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Abstract

The recent rise of injectable ‘wonder drugs’ for weight loss has been rapid and unregulated (so rapid that it has resulted in a worldwide shortage of Ozempic). We analyse the commercialisation of these drugs, and the political manoeuvres companies engage in to leverage and manufacture the gendered capitalism of ‘care’. Marketing relies heavily on situating ‘obesity’ as a chronic disease influenced by genes or other aspects of biology, working therefore to supposedly mitigate the blame and shame of the taken-for-granted aetiology of ‘obesity’, overwhelmingly understood as excess food intake and insufficient activity. Armed with this evidence, women are told to ‘stand up against weight care judgement’ and to engage in ‘shame free’ care. Pharmaceutical interventions are at the ready to inject this weekly dose of care, producing freedom through neoliberal pleasure but, ironically, in doing so, sacrificing the pleasure of food and non-conditional self-acceptance as vital forms of self-care.

Keywords

care freedom gendered capitalism obesity pleasure

Introduction

For decades Western feminists have highlighted the ways in which women and their bodies are embedded in a range of cultural, disciplinary practices that frame the gendered habitus of heteronormative (white) femininity (Farrell, 2023; Gatens, 1992; Murray, 2008; Rothblum and Solovay, 2009; Strings, 2020; Young, 1990). Sandra Bartky (1990) and Susan Bordo (1993) led the charge in the early 1990s, drawing on Foucault's offerings of modern power to argue that women are caught in axes of power, where feminine beauty standards constructed by patriarchal powers are embodied by women. Turning the male gaze inward, Bartky and Bordo suggest that the internalisation of power through the minutiae of daily, disciplinary practices exhort women to constantly work upon themselves in order to comply with dominant beauty ideals of thinness. Dieting and exercise are key to these disciplinary regimes, and slenderness has come to embody moral judgements concerning good health, beauty and ideal femininity. No longer requiring just the external surveillance of those in positions of authority (e.g. medical doctors), modern forms of power are practised through relentless forms of self-surveillance and self-discipline.

This foundational work continues to resonate with contemporary analyses of gendered bodies and weight that position such technologies of self in light of postfeminism, neoliberalism and healthism (Bombak and Monaghan, 2017; Gill, 2008; Musolino et al., 2015). In her own semi-autobiographical exploration of diet culture through Weight Watchers, feminist philosopher Cressida Heyes approaches weight loss dieting ‘not only as a quest for the ideal body, but also as a process of working on the self, marketed with particular resonance and sold to women, that cleverly deploys the discourse of self-care feminists have long encouraged’ (2006: 126). Women are thus not simply duped into such capitalist ideologies, but actively seek out such enterprises in order to benefit from the societal rewards of conforming to dominant, Western beauty standards. No longer Foucault's docile bodies, women are active consumers taking pleasure in the empowering choices they make to take control of their weight.

In this paper we extend this work to explore how the recent and rapid rise of injectable ‘wonder drugs’ for weight loss feeds into discourses and practices of care, providing women with a ready-made solution to weight that frees them from the perceived failures of self-discipline and dieting. Our case study focuses on an Australian company called Juniper that offers an alternative and faster route to weight loss than diet culture. Tapping into the disciplinary practices that Bartky and Bordo describe so well, Juniper marketing relies heavily on situating ‘obesity’¹ as a chronic disease influenced by genes or other aspects of biology, working to mitigate the cultural blame and shame of the taken-for-granted aetiology of ‘obesity’, excess food intake and insufficient activity. Armed with this evidence, people are told to ‘stand up against weight care judgement’ and to engage in ‘shame free’ care. Juniper extols its customers to take care literally into their own hands with pre-filled pens of injectable medicine. Pharmaceutical interventions are thus at the ready to inject this weekly dose of care, producing freedom and pleasure by ascribing to dominant forms of femininity.

The paper begins by describing the online ‘telehealth’ marketing platform of Juniper, including a brief outline of our research methods. We then examine the capitalist tactics of care (Nadasen, 2023; see also Chatzidakis et al., 2020) that Juniper engages in through its promotion of ‘obesity’ as a medical problem requiring a medical and pharmacological solution, and its supposed absolving of weight stigma, individual failure and shame. It is through this linking of capitalism and care – of injecting care – that we demonstrate how the pharmaceutical diminishment of hunger in turn diminishes the self-care that comes with the pleasures of food and eating.

