Ozempic is not a weight-loss drug — at least not officially. According to the company website, the product — based on semaglutide — is for adults with type-2 diabetes and is “not for weight loss”. However, there is the coy admission that “Ozempic may help you lose some weight” — hence the avid public interest, which will only be increased by reports today that the drug could reverse heart disease symptoms, according to a landmark global trial.

Unsurprisingly, the fat-acceptance movement is upset. There’s a prime example of this in an article for The Conversation by Fady Shanouda, an assistant professor of “critical disability studies” and Michael Orsini, a professor at the Institute of Feminist and Gender Studies in Ottawa.

For connoisseurs of progressive academic language the piece does not disappoint. For instance, we’re told that Ozempic has been “heralded by many to culminate in the elimination of fat bodies”, and that it can be understood as a form of “pre-emptive obesity biopolitics” (whatever that is). Then there’s the claim that talk of ending the obesity epidemic is “laced with the idea of eradicating fat people”.

Really? If a fat person gets thinner to the point of no longer being fat they haven’t been “eradicated”: they’ve just lost weight. One would think that the part of them which matters is the person, rather than their body shape. The authors decry “policy interventions that seek in the present to prevent fat futures”, but helping people to lose weight might just give them a longer future.

And yet, in the midst of the overwrought identity politics, Shanouda and Orsini do make a necessary point. This comes when the authors warn that we’re reaching a moment when “banal and commonplace fat-shaming” could be elevated to “an unprecedented level”. In my view, that moment will come if semaglutide, or something similar, is optimised and approved as a weight loss drug for the general population.

Over a quarter of adults in Britain are listed as obese, with a further 38% falling into the category of “overweight”. Given that obesity costs the NHS £6.5 billion a year, the Government has a clear economic incentive to tackle a fattening population. The more evidence there is of drugs like semaglutide working, the more likely health authorities are to encourage their uptake by the general population.

In free societies, healthcare is sometimes compelled on the unwilling — for instance, people with dangerously contagious diseases can be quarantined, the severely mentally ill can be sectioned and, as we saw in some EU countries during the Covid epidemic, vaccination can be made compulsory. 

Of course, in all of those cases, the justification is one of public safety — which would not apply to obesity. However, given that being overweight is a risk factor for various medical conditions, there would be a huge financial motivation to systematically minimise those risks and hence the long-term costs of treatment. For instance, private health insurers could punish customers who won’t take their weight loss drugs by increasing their premiums, and employers could withdraw cover from uncooperative employees.

As for public healthcare systems, “difficult” patients could be deprioritised for the treatments that they do want. Here, the ground is arguably already being laid, with Health Secretary Steve Barclay claiming the drug could cut NHS waiting lists and trim benefits.

When effective weight-loss drugs become available, Barclay’s plans could result in the public feeling pressured to take them. Even if one laughs at ideas like “fatphobia”, the libertarian principle of bodily autonomy is nevertheless at stake. We don’t force invasive treatments such as liposuction or gastric bands on overweight people, so, when the time comes, we shouldn’t do the same with their biochemical equivalents. That, rather than the “elimination” of a self-interested group identity, should be the concern of the fat-acceptance activists.

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Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.

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