Dickens’ Dream

A Tale of Two (or More) Obesities

When a medical condition starts to define how we see ourselves, the conversation about it gets messy. Is this a health concern? Or is it about appearance and vanity? Is concern about obesity something for the few and the wealthy? Or something that profoundly affects the health of a large segment of the population across the board? Something that can no longer be pushed out of the realm of medical care? We are confronting a tale of two obesities.

Some people struggle to get medically appropriate care for obesity that will restore their health. Others don’t think twice about paying many thousands of dollars out of pocket to shed some weight left over after expensive fertility treatments and giving birth to a baby. The contrast is jarring.

Worried About “Ozempic Face”

Amy Synnott reports on the rise of a new secondary concern for people who have ready access to a new generation of obesity medicines. Dermatologist Paul Jarrod Frank, who coined the phrase “Ozempic face,” describes the phenomenon in his New York clinic:

“I see it every day in my office. A 50-year-old patient will come in, and suddenly, she’s super-skinny and needs filler, which she never needed before. I look at her and say, ‘How long have you been on Ozempic?’ And I’m right 100 percent of the time. It’s the drug of choice these days for the one percent.”

One might call this the medical spa view of obesity. And in fact, many of these persons might deny that obesity is a problem they face. “I just needed to lose some weight.” We hear it more times than we can count, from people who present with adiposity that ranges from negligible to quite substantial.

A Struggle for Health

A more common view in this tale of two obesities comes from folks like Nikki Tibbs, a registered nurse for whom coping with obesity is a daily struggle for health. She tells us:

“Living with obesity is a daily struggle – just as it would be for someone living with diabetes. Food is often the center of celebrations, cookouts, holidays, and family gatherings. I have to think about every meal and pre-plan everything to ensure that I am staying within my boundaries.

“I still have a BMI in the range of obesity by medical criteria and by social standards. But I have come a long way and I am proud of my accomplishments.”

Many Different Slices of a Real Medical Problem

So you see, even though obesity is a very real and sometimes profound medical problem, people can experience it in very different ways. Many people struggle to cope. A few pay large sums of money out of pocket and remain enthusiastic about the money they’re saving on trainers and other things they no longer need.

Somewhere in between the extremes of no access to care and medical spa luxury, we believe there is room for routine medical obesity care to help people improve their health and quality of life. It will likely reduce the burden of other chronic diseases as well.

Click here for Synnott’s report on “Ozempic face” and here for more on disparities in access to care for obesity.

Dickens’