playing god?

Rebecca Morrison: If my doctor
said you need to be on this, I

would get on it. My doctor has
not said that. I do need to

probably lose some weight. I
keep saying that, but my blood

work is good. I'm more or less
healthy. My stats are positive.

I've gone to a cardiologist to
make sure I don't have a risk of

heart disease. I don't. So many
women are in this middle place.

We are not obese in the way that
is dangerous for our health. We

are just visually bigger than
the ideal that is portrayed in

the media. How do we deal with that?

Lauren Arora Hutchinson: That's
Rebecca Morrison. Like so many

people today, she is struggling
with a decision about a new

class of weight loss medications
called GLP-1s.

Rebecca Morrison: I mean, I'm
just a person that is trying to

determine something for my own
health. What is the responsible

thing to do as a human being, as
a woman, as a mother, as a wife,

as a daughter, as a person.
Should I do it? Do I need to do

it? Do I have to do it?

Lauren Arora Hutchinson:
Rebecca's question isn't just

about medication, it's about
something many people are

quietly wondering right now.
When a medical intervention is

promoted as both a public health
revolution and a way to achieve

a cultural ideal, how does that
shape the choices we make about

our bodies?
I'm Lauren Arora
Hutchinson. I'm the director of

the iDeas Lab at the Johns
Hopkins Berman Institute of

Bioethics. I've spent years
working on stories where

medicine and science show up in
people's everyday lives, and in

this episode we're looking at
GLP-1s. This is playing god?

Rebecca Morrison: Being in my
50s now, and having children of

my own, I understand my mother's
story much better than I did

when I was 13-14. She thought,
at the time, that being thin

equaled being beautiful equaled
having power, having worth as a

woman.
This came from her own
experiences in Iran, where

before the revolution, Iran was
very Western. We were seeing the

fashion of the world and
European fashion, American

fashion, and maybe culturally
that beauty of a woman was very

important.
It determined a lot
about how her life was going to

end up, what kind of husband she
would get, what kind of

attention and respect she would
get. So she comes to America.

She thought I was very beautiful
when I was young. I was tall for

my age. I could be a model, or I
was this statuesque woman, and I

hit puberty, and I was eating,
and she was shocked by the

change in my body. In her mind,
that dream of hers for me was

shattered, and the more she
fought to get me back to that

thin ideal, the more I fought
against it.
Maybe it's just who

I am, maybe it's genetics of my
body. After 13-14, I never got

back to my pre-puberty body. I
was never thin again. So,

binging for me was always this
feeling of freedom, along with

the sensation of all these foods
that I wasn't allowed to eat.
I

was bulimic for decades into my
40s, so that's, you know, that's

a long time of keeping a secret,
of closing the bathroom door and

putting on the shower, so nobody
can hear you. I felt like I was

so broken or wrong, and I would
not be loved. I would not be

accepted if I didn't try to lose
weight, and those were the times

where I really fell into the
eating disorder.

Lauren Arora Hutchinson: For
Rebecca, food and body size were

never just about health; they
were tied up with identity,

emotions, expectations, family,
and what it meant to be valued.

Rebecca Morrison: When I got
married, that helped, because it

was a man who I loved and
respected enormously. It

confirmed all my beliefs, all my
fight, my whole life, that I am

worthy of everything that anyone
else is at a different size. I'm

really proud that in my 40s I
was able to look at myself in

the mirror and say, never again.
I'm not going to hurt my body

for that reason. I settled into
an average American-sized body.

I think I had read a couple
times throughout the years that

the average American body was
maybe size 14 or 12 or

something.

Lauren Arora Hutchinson: But as
Rebecca worked to rebuild her

relationship with food,
unbeknownst to her, to most of

us, there was a medical
revolution occurring.

Mara Gordon: My name is Dr. Mara
Gordon. I am a very busy primary

care doctor. The vast majority
of my patients are publicly

insured, meaning Medicaid or
Medicare, and I have prescribed

GLP-1 agonists since I graduated
medical school in 2015.
They're

not new medications, I've used
them for years. We had a couple,

I believe, versions of GLP-1
agonists that were used

exclusively in patients who had
a diagnosis of diabetes, and

they were really helpful
medicines. I mean, I pretty

proactively recommend them for
people who have a diagnosis of

diabetes, heart disease,
metabolic dysfunction associated

steatotic liver disease, sleep
apnea, they can all be useful

for. So, I'm so grateful for
their existence. They really,

really helped my patients.