The following section turns to explore the multiple pleasures that are entangled in these practices of care, highlighting how these relationships are in constant tension. Despite a small number of notable exceptions (Coveney, 2006; Kulick and Meneley, 2005; Vogel and Mol, 2014), there is surprisingly little scholarship on pleasure and ‘obesity’, perhaps because those deemed to be ‘obese’ are already positioned as having dined on too much pleasure and are now in need of serious restraint.² The fierce cultural curtailment of female desires has led to fatness on women being culturally coded as both revolting and attractive and as signifying both hypersexuality and asexuality (Farrell, 2011; LeBesco, 2004). Both the right to pleasure and its subversive strategic deployment are hallmarks of fat activism (Cooper, 2016; Farrell, 2011), and the fat studies literature contends with the tensions of corporeal pleasures, such as fat sex and eating, in a fatphobic world (Andrew and Friedman, 2020; Jones, 2019; Pausé and Renee Taylor, 2021). These tensions will likely only be magnified when women are provided with a means of artificially restraining their pleasures, which Juniper's marketing suggests.

To unpack the complexities of pleasure that Ozempic produces beyond the binaries of excess versus control, we take theoretical inspiration from scholarship that has examined pleasure in critical drug studies (Dennis, 2017, 2019; Race, 2008, 2009), and the more nuanced understanding of pleasure as always in tension. We demonstrate how pleasure and care work across differing affective, political, medical and gendered discourses in the Ozempic space; there are pleasures associated with the freedoms of ‘slimming down’ and taking a pharmaceutical agent that frees one's ‘willpower’ to control weight. There is a simultaneous loss of pleasure that food and its associated sensory and relational worlds engender. All forms of pleasure, we argue, are tightly circumscribed by the patriarchal and capitalist structures in which women act, and their inherent contradictions and tensions.

Our final section discusses self-care and its relationship to self-acceptance. Juniper's marketing suggests that stigma can be vanquished by avoiding stigmatising healthcare providers and pharmaceutically suppressing your appetite to achieve the slender ideal. Such an approach to self-care, however, may fail to produce an enduring bodily appreciation that transcends (the potentially transitory) validation of achieving gendered body ideals. Rather than self-care, it suggests a form of self-abrogation that perpetuates the enduring pressure on women to deny, trim away and improve themselves under the guise of ‘what women have been waiting for’.

The uberfication of weight loss

Juniper is an Australian-owned online business that promotes medical treatments for women who want to lose weight. Started in 2021 by a young Australian marketing entrepreneur (Tim Doyle), Juniper describes itself as ‘a telehealth clinic and community celebrating and supporting women’. As Juniper is a publicly available digital platform we sourced our data for this paper from its Australian website, looking through all pages accessible through the dropdown menus. We accessed their Facebook and Instagram accounts, collecting posts going back to the creation of the accounts in 2021. This process was repeated with the websites and social media accounts of Juniper UK (the UK social media accounts were created in 2022). Bailey George used the following concepts to ground an initial search: obesity/weight loss; care/empathy; stigma/guilt; doctors and/or medication. As we familiarised ourselves with Juniper's content, we sought more complex themes that were relevant to the project, such as medicalisation/pharmaceuticalisation of weight loss, ‘obesity’ as a disease, long-term care, reducing hunger/appetite, and conditional acceptance. Posts that contained these themes were collected with screenshots. In addition to capturing Juniper's social media marketing, we also sourced a range of wider online grey material that has been reported on Ozempic, including government websites (Australian Government Therapeutic Good Administration (TGA)), online newspapers such as the Australian Financial Review and public media.

Originally focusing on menopause, Juniper exclusively taps into the cultural anxieties and visible stigma that is associated with women's weight and the cultural fear of anyone at any size gaining weight. It has capitalised on the rise of injectable pharmaceuticals, providing women with a clinical and highly medicalised rationale that distances the blame and fat shaming that accompanies large bodies. Persuasive in its range of platforms (web, apps, Facebook, Instagram), Juniper acknowledges that a new approach to weight loss is needed, and that diets and exercise do not work on their own. It is via this recognition that Juniper steps in to care for consumers, emphasising how most of women's weight is ‘determined by your genes’ and needs to be addressed at ‘a biological level’. In thoroughly medicalising weight loss, and thereby (purportedly) absolving individual blame, Juniper suggests that it provides a ‘gamechanging’ solution via its ‘Weight Reset Program’, which works on ‘a cellular level’ to ‘target metabolism and overhaul hunger signals’.

