggest issue with what the drugs have done for the landscape of body images.

12:35When people take them, and I agree, you don't owe anybody an explanation. Really, in my opinion, we don't need to be talking about these kinds of things with people that we don't know. I don't think influencers owe us an explanation necessarily, but what I do think they owe people is decency. I think you owe it to people not to perpetuate the societal rhetoric that got you to that point in the first place. People will say fatphobic things around me and I usually just say, oh, that's a weird thing to say out loud. And I think if that leads to a conversation, I ask them, what made you feel this way about your body?

13:09And most often, it's when people are talking negatively about their own bodies in front of you, right? And so it's like when people lose the way they take the drugs and then they suddenly start to disparage their old body and therefore everybody who still exists in that body, that's when I think you have done something wrong and you can do whatever you want for whatever reason, but I don't think it's okay to then turn around and weaponize that against other people. I've actually found that I've had health veiled criticism about my weight from complete strangers quite frequently. I operate a lot, as I mentioned previously, in the body positivity space.

13:46I would be quite present online telling people, you know, you are okay the way you are and very often I will get comments you are glorifying obesity with these statements you are promoting being fat and everyone will get really ill and be very ill and sick because they will be really fat like you and they will think it's okay it's so preposterous because these people don't care about you or your health they don't care no um and you're also very regularly not up there saying we should all be fat fat is the lifestyle everybody come and let's let's get fat together it's more often than not just being like you know yourself you're okay like it's such a foreign concept and um people that aren't fat don't realize that actually it benefits them too if we all as a society become more body positive it's not just plus size body positivity it is blanket body positivity.

14:44Emilia, Paige, Jordan and Virgie, positive about body positivity. America is changing and so is the world. But what's happening in America isn't just a cause of global upheaval. It's also a symptom of disruption that's happening everywhere. I'm Asma Khalid in Washington, D.C. I'm Tristan Redman in London and this is The Global Story. Every weekday, we'll bring you a story from this intersection, where the world and America meet. Listen on BBC.com or wherever you get your podcasts. I want to put all the issues on the table that keep me up at night. The interview brings you conversations with the people shaping our world.

15:31From global leaders. I've much more than fulfilled the promises that I've made. To cultural icons. I'm just interested in how it feels to be playing songs that are 50 odd years old. Songs are like children. They're with you forever. The interview from the BBC World Service. Listen now wherever you get your BBC podcasts.

15:53Eric Marante had always been a fighter. Age 21, he found himself with a squad stationed on a bridge in Iraq. On the morning of April 21st, 2007, a truck packed with 3 ,000 pounds of explosives was detonated just a few feet below them. This is a story about a man who turned pain into purpose. Therapy for me is being in the boxing ring. It's just good for your soul, good for your body. This is season four of Legacy. Defiant. Search Defiant Legacy wherever you get your podcasts.

16:34I'm James Reynolds. You're listening to The Documentary from the BBC World Service.

16:47The global GLP-1 industry is worth tens of billions of dollars. Drugs including Ozempic and Munjaro, slow digestion, curb appetite and increased feelings of fullness. So you eat less. But there can also be side effects, including nausea and vomiting. Nevertheless, if you've got the money, the jabs are an increasingly attractive option for those trying to lose weight. As we'll hear again in our next conversation, though, the debate around the drugs is as much about physical well-being as it is about body image and self-worth. We brought together two men who've used weight loss jabs. 30-year-old Paulo is from Brazil.

17:30He now works here in London. And 39-year-old Chris is in the US state of Georgia. I have more energy. I sleep better. I feel better about myself. I don't think that people are staring at me when I go out in public because of my size. My overall self-esteem has went through the roof. I think to me, self-esteem was the main thing. I feel like it definitely impacts on how confident I feel about myself as an overall. I feel like it kind of redirected me to have a different relationship with food. I never really paid attention so much. I needed that change in the sense of not just in the appearance, but like in the mindset of like trying to be healthier.

18:12So the majority gave me that direction to almost like calorie count and a bit more. Now that I'm off on it, I still managed to maintain really well. So it was like, it was a good redirection in that way. I agree that the medication helps your relationship with food. In my honest opinion, Most people that use these medications are people that are at risk for diabetes, heart disease. Obesity is a disease and it has turned into a vanity thing lately, which everybody can do what they want to just under the care of a doctor. Chris, do I take it from that that you're a little bit cautious of people who take it for aesthetic reasons?

18:58I'm 50-50 on it because, you know, I believe that everybody can, you can do what you want to with your body. But people that truly need the medications aren't able to get them most of the time because their insurance doesn't cover it or they can't afford it. And then you have people that just want to lose 10, 15 pounds for aesthetics. It's a hard pill to swallow. I wonder if there's another issue as well, that these drugs are new. and with any new drug there needs to be a test about long-term consequences paulo we don't know what it's like for a body to keep on these drugs for many many years yet is that something that's on your mind about possible dependency over many years and possible side effects later i don't feel like i was dependent because i did a treatment i finished and i just kept going with my life So I don't really think about the actual side effects in the future.