Lauren Arora Hutchinson: But
also, Dr. Mara Gordon says...

Mara Gordon: Patients often lost
a little bit of weight on them,

so I sort of thought of it as
like a side effect of these

medications, but over time
researchers have started

experimenting with using much
higher doses, and they found

that when you used much higher
doses, often four times the dose

that I was using in my patients
to treat their diabetes a decade

ago, people tended to lose
weight, and often quite a lot of

weight, 10 to 15, upwards of
sometimes 20% of their body

weight, and that was sort of the
moment I pinpoint, like, ooh,

everything's going to change.
This is going to be a big deal.

Somebody is going to get really
rich off of this.

Lauren Arora Hutchinson:
Scientists are still learning

about the full range of effects
of these drugs designed to treat

diabetes, but it appears that
GLP-1s work on a number of our

systems simultaneously. I asked
Mara Gordon what a drug like

this does...

Mara Gordon: Basically, it
regulates glucose. It causes

weight loss through several
mechanisms. The primary one is

that it slows gastric emptying,
so what that means is the

stomach is basically fuller
longer. It sort of empties at a

slower pace.
People, when
they're taking these

medications, have a sensation of
satiety that lasts longer. It

also enhances insulin secretion
from the body, which can help

with glucose levels in the
bloodstream. They also promote

satiety through the central
nervous system, so they act

centrally on the brain to sort
of suppress appetite in ways

that are not fully understood.

Lauren Arora Hutchinson: But
despite ongoing questions about

short and long term effects,
since this weight loss side

effect became widely recognized,
interest and demand for these

GLP-1 drugs has been enormous.

Mara Gordon: I would say people
started asking about them, maybe

in like end of 2021 beginning of
2022. It sort of started to

enter the public consciousness,
and I would have people sort of

specifically coming in saying,
"Hey, I heard about this weight

loss medication, do you think I
should try it?"
It has just

sort of reached a fever pitch.
In my primary care clinic, I

would say have conversations
about GLP-1 agonists maybe five

to seven times a day. Often
patients who have no

comorbidities, no diagnoses,
often will say, "Hey, you know,

I feel really fat, should I try
Ozempic?" People are pretty

desperate to lose weight.

Lauren Arora Hutchinson: For
decades, losing weight has been

framed as a matter of willpower.
Now, for the first time, that

may not be true, and that shift
has implications not just for

health, but for how we
understand responsibility,

pressure, and choice. What
happens when control comes from

a medication instead of from
within?

Alex Brewis: I'm Alex Brewis.
I'm a social scientist at

Arizona State University.

Lauren Arora Hutchinson:
Professor Alex Brewis describes

herself as a bio-cultural
anthropologist. Her work

combines social science and
human biology, and she studies

body image across different
cultures.

Alex Brewis: I have been working
for a number of years, since

about 2007 on cross-cultural
views of body image, and we've

now worked in many different
countries, and we've established

that negative attitudes towards
fat have been expanding and have

become really a globalized
phenomenon.
We have these

clinical definitions that were
set up actually in the 1930s or

so for what constitutes obesity?
There's just a single number

that's height by weight that
gets used a lot. You are

so-called normal weight at 24.5
body mass index, and then at 25

you become technically
overweight, or at 30 you become

technically obese.
People hate
those labels because they are so

laden with all sorts of feelings
of judgment, and they

re-categorize you within
society. You feel now like a

kind of a different person
because you've had these labels

applied.
These are arbitrary
labels, in the sense that

there's plenty of people that
have as technically overweight

or obese body mass index that
have great metabolic health, and

there's plenty of people that
have so-called normal or ideal

body mass that have all sorts of
metabolic issues.

Lauren Arora Hutchinson: Taken
together, the messages people

receive from medicine, from
media, from culture all point in

the same direction: lose weight.
And now, there's a drug that

makes it feel possible.

