The Ozempic boom and new obsession with thinness are threatening body positivity

The controversial campaign by pharmaceutical company Novo Nordisk to speak “without filters” about obesity has reignited a deep societal dilemma: how obesity is perceived and how it fits, in the era of Ozempic, with the body-positivity movement. The rise of anti-obesity drugs and the growth of online communities that promote thinness have put increasing pressure on movements advocating for body diversity and self-acceptance.

The Novo Nordisk campaign in Spain was quickly met with strong backlash on social media, being labeled fatphobic, “tasteless,” and “indecent” — and even prompted the intervention of the Spanish Ministry of Health, which requested “clarifications” over concerns that it may constitute covert advertising.

Novo Nordisk itself, the maker of drugs like Ozempic, defended the campaign — which warned in bold capital letters that obesity is “a disease” that “can kill” — saying: “The conversation about obesity is loaded with filters that, in an attempt to avoid offending sensibilities, offer a distorted reality that prevents people from making sound health decisions.” The company’s position was clear: “We want to separate obesity from aesthetic trends or the body-positive movement to create real public awareness about the importance of seeing a doctor.”

Philosopher Magdalena Piñeyro, activist and author of Stop Fatphobia and Subversive Bellies, felt targeted by the controversial ad: “It seems that this so-called ‘unfiltered’ talk is a response to the supposed pressure or censorship that activists like us are placing on those who pathologize and discriminate against us. It reminds me a lot of the whole ‘snowflake generation’ accusation and the usual conservative complaints that ‘you can’t say anything anymore.’”

Novo Nordisk also argued in its campaign that obesity is not about aesthetics, but about health. However, Azahara Nieto, a clinical nutritionist, sees flaws in that premise: she argues the campaign is “populist, and it penalizes and pathologizes larger bodies regardless of their actual health. It denies body diversity. A person can weigh more and still be healthy.”

When asked about how these drugs may be transforming body ideals and undermining conversations about body acceptance, nutritionist Azahara Nieto argues that the current wave of enthusiasm for weight-loss medications is shifting the focus away from body diversity: “All these movements in defense of body diversity are being pushed aside by the cult of thinness and the discipline of the body.” At the same time, however, she sees a growing response from “the fat liberation movement that emerged in the 1970s and continues to fight against the pathologizing of fat bodies.”

Diego Bellido, president-elect of the Spanish Society for the Study of Obesity (SEEDO), doesn’t believe that the rise of Ozempic and similar drugs has reversed the progress of body-positivity or self-acceptance movements. Still, he acknowledges that these medications have spread the idea that losing weight is easy, and warns of the dangers of trivializing their use. “It’s not just a matter of prescribing the drug,” he says. “A patient might be losing weight at the expense of muscle mass, and that’s not a gain in health — it’s a loss.”

Rethinking the medical view of obesity

In the ongoing reshaping of how society views obesity, the medical and scientific perspective plays a central role. The World Health Organization classifies obesity as a chronic disease, but among experts, there is still ongoing scientific debate about whether it should be defined as an illness in itself or rather as a physical condition that increases certain health risks.

A recent study published in the BMJ medical journal also challenges the traditional medical approach to obesity, which has primarily focused on lifestyle interventions to achieve weight loss. The research argues that this strategy has “little to no effect on sustained weight loss and no benefit on hard outcomes such as cardiovascular events or mortality.” It also warns: “A focus on weight loss may contribute to discrimination and internalized stigmatization.”

Piñeyro has a lot to say about the medical perspective. “The main reason why overweight people stop going to the doctor is discrimination, not being heard, and diagnostic errors,” she says. She points to examples such as the absence of adapted infrastructure — like exam tables and wheelchairs that fit larger bodies — or being denied treatments and surgeries based solely on BMI.

Skinnytok and the cult of thinness

The controversy and paradigm shift triggered by the Ozempic boom has coincided with a resurgence in the cult of thinness and a revival of the early-2000s “heroin chic” aesthetic.

“We’re seeing it on social media. We’re back to Skinnytok, to thinness and perfection. We’re returning to bodily neoliberalism,” warns Azahara Nieto, a clinical nutritionist. On platforms like TikTok, communities glorifying thinness as a symbol of success are thriving, with influencers like Liv Schmidt leading the charge — her brand of internet space, founded under the hashtag #skinnytok, features white, thin women giving advice on how to stay skinny.

Nieto cautions that these narratives, which put thinness back in the spotlight, are leading to “a surge in eating disorders (EDs).” Cristina Carmona, clinical psychologist at Hospital Sant Pau, agrees: “We’re seeing again that people are developing a negative view of obesity. If a few years ago thinness was seen as a beauty ideal, now it’s seen as a health standard. Many people develop an ED just because they want to be healthy — they think eating little is healthy.”

Towards body neutrality?

In the face of what could be a regression in the social acceptance of body diversity, Nieto proposes a different narrative: embracing body neutrality instead of body positivity. Both movements advocate for self-acceptance, but body positivity still emphasizes appearance — it promotes beauty at every size — while body neutrality shifts focus toward appreciating the body for its functionality, not aesthetics. Ideally, the approach would be health at all sizes,” she concludes.

Bellido, however, disagrees with this idea: “I don’t believe in metabolically healthy obesity. A patient with excess fat will always have comorbidities, even if it takes time to see the damage.” However, he does agree that “focusing only on weight is bad practice” and advocates for evaluating both fat and muscle to get a more accurate health profile than outward appearance alone can provide.

The ideological undercurrent

Beneath the broader debate around social perceptions of obesity and shifting body ideals lies a deeper ideological tension. In both the criticisms and defenses of Novo Nordisk’s controversial campaign, there are political undertones — particularly in references to “woke culture,” which champions social awareness and sensitivity toward diversity.

Nieto links this back to neoliberal ideology: “We’ve gone from ‘you’re poor because you want to be’ to ‘you’re fat because you want to be — because you could fix it with medication and exercise.’ The sense of bodily discipline and control is a false form of self-mastery, even though not everyone starts from the same place. And if you can’t reach it, it’s framed as a failure.”

Piñeyro adds: “We can’t forget that in this fatphobic society, thinness is associated with discipline and self-control — moral virtues held up as aspirational and central to self-creation (this idea of ‘the successful self-made man’). That morality often borders on eugenics — and is, of course, deeply neoliberal and individualistic — erasing the social, cultural, and economic contexts that shape people’s lives and bodies.” As long as thinness is applauded as a reward for individual effort, she argues, “we’ll continue feeding the dangerous idea that some people are worth more than others.”

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