While Juniper purports to promote a ‘holistic’ approach to weight loss, the main component of the programme is the delivery of the drug Ozempic³ to your front door. Ozempic is the brand name for semaglutide, a drug manufactured by the Danish pharmaceutical company Novo Nordisk, originally developed to lower blood sugar levels in people with type 2 diabetes. A side effect of Ozempic is suppression of appetite/cravings and significant weight loss (as well as nausea, diarrhoea and potentially increased risk of thyroid cancer) (Novo Nordisk, 2023; Reynolds, 2023; Shu et al., 2022; Sodhi et al., 2023). Realising the market potential of a drug that induces rapid weight loss, clinical trials were conducted to investigate weight loss in people without diabetes. Proving to be effective, semaglutide was approved as a weight loss injectable in the United States (rebranded as Wegovy and offered at a higher dose).⁴ It works by mimicking a hormone called GLP-1 (glucagon-like peptide) that is triggered in response to eating (working on the brain to lead to a feeling of fullness); and there is now a range of ‘new generation’ weight loss drugs (tirzepatide, dulaglutide, liraglutide) that similarly target hormones released after eating. Ozempic is self-administered via a weekly subcutaneous injection, and in Australia it has been approved by the TGA and subsidised on the Pharmaceutical Benefits Scheme (PBS) for the treatment of type 2 diabetes. It can, however, be prescribed as an ‘off-label’ drug by medical practitioners to treat conditions other than those approved by the TGA (e.g. ‘obesity’).

There is a plethora of social media stories about who is using Ozempic and Wegovy (e.g. Elon Musk and Sharon Osbourne). The popularity of the hashtag #Ozempic also fuels speculation about Hollywood celebrities – such as Kim Kardashian – who are ‘suspected’ of using the drug. Oprah Winfrey has recently abandoned her Weight Watchers ambassador role and publicly disclosed her current use of injectable medications, featuring this ‘weight loss revolution’ on her website (Oprah Daily, 2023). Her 2024 special, entitled Shame, Blame and the Weight Loss Revolution (March 2024) draws on decades of her personal struggles with dieting, and how the experiences of a weight loss ‘wonder drug’ have finally freed her from ‘the disease’ of obesity:

The fact that there's a medically approved prescription for managing weight and staying healthier, in my lifetime, feels like relief, like redemption, like a gift, and not something to hide behind and once again be ridiculed for. I’m absolutely done with the shaming from other people and particularly myself. (Leonard, 2023)

Unlike the United States, it is unlawful in Australia to buy prescription medicines online without a valid prescription. The TGA regulates the advertising of therapeutic goods to Australian consumers, and prescription-only medicines such as Ozempic cannot be advertised to the public. It is for this reason that Juniper does not advertise which drug is included in its ‘Weight Reset Program’. To gain access to this drug, consumers complete an online quiz on the Juniper platform, which is then said to be assessed by one of their qualified medical practitioners. Ozempic can then arrive at your door as a packaged gift without the weight stigma from a clinical encounter, in what some are characterising as an ‘uberfied model of healthcare’ (Robin, 2023).

Juniper explicitly and exclusively targets women, knowing that its marketing will be especially appealing for women. Women are disproportionately affected by weight-based stigma, experience weight-based stigma at lower weights than men (Gupta et al., 2020; Hansson et al., 2010; Hatzenbuehler et al., 2009; Puhl et al., 2008), and report higher levels of internalised weight bias and weight dissatisfaction (Blake et al., 2013; Himmelstein et al., 2017). Women of colour and women in circumstances of disadvantage further experience multiple bodily stigmas related to the intersectional axes of racism, classism and sexism (Strings, 2015, 2020). Experiencing weight stigma is indeed associated with women avoiding healthcare (Amy et al., 2006; Lee and Pause, 2016; Mensinger et al., 2018) or receiving poor healthcare (Kost et al., 2024; Valdez, 2021). Primary care physicians prioritise women patients’ weight above cardiovascular issues; and women cancel or delay appointments until they have lost weight (Bairey Merz et al., 2017). As a means to counter stigma, Juniper's geneticisation of ‘obesity’ is fundamentally limited, of course, in that it fails to challenge anti-fatness (LeBesco, 2004).

Owing to the popularisation of Ozempic as a ‘miracle cure’ and its subsequent high demand as a weight loss drug, there has been a shortage and limited global supply since April 2022 (continuing through 2023 and into 2024). Australia clinicians have been asked to restrict the usage of Ozempic, to prioritise its prescription for people being treated for the management of type 2 diabetes, and not to prescribe Ozempic to new patients (Australian Government Therapeutic Goods Administration, 2023). The TGA, however, cannot stop off-label prescribing or the purchase of Ozempic from overseas entities, enabling those with financial resources to purchase the drug. In Australia, off-label Ozempic can cost anywhere in a range of AUS $300–600 per month, with Juniper's Weight Reset Program costing $599 a month. Juniper is thus only available to those women with financial resources to purchase the product, or who are willing to reprioritise other necessities in their lives. Exploiting a dominant Western desire for the values associated with thinness, Juniper is simply part of a global capitalist market that feeds directly into neoliberal, individualistic tropes of the commercial determinants of health.⁵

Capitalising on care

Juniper has entered centre stage as part and parcel of the care economy. In her book on care and capitalism, US historian Premilla Nadasen describes the care economy as ‘an institutionalised, hierarchical, profit-oriented system in which wealth is accumulated by the for-profit sector’ (2023: 21). Juniper arrived during a time that afforded a number of intersecting opportunities around care – care for women who are burdened by time poverty (Fraser, 2023: 99), care by the convenience of pharmaceutical assistance delivered to your door, care through a range of anti-stigma narratives, and provision of a service that allows women to care for themselves.