Alex Brewis: People are being
much more proactive than we

normally see around weight.
You're having people drive the

conversations with doctors, so
from a perspective of action

orientation, people are
definitely more, you know,

they're using more agency around
these drugs. So they're... they

feel in some ways more in
control of the ability to access

tools to lose weight.

Jeffrey Kahn: I think that's
really important, actually, as a

point in that these drugs are a
tool that are empowering people

to take charge of their health
in a way that they may have

wanted to, but it was very
difficult before, but there are

many examples of social
pressures where people feel like

they really need to do something
to conform. That feels like

what's happening with GLP-1s.

Lauren Arora Hutchinson:
Professor Jeffrey Kahn, our

resident bioethicist and
director of the Johns Hopkins

Berman Institute of Bioethics.

Jeffrey Kahn: At the same time,
it's not just about, you know,

people need to look a particular
way. Public health experts have

been messaging for a long time,
and physicians have been

messaging for a long time, that
the proportion of Americans, in

particular, but it's not true
only in America, that are obese

had been growing and was
unhealthy. Unhealthy for the

individuals, and it's unhealthy
as a matter of public health,

and so, the messaging has been
people need to lose weight.
So,

it's a combination. This is what
I think makes it a kind of

unique moment. A combination of
there's this health problem that

we've had a very difficult time
addressing over decades, and

there's this ideal body image
that are pulling in the same

direction.

Rebecca Morrison: So I am a
curvy woman. I always have been.

I've been size 12 to 14 most of
my life, mostly 14. So I'm

not... I'm medically obese for
sure, but maybe on the street a

person looking at me wouldn't
say that I'm obese, but I'm

overweight for sure, nobody
would not say that.
My face is

not bad, you know, I've got a
good face, I've got good hair,

but I have a, you know, bigger
body. But the pressure is

enormous. I feel like, am I, am
I irresponsible if I'm not

taking this drug as an
overweight person? Am I hurting

my body by not taking a drug for
the rest of my life that would

make me thinner?

Lauren Arora Hutchinson: How do
you balance loving yourself and

doing your best to be healthy
all while not giving in to

societal pressure? This is the
question Rebecca finds herself

grappling with. It's a question
made all the more difficult by

the marketing of these GLP-1
medications.

Rebecca Morrison: You see it on
social media all the time. I am

bombarded with those
commercials, Ozempic

commercials. Maybe it's just me.
Articles, magazines, doctors,

it's everywhere.

Alex Brewis: They are really
playing on people's deepest

anxieties and telling them, you
know, if you feel these

anxieties, then you need these
drugs. So, what we're seeing

very quickly is a shift into
cosmetic use for people that

don't have a medical sort of
pathway in, and it's pushing a

product that is making enormous
profits for these telehealth

companies.

Lauren Arora Hutchinson:
Pharmaceutical marketing is

always fraught. It involves the
uncomfortable coupling of

science, which is slow,
deliberate, and searching for

the truth with salesmanship, an
endeavor not known for any of

the above. And in the case of
these drugs, Jeffrey Kahn says

the salesmanship seems
especially out front.

Jeffrey Kahn: The process of
information and its delivery

runs a continuum between, you
know, here's just information

you decide at one end of a
spectrum to something that's

more like persuasion all the way
through to coercion. So, if you

don't do this, I will harm you.
And then, when you're going from

persuasion on the way to
coercion, there's an in between,

which is manipulation.
The
individual's weaknesses are

being taken advantage of by the
person who has power or

influence or information, and is
using that weakness in a way

that gets them to make a
decision that the individual

who's got the power wants them
to make, so that's that's less

of a free decision than just
being given information and

having the individual decide for
him or herself.
It sort of

feels like what's happening in
the context of GLP-1s is the

inundation of advertisements,
often by very well-known

celebrities who are very fit
people who are saying, I use

this, so should you. It's a kind
of manipulation, right? You want

to look and be like me, doesn't
everybody want to look and be

like that person? And if you do,
then it's easy for you to do so.

Just call this number or go to
this website, and we're standing

by to provide you this drug.
When what's being marketed is

ideal body image, it's, it's
harder for us to resist, and in

the context of something that
has been deemed a public health

epidemic, and so GLP-1 feels
like it's it's in that

combination of advertising, so
that you will want to look like

the celebrity spokesperson, but
also so that you will be

healthier and fitter, and that's
better for you and the public's

health. So these are together
very, very strong messages that

make I think it hard to say no.