19:55But so far, I've been pretty well afterwards. I'm willing to take the chance on what could happen due to the fact that I have tried to wean myself off of the medication. And my inflammation has come back. Some weight had come back. And right now, all of my labs are normal. Everything is stable. and I do try to keep an eye on the trials just to see if anything new comes up. But I'm willing to take the risk to be able to live a healthier life. Let's turn to the cost of these drugs. Paolo, how much have you had to pay? I got mine from a doctor in Brazil. It lasts for like a six-month supply probably, I would say around nearly£1 ,000.

20:44Okay, so maybe around$1 ,200 or so. Yeah, but it's also like because I didn't just get that. I just had to get the vitamin replacements also. If I had to add the entire treatment itself, it would be probably like two and a half K. Chris, what are the costs for you? So in the US, if you don't have insurance, Mount Jaro can be anywhere from$1 ,200 to$1 ,500 for the pins. And then the vials, if you're on Zetbound, which is the weight loss version, I believe it's up to$500. I was lucky and they had a savings card when I started so I paid$25. Chris when you speak to others in America who might want to do the same as you've done and take weight loss drugs under medical supervision are there some people say to you they'd love to do it but just the cost is beyond them?

21:38Yes I hear it every day. Do people treat you differently now Chris, that you've lost a lot of weight? Not really in person, but online, I get a lot of hate online. Why is that? Where I'm taking the easy way out. I'm cheating. All it took was me moving my body and eating right. And I could have lost the weight the same way. And I just like to to tell them that education is key and there is research and data out there that not everybody can lose weight the same way that there are metabolic dysfunctions that can make it harder for people to lose weight with just diet and exercise. At the end of the day, it was my body and now you have your own choice of living.

22:29So I've done it. But then I also got people that pretty much same as Chris saying that I was taking a quick turn or that I wasn't fat to do it like I've lost 23 kilos on it which was a lot and then when I first started I didn't even think I was I needed to lose that much but then you get like that kind of mixed opinions some people I answer towards it but I was confident before I'm confident after so it's just like don't think there is someone on social media that will have the power to take myself down or make comments that will make me feel embarrassed about about doing it and i just also don't get it why people feel embarrassed because i have friends that are on it and they don't want people to know because it's almost like you're doing this span and then you don't have to do nothing else you still need to diet you still need to calorie count so it's just like obviously controls your appetite but you still need to do the work has there been a moment where you've looked in the mirror at yourself and thought this is what i want to look like i think before i went on summer holidays i was like there we go I was like, I've made it.

23:29So I was kind of feeling like really, really happy. I think where I didn't know I could look like that before, because I don't even remember the last time I looked like that at like probably 10 years ago. So I kind of felt like really, thank God I did it. But one thing I would probably say to people is just like, have that mentality that it is a mindset change. Like I really, really thought of it probably like one year before I actually did it. Since last year, I'd be thinking about it. Until I actually done it, I was really sure that I needed to change the mindset because my worst fear was like doing it, losing all the weight and then putting their weight back.

24:04Of course, a lot of people, when they listen to you, will understand what it's like to look at yourself and think, yeah, I've just arrived. But I think some other people would say, isn't there another way of looking at life, of looking at the mirror and no matter what you weigh, so long as it's not medically obese with health conditions, think, yeah, this is who I am and accept that? Yeah, I guess so. I feel like people have different beauty standards all over the world. You know, beauty is very subjective. Like what's going to be beautiful for me is not going to be for some and vice versa. I feel the same for skinny.

24:37If you are happy in the way that you look in the mirror, I'm like, I'm glad for people that feel like that. But then also, I'm also glad that there is those tools to support us to look in the way that will make us feel better, not necessarily saying that that's the right way of looking because, as I said, beauty is very subjective. But then equally, if for yourself, being skinny is the pretty way or the right way of living. And if you can be like that, if you can be happy with yourself, I feel like openly that's the goal. I carried myself well in a bigger body, but I was very unhappy. So when I hit my goal weight, It was eye-opening because this is who I was inside, but the outside didn't match.

25:22It was a big mental shift to see myself in a smaller body. I felt better about myself. So then it was almost like the people around me felt better because I was happier. It wasn't like that when I was in a bigger body. I was miserable. Given that you've lost so much weight, are there things that you can do now physically that you couldn't do before? Oh, yes. running, jumping on a trampoline without my knees hurting, riding a bike. Everything is so much easier. Things that people take for granted. Heavier people just can't do them. And I can do anything now. I mean, the trampoline, I have to admit, that sounds fun.

26:03Yeah. My knees still hurt now because I'm older, but... Chris and Paolo there. Our thanks to them and to all of our guests this week for sharing their experiences. I'm James Reynolds. You've been listening to the documentary from the BBC World Service.

26:29America is changing. And so is the world. But what's happening in America isn't just a cause of global upheaval. It's also a symptom of disruption that's happening everywhere. I'm Asma Khalid in Washington, D.C. I'm Tristan Redman in London, and this is The Global Story. Every weekday, we'll bring you a story from this intersection, where the world and America meet. Listen on BBC.com or wherever you get your podcasts.