Created during global Covid lockdowns, Juniper knows its market and taps into cultural fears of ‘dual pandemics’ of ‘obesity’ and COVID-19, lingering dissatisfaction with government handling of health(care) crises, and the futility of a weight loss-focused health paradigm (Monaghan et al., 2022; Warin and Zivkovic, 2019). Echoing critiques of such failures in its social media platforms, Juniper states that ‘clearly, the “eat less, move more” approach to weight loss is failing Australian women’. From its own commissioned 2023 Women's Weight Loss Study⁶ (Juniper, 2023), Juniper describes how ‘1 in 5 Aussie women spend roughly 1 working day thinking about their weight every week’. Juniper acknowledges that ‘more time and money than ever before is being invested in dieting … when obesity is a medical condition that requires professional support and medical intervention’. ‘Diet culture’ they state, ‘is wasting women's time.’ The Juniper survey results describe the pressures placed on women in terms of achieving normative ideals of bodily size, and the emotional and financial lengths that many women will go to in order to conform to these standards. This includes the emotional toll of dieting, in which Juniper reveals ‘35% of Australian women attempting to lose weight experience negative emotions, including feelings of depression, anxiety, stress, overwhelm, powerlessness, or sadness’ (Juniper, 2023). Drawing on some of the critiques that fat scholars and activists raise, Juniper highlights how these social stigmas and negative emotions can be exacerbated following consultations with some medical professionals and are magnified (especially for women living in regional areas of Australia) by limited access and high costs of health care (Juniper, 2023).

In offering a pharmacological solution that overrides the ‘emotional strain of weight loss’ and releases women from their time poor lives, Juniper presents a heroic narrative that unbridles women. This form of emotional care is made evident in ‘patient’ testimonials posted on their webpage and Instagram platform – ‘I definitely didn’t think weight loss was within the realm of possibility before Juniper came into my life’ (Leah, Juniper patient, Instagram). Juniper draws on scholarly evidence that is already well cited and constructs itself as the saviour: not only saving women from the failures of government interventions, but also saving women from the burdens of ‘lost time’ spent worrying about their weight, or the shame they might encounter when visiting a medical professional and in everyday life. Juniper claims that their digital healthcare company provides ‘high-level continuity of care [that] is unrivalled by physical GP clinics, even in metro areas’ (Juniper, 2023).

Instead of examining why the ‘eat less, and move more’ paradigm has failed, or interrogating the capitalist underpinnings of the food system and food industries, Juniper pulls back from lifestyle and behavioural change messages, and positions ‘obesity’ squarely as a metabolic disease. Using a medical approach to weight loss, they state that ‘up to 80% of weight gain is determined by your genes, which is why diets and exercise don’t always work’. ‘Obesity’ is constructed solely as a medical problem, which then requires a pharmaceutical intervention to ‘regulate metabolism and hunger hormones’. Addressing weight at what they refer to as ‘a cellular level’ is key to their mission to ‘reframe the conversation and shed the stigma that weighs so many Australians down’.

Such biologically essentialist and pro-pathologisation arguments (Bombak et al., 2022) supposedly cut out any blame and stigma directed towards women's individual behaviours. This is precisely the effect of the Oprah Culture Industry (Springer, 2009), in which Oprah talks of her ‘epiphany’ in ‘realising’ that ‘obesity’ is a disease, thus garnering a stamp of respectability through clinical expertise and the need for a clinical solution. Proponents of these arguments claim they are working to highlight weight stigma and advocating for anti-stigma stances (Bombak, 2023; Gingras and Stranz, 2023), although in ways that may not be in line with the long-standing fat acceptance movement. In addition, this stance seeks to absolve any criticism that might be directed back to Juniper's exploitative and care-washing approach to women and their health (Chatzidakis et al., 2020).

Like any capitalist and profit-making exercise, Juniper is pretending to solve the very crises that capitalism and commodification have created – turning anxieties and crises around women's relationships with food and their weight into opportunities to make a buck. In many ways this is a continuation of the self-care that the hundreds of dieting apps and tracking devices have leveraged, specifically designed to enable women to monitor and self-surveil their weight loss (Lupton, 2020). Juniper offers this technology of care through an app on your mobile phone, enabling you to track your progress, receive weight-related health education, and purchase weight loss ‘nourish’ shakes or meal plan guides in the palm of your hand. As Lupton and Jutel (2015) suggest in the title of their research on health and phone apps, ‘it's like having a physician in your pocket’. This is all done privately in your own home, with even visits to the pharmacist unnecessary. This privacy and self-management (like the medicalisation of ‘obesity’) provides a form of self-care that is deemed empowering:

We believe in empowering women – through education, professional support, and clinically proven treatments – to take control of their weight journey and discover a healthier and more sustainable lifestyle. (Juniper, 2023)

Crucially, there are already indications that injectable weight loss medications will follow the same trajectory as other weight loss technologies, constructed and marketed as ‘cures’. While ‘cure’ suggests an eradication of the issue, as Clare (2017) points out, the elusive cure for fatness has meant in practice that we select ‘potential cures, partial cures, and failed cures’ (2017: 77). Weight loss diets are notoriously inefficacious (2017), and drugs and surgery are prone to side effects (Aagaard et al., 2016; Arterburn et al., 2020; Groven et al., 2010). Within the medical-industrial complex, ‘the quest for slenderness, for an eradication of fatness, is seemingly worth all the failures, dangers, dubious medical procedures, and direct harm’ (Clare, 2017: 77).

Bariatric surgery was also once marketed as the ‘cure’ to ‘obesity’ (Greenhalgh, 2015); however, bariatric surgery failures requiring revisional surgeries do occur, such as in the form of ‘inadequate’ weight lost (Mann et al., 2015). Bariatric surgery does not necessarily improve mental health-related quality of life (Backman et al., 2016; Szmulewicz et al., 2019), and following bariatric surgery, patients can be at (still or elevated) risk of substance use disorders, depression and suicide attempts (Backman et al., 2016; King et al., 2012). Furthermore, side effects can be substantive (Arterburn et al., 2020; Groven et al., 2010; Padwal et al., 2011; Shen et al., 2015), and weight regain is common (Athanasiadis et al., 2021). As such, any (potential or partial) ‘cure’ for ‘obesity’ must be viewed with scepticism, particularly as ‘failures’ are often attributed to patients (Boero, 2012; Clare, 2017).

With respect to the ‘miraculous’ GLP-1 agonists, weight loss varies among users (Wilding et al., 2016, 2022); weight loss plateaus (Wilding et al., 2021; Zhang, 2024); and side effects range from gauntness, ‘Ozempic face’ (Tay, 2023), ‘Ozempic butt’ (Miller, 2023), and gastrointestinal complaints, to pancreatitis and stomach paralysis (Shu et al., 2022; Sodhi et al., 2023). People regain weight when they cease treatment (Wilding et al., 2022), and one study has shown that up to half of those prescribed GLP-1 receptor agonists for diabetes discontinued the medication after one year (Liss et al., 2023). For those without diabetes, two-thirds may discontinue GLP-1 receptor agonists after one year according to American medical and pharmaceutical insurance claim data (Gleason et al., 2024). All this suggests Juniper's revolutionary care technology will (again) frustrate rather than empower women, reproducing a cycle in which both weight loss and weight gain benefits consumer capitalism. Indeed, the US$76 billion dieting industry is already adapting to the medications, often offering them in concert with their behavioural change or food substitution plans or positioning their products as alternatives or complementary to the medications’ use (Petersen et al., 2023).

Trading pleasures (eating for anticipated weight loss)

The care that Juniper extends is premised on both the care of the ‘holistic team’ behind the digital platform, and the capacity for consumers to be empowered through practices of self-care. This section explores how these practices of care deliver differing, and sometimes contradictory, forms of pleasure. The production of pleasures, as Foucault suggests in his second volume of the History of Sexuality (Foucault, 1986), is derived from the management of ‘ethical selves’, where one is required to manage sexual relations and everyday pleasures such as food (see also Beasley, 2008; Coveney, 2006: 26–27). Linking pleasure to care of the self opens possibilities for both ascribing to discourses of moderation and affording the subject a ‘greater degree of freedom in shaping their existence’ (Race, 2008: 420). These tensions are not necessarily binaries working in opposition but produce a range of differing and simultaneous e/affects as they are enacted in and out of bodies, discourses, emotions and technologies.

In Bombak's (2015) previous research studies, participants frequently discussed how badly they wanted a ‘pill’ that would help to once and for all cure their often-lifelong struggles in trying to acquire and maintain a normative, hegemonically thin body. In some instances, such a pill would eliminate the need for food entirely in participants’ imaginations, and thus ease the angst and hyper-vigilance weight loss dieters face in every caloric encounters. Ozempic and other similar pharmaceuticals biochemically dull the ‘pleasure centre’ in the brain, meaning that the desire and sometimes taste for food is significantly lost. On the one hand, this dulling of appetite takes away pleasure of food, but the resultant weight loss in itself affords pleasure:

Pleasure in being able to sit through a meal without obsessing about what's for dessert. There is pleasure in being thin enough that you can sit on the ground and enjoy a picnic with your family without needing someone to help you up. And there is great pleasure in being able to exercise for the first time – take long walks, go on a hike, even run a race – because you aren’t carrying all the extra pounds. (Reiley, 2023)

Juniper capitalises on this understanding of pleasure – pleasure that is associated with the ‘free’ world of subjects. Freedom is characterised on Juniper social media as a release from incessant ‘food noise/food chatter/head hunger … that doesn’t shut up [and] overshadows other aspects of life’. Patient testimonials highlight this freedom, as Stacey recounts: ‘Since Juniper I feel freedom. I’ve gone from always thinking about food to thinking about food as fuel’ (Juniper, 2023).

Juniper states that it can help free one's body of the burden of worrying about how to manage hunger, weight and stigma, as well as freeing women from developing ‘further serious medical conditions’ such as diabetes and cardiovascular diseases (Juniper, 2023). This freedom is intimated to extend to future citizenship, where complications related to ‘obesity’, such as heart disease and certain types of cancer, are claimed to present considerable future risks to women who are ‘obese’, and significant financial strain on already over-stretched health care services and resources. This entrepreneurial concept of freedom links directly to the production of morally responsible and governable citizens, who are choosing particular forms of health to ‘maximise one's life as a kind of enterprise’, what Rose et al. describe as one of the principal strategies of ‘advanced liberal government’ (2006: 90–91).

In her research on drug use and addiction, Fay Dennis describes this style of pleasure as ‘neoliberal pleasure’ (2017: 155). Neoliberal pleasures are tied up with notions of freedom, rationality and reason. Juniper promises freedom from temptation, disinhibition, self-recrimination and failure; and freedom from prejudice, discrimination, disappointment and disapproval. However, this exercise in empowered self-care is not without ambiguity or tension. For example, people with diabetes in Buchmann et al.'s (2016) study felt immense internal and external pressure to manage themselves as moral citizens and eat and exercise in line with medical recommendations. They discussed unremitting pressure to live a ‘joyless existence’ and were disappointed and felt misjudged when their efforts did not manifest physically. Food abstention could be confusing, painful and prompt social exclusion, but excitement was generated by positive laboratory results. In some exceptional circumstances, the need to abstain could free individuals from burdensome family obligations. When ‘lapses’ did occur, individuals could engage in elaborate rationalisations, and the complicated nature of abstention ‘may give some patients freedom to define food that is emotionally important for them as healthy’ (Buchmann et al., 2016: 6). Thus, if pleasure is understood in material, social and discursive ways, we can appreciate how Juniper's marketing of self-care does not completely eradicate a pleasurable life. However, ‘freely choosing’ to conform to a thin ideal, achievable to many apparently only through appetite-suppressing injections, is a distinctly neoliberal pleasure (Dennis, 2017), and arguably an archetypical form of postfeminist faux-emancipation (Gill, 2016).

There is also, of course, pleasure that emanates from the body (Dennis, 2017). In decentring subjective human experiences of pleasures, obfuscating and abstracting them, there is a risk of further marginalising women from their own experiences, and dislocating them from their pleasures (Walker, 2021: 37). Thus, while it may be arguable that ‘nothing tastes as good as skinny feels’ – a quote often attributed to (a now regretful) Kate Moss (BBC, 2018) – the revulsion to food produced by the drugs is what makes them valuable for weight loss, and the political implications of turning women's pleasures into visceral aversion must be considered.

This reaction may also jeopardise the drugs’ sustained usage. A scientist involved in developing GLP-1 agonists noted in an interview with Wired that ‘being unable to finish [a] meal … because they were getting full and feeling nauseated and saying they didn’t want to eat any more food’ interfered with early study protocols on diabetes treatment, which were focused on blood insulin (Joel Habener, quoted in Reynolds, 2023). When it comes to using these drugs for weight loss – rather than diabetes treatment – this repulsion to food is a feature, not a bug. Despite their framing as ‘miraculous’, treatment with the drugs comes at a cost; a fellow drug pioneer notes in Wired, ‘you lose your appetite and also the pleasure of eating, and so I think there's a price to be paid when you do that. If you like food, then that pleasure is gone.’ Indeed, such tedious despondency may be what leads to discontinuation of the therapy, ‘that may eventually be a problem, that once you’ve been on this for a year or two, life is so miserably boring that you can’t stand it any longer and you have to go back to your old life’ (Jens Juul Holst quoted in Reynolds, 2023). Indeed, users of the drugs’ social media posts indicate that while some users reported improvements in mental health, including after weight loss, others reported negative effects, including being ‘afraid of solid food’ and ‘feeling too awful … to enjoy life’ (Arillotta et al., 2023: 6). In considering these tensions, one component of self-care and pleasure is especially obscured by Juniper's marketing – that of self-acceptance and resistance to gendered body ideals.

Self-acceptance, pleasure and self-care

While touted as all-new and all-different, a revolutionary ‘gamechanger’, semaglutide is the perpetuation of a legacy of products and procedures promised to transform women's bodies (Stearns, 2002). GLP-1 agonists may be very helpful in controlling glucose levels where medically indicated, although Juniper's mode of delivery may circumvent identifying those people for whom GLP-1 agonists may be cardio-metabolically appropriate. What we seek to problematise, however, is its marketing as an unalloyed good in service of women's ‘self-care’ through body transformation and mediating pleasures. Weight loss is no guarantee of improved mental health quality of life (Warkentin et al., 2014), not even the method considered most efficacious, bariatric surgery (Szmulewicz et al., 2019). Indeed, the long-term benefits of weight loss are relatively limited and difficult to disentangle from changes in exercise and behavioural habits (Tomiyama et al., 2013). Nor are fatness and unhealthiness mutually exclusive, any more so than thinness guarantees healthiness (Tomiyama et al., 2016). Looking at the 2005–2012 National Health and Nutrition Examination Survey, Tomiyama and colleagues found nearly half (47%) of individuals classified as ‘overweight’ on the body mass index (BMI) were cardio-metabolically healthy; furthermore, 29% of ‘obese’ individuals were healthy, as were 16% of individuals at the highest weights (‘obesity’ type 2 and 3). In the normal weight category, 31% of individuals were cardio-metabolically unhealthy. Indeed, having a BMI in the ‘overweight’ category reduces the risk of mortality compared with the ‘normal weight category’ (Flegal et al., 2013). Losing weight if one is in the ‘obese’ category and healthy may even increase mortality risk (Bosomworth, 2012).

The literature regarding weight, health and fitness is enormous and often contradictory. We are not stating that the preceding findings are not contradicted elsewhere or are the definitive statement on fatness and health. We are seeking to emphasise the uncertainty in such literature, and in doing so, are echoing prominent mainstream ‘obesity’ experts in biomedical journals who have commented on how frequently assumptions and myths stand in for science in weight-related research (Casazza et al., 2013; Hebert et al., 2013). This ‘common-sensical’ approach to weight-based science (and its underlying morality) was recognised decades ago by Gard and Wright (2005). Physical, mental and behavioural improvements in health are possible in the absence of weight loss (Bacon and Aphramor, 2011; Bombak et al., 2019; Khaw et al., 2008; Kvaavik et al., 2010). Individuals with reduced weight stigma internalisation have better outcomes in weight-neutral behavioural interventions (Mensinger and Meadows, 2017). Therefore, health improvements do not have to rely on pathologising, degrading or othering certain bodies, and there has been a greater push for weight-neutral approaches to health in practice and policy (Bombak, 2014; Bombak et al., 2019; Monaghan et al., 2022; Tylka et al., 2014). Long-term weight loss has proven elusive for many (Mann et al., 2007). The long-term efficacy of GLP-1 agonists (even amongst those who do persist in chronic usage) is still unknown. Therefore, we suggest that a form of care for women less fuelled by neoliberal appearance standards and fraught with potential for endless (pleasure-numbing) self-defeat is that of self-acceptance.

Without suggesting an overly simplistic capacity to overcome ambivalence over one's size in a fatphobic society or to deny thin privilege (Donaghue and Clemitshaw, 2012; Murray, 2008), a focus on self-acceptance is a form of self-care that can liberate individuals from the cruel hope and stigma perpetuated by diet/thinness culture (Donaghue and Clemitshaw, 2012; Striley and Hutchens, 2020). Immersion in this culture can promote obsessional self-monitoring (Glicklich and Cohen Shabot, 2022; Ogden et al., 2012), continual dissatisfaction (Glicklich and Cohen Shabot, 2022), depressing weight cycling (Glicklich and Cohen Shabot, 2022; Quinn et al., 2020), and constant devaluation of one's fat past and present, while investing in an unrealisable utopian fantasy of the ‘future’ (Donaghue and Clemitshaw, 2012; Glicklich and Cohen Shabot, 2022). While Juniper's customers may experience pleasure at achieving positive results, this is precarious given the high likelihood of weight plateauing and regain (Wilding et al., 2021, 2022; Zhang, 2024). This turmoil will be painfully familiar to dieters (Mann et al., 2007), as will the rigorous habits frequently required to maintain lost weight (Ogden et al., 2012). In contrast, a more stable form of self-care, and what has been described as ‘freedom’ from the ‘misery’ of dieting, may be produced through less-conditional self-acceptance (Donaghue and Clemitshaw, 2012: 419). Semaglutide and its ilk are not alternatives to weight loss dieting; this is apparent from the requirement for lifelong use, food restriction and high rates of discontinuance. Rather, they are merely adjuncts to the lifelong pursuit of the feminine thin ideal, which are being pushed by Juniper as somehow emancipatory for women.