Lauren Arora Hutchinson: When
you put all this together, what

will it mean?
Not just for how
we'll see ourselves, but how

we'll see our neighbors, our
family, our friends.

Alex Brewis: I think the
universal thought from all those

teams that have talked to so
many people in so many different

places is that it's just going
to make the stigma around weight

worse, because now it's also a
signal of failure to be able to

afford or be able to access the
solution.

Jeffrey Kahn: When we say body
image, it's not just how you

feel and look, but how others
perceive how you look. There's

now a thought, how did that
person lose weight, or if they

aren't of ideal body size, why
are they not taking advantage of

this miracle drug?
It's going
in the direction that they're

becoming more available, easier
to administer, lower in price.

So, in every respect, I think
those kinds of issues are only

going to get more pronounced.
The stigma around people who are

overweight in a, in an era when,
like, why would anybody be

overweight?
Will people feel
like they can resist, and sort

of, how do we even think about,
you know, what it means to

resist? Like, I don't want to
take drugs like that for the

rest of my life. I shouldn't
feel like I have to, and I don't

feel like I should be shamed and
stigmatized for what is a

decision that I think is for my
best interests, right? So, we

don't want that to be the
environment in which people are

making healthcare decisions.
That seems wrong. It seems to be

against individual autonomous
decision making, and so how do

we create a space for people to
say that's just not for me, and

not have them feel like they're,
you know, shamed and shunned as

a result.

Lauren Arora Hutchinson: There's
still a lot we're learning about

these drugs, how their effects
play out over time across large

populations, and what happens
when people stop taking them.

One place those questions are
starting to surface is around

eating disorders. By suppressing
appetite so effectively, GLP-1s

can make it easier to restrict
food in ways that resemble an

eating disorder.
There are
concerns among some clinicians

that in some cases people may
develop new patterns of

disordered eating, while in
others, symptoms that have been

under control for years might
return, and because these drugs

are often so easy to access,
those risks may not always be

recognized ahead of time. For
Rebecca, it's one more layer in

an already complicated decision.

Rebecca Morrison: I've spent my
entire life, first fighting

against my mother's ideas, and
then really fighting against

society telling me that I'm
anything other than worthwhile,

lovable, and frankly beautiful.
My goal is to live a healthy

life and to live a long time. If
my longevity is at risk because

of my weight, I will consider
GLP-1s, and I'm already

considering them. That's the
truth. I've talked to my doctor

about it numerous times.
I've
thought, yes, no, yes, no, I

don't know. I still am not 100%
convinced that I have to take a

drug for the rest of my life
that I'm not sure supports my

ideals as a woman of what it
means to have worth and purpose

the way I am.

Lauren Arora Hutchinson: Coming
up next week on playing god?

Ashley Womble: The first doctor
visit I had after I became

pregnant... They were like,
“Well, if that's what you think

you should do.” Why isn't there
any guidance around this?

Ruth Faden: It's sort of like a
mass social experiment.

Lauren Arora Hutchinson: Many
thanks to our guests in this

episode—to Rebecca Morrison for
sharing her story with us, and

to Jeffrey Kahn, Alex Brewis,
and Mara Gordon.
playing god?

is a production of the
Dracopoulos-Bloomberg iDeas Lab

at the Johns Hopkins Berman
Institute of Bioethics, made

association with Sea Salt and
Mango Productions.
This episode

was produced by Lyric Bowditch,
Irene Carter, and Redzi Bernard,

with help from Brian Ricker.


Our Executive Editor is Tony

Phillips.
Music and sound
design by Alexander Overington.

iDeas Lab Producer, Lyric
Bowditch.
Researcher, Brian

Ricker.
Story Editor, Simon
Adler.
Show art by Barry

Pousman and Shawn Carney.
Our
Production Coordinators are Leah

Lord and Susan Snead.
Our
Executive Producers are Jeffrey

Kahn and Anna Mastroianni.


I’m Lauren Arora Hutchinson,

host and Managing Editor.


Come back next week for more

playing god?