Oprah Winfrey famously struggled with her weight for years, so she’s tackling a subject that’s fascinating to both her and many other Americans: new weight-loss drugs that are reducing appetite and changing people’s relationship with food.
They include Type 2 diabetes medications such as Ozempic and Mounjaro, which doctors are prescribing off-label for weight loss, and Wegovy, which has been specifically approved for shedding pounds.
More than 2 billion adults — one quarter of the world’s population — are overweight or obese, with obesity killing more people than malnutrition, Winfrey said on her "State of Weight" conversation on Oprah Daily on Wednesday. Panelists included obesity specialists Dr. Fatima Cody Stanford and Dr. Melanie Jay; psychologist Rachel Goldman and Sima Sistani, CEO of WeightWatchers.
On the show, Winfrey mentioned she's been an investor and on the board of WeightWatchers since 2015. Earlier this year, the company bought a telehealth platform that facilitates access to the new weight-loss drugs.
“You all know I’ve been on this journey for most of my life. My highest weight was 237 pounds. I don’t know if there is another public person whose weight struggle has been exploited as much as mine over the years,” Winfrey said. “So I am ready for this conversation.”
Stigma of being overweight
The American Medical Association declared obesity a chronic disease in 2013, but many people can’t wrap their brain around what that really means, she pointed out. Winfrey compared it to her efforts decades ago trying to explain that alcoholism is a disease, with many people refusing to believe it.
Obesity is a disease because there’s dysfunction in how the body is regulating weight, said Stanford, an obesity medicine physician scientist at Massachusetts General Hospital, on the show.
Stanford serves as an adviser to Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy, and has received consulting fees from Eli Lilly, the company that makes Mounjaro, according to Open Payments.
"It’s going on in our brains,” Stanford said. “It’s about how much we take in and how much we store.”
The brain knows where it wants body weight to be and it’s going to do whatever it can to bring a person back to that set point, she noted. Some people’s bodies defend “a very lean set point,” while others have a body that’s predisposed to storing more fat.
“Damn sure mine is,” Winfrey said. “You all have watched me diet and diet and diet and diet. It’s a recurring thing because my body always seems to want to go back to a certain weight.”
Winfrey recalled feeling the stigma of being overweight, noting she’s treated differently if she weighs more than 200 pounds compared to when she’s slimmer. The talk show host added that she shamed herself, and “was shamed in the tabloids every week about for 25 years,” about not having the willpower to eat less.
“It’s nothing you did wrong, it’s just the brain is super powerful,” Stanford said. “This isn’t about willpower.”
Hope in new medications
The idea of weight being a matter of calories in, calories out, or moving more and eating less, doesn’t apply to everyone, Goldman, a licensed psychologist and clinical assistant professor of psychiatry at the NYU Grossman School of Medicine, said on the show.
Winfrey pointed out she can’t eat after a certain time, noting she’d be 2 pounds heavier in the morning after eating a slice of apple pie at 11 o’clock at night.
The new weight-loss medications, which people self-inject once a week, would likely cut cravings for that late-night apple pie.
Ozempic and Wegovy contain semaglutide — a synthetic version of a hormone known as GLP-1, which the body releases into the intestine when people eat food, as TODAY.com previously reported.
When the medication hits GLP-1 receptors in different parts of the brain, that triggers a reaction, stimulating nerves that mimic the effect of eating food — people have reduced appetite, and when they do eat, they feel full sooner.
Another way the medication works is that it slows down stomach emptying, which slows down the absorption of calories and may contribute to the feeling of fullness.
Mounjaro contains tirzepatide and also mimics a second hormone, called GIP, which may improve how the body breaks down sugar and fat in addition to reducing appetite, NBC News reported.
All of the medications come with side effects. Common ones include nausea, diarrhea, vomiting, stomach pain and constipation. Possible serious side effects include pancreatitis, kidney problems and other issues.
'I hope this conversation begins the un-shaming'
Is semaglutide or tirzepatide best for shedding pounds? A head-to-head comparison hasn’t been done yet, Stanford said.
“It looks like from the studies that you get a little bit more weight loss with the Mounjaro because you have that combination, and there’ll be other combinations coming out, by the way,” she noted.
One patient taking Ozempic for three months said on the show that the medication silenced the food noise in his brain, which he described as “a constant obsession about food.” He said he's now “at peace” with not eating everything on his plate.
Winfrey asked the doctors on the panel if this is a “miracle moment” when it comes to obesity treatment.
“I would be very hesitant to say that anything with obesity is a miracle,” said Jay, co-director of the NYU Langone Comprehensive Program on Obesity.
“I’m so excited that we finally have effective treatments for obesity.”
Doctors are still learning the best way to give patients these medications, and some patients may need another drug when their current one stops working as well, she added.
Most people will need to be on the drugs long-term to maintain their weight-loss, she said, and it's still important to eat a healthy diet while on the treatments.
People should be able to lose weight the way that’s best for them, including taking medication, Winfrey said.
“It should be yours to own and not to be shamed about it. As a person who’s been shamed for so many years, I’m just sick of it. I’m just sick of it. I’m just sick of it. And I hope this conversation begins the un-shaming.”