Juniper's understanding of self-care, with its explicit focus on changing or denying oneself, runs counter to some other models of embodied self-care. Sturgess and Stinson (2022) describe their embodied framework for weight stigma healing and resistance, which they argue could enhance self-care. Rather than endorsing weight loss, their framework includes embracing a fat-positive identity and bodily needs, fat-positive community and perspectives, and desire and sensual pleasures, without reproducing the value of feminine denial, as Juniper does. Crucially, Moulding (2016) in her study on women's recovery from eating disorders, highlights that disordered eating operates within a matrix of gendered power relations, social control and preoccupation with female thinness (see also Musolino et al., 2015). In contrast to the need for self-acceptance that participants in her study espouse, Juniper's version of care recognises and seeks to capitalise on women's intersubjective relational stresses but does not challenge the damaging sociocultural standards women encounter. Working towards self-acceptance may be a pleasurable, valuable form of self-care. However, without losing sight of the importance of women prioritising their own wellbeing, true emancipation from damaging and limiting gendered body expectations will not occur without collective action and structural reform. Resisting gendered capitalist commodification of the (potentially fleeting and unachievable) validation from weight loss and disrupting fat phobia are crucial political projects (Donaghue and Clemitshaw, 2012; Striley and Hutchens, 2020).

Conclusion

The marketing of Ozempic is inextricably linked to gendered discourses and practices of health, anti-stigma, self-care and pleasure. In the guise of care, Juniper taps into the cultural construction of ‘overweight’ and ‘obesity’ as a highly stigmatised form of ‘normative’ femininity in Western societies, offering a solution to a problem that is perceived to be ‘determined by your genes’. Biologically essentialist explanations are offered to supposedly absolve personal responsibility and offer freedom from the labours of dieting and bodily discipline. As we have argued, the presentation of a costly ‘block buster pharmaceutical’ provides relief from the emotional toll that accompanies the endless hard work of self-discipline and self-surveillance.

This capitalist relief is highly gendered – from the young men who own the Juniper company and are making huge profits from their ‘entrepreneurial individualism’ to the women who are targeted as their key market. Invariably, these are not just women with readily available funds to purchase Ozempic (such as ‘size 12 [women] who want to be size 10s … from Double Bay to Toorak’ (Robin, 2023)), but also women with lesser financial resources who are drawn to the commodified allure of self-care through thinness. There are also warnings that women with disordered eating are seeking Ozempic in their desire to reduce body size (Sharp et al., 2023), with critics declaring that Ozempic is in itself an ‘eating disorder’ (Bonyhady, 2023).

In examining the uses of pleasure and care in the current trend of anti-‘obesity’ pharmaceuticals, there are clearly multiple entanglements of pleasure in play. Pleasure, as Dennis writes in her drug studies, can be ‘a matter of the body (somatically produced and felt), a matter of politics (its existence being dependent on the political context), and language (neoliberal discourses of reason and rationality restrict corporeal pleasures)’ (Dennis, 2017: 154). Pleasure can be a ‘measure of freedom’ (Brown, 2019: 3), but when pleasure is heavily marketed as a medical pharmaceutical to liberate women from the ‘tyranny of fatness’, the freedom is elusive, as it does nothing to undo the harms of diet culture, of weight stigma, or of the gendered and politicised power relations embedded in our fat phobic world. The commodification of weight loss drugs is fuelled by a capitalism that pretends to care, but is ‘wily and sticky, [catching] us all: few can elude a system that snares us with your own embodied vulnerabilities’ (Aronowitz, 2018).

Footnotes

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Megan Warin is a professor and social anthropologist at the University of Adelaide. Her research focuses on the gendered dynamics of disordered eating, structural disadvantage and obesity, public health interventions, and the politics of gender and racism in the field of developmental origins of health and disease and epigenetics in relation to nutritional (and other) exposures.

Andrea Bombak is a critical weight, health services, and public health scholar whose research critically explores messaging and policy concerning the ‘obesity epidemic’ and the lived experience of weight stigma.

Bailey George is a recent graduate from the University of New Brunswick, with a Bachelor of Arts in Psychology and Criminology, with wide-ranging interests in social psychology, critical criminology, politics, and history.

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Injecting care and negotiating pleasures with weight loss pharmaceuticals

Abstract

Keywords

Introduction

The uberfication of weight loss

Capitalising on care

Trading pleasures (eating for anticipated weight loss)

Self-acceptance, pleasure and self-care

Conclusion

Footnotes

Declaration of conflicting interests

Funding

Notes

Author Biographies

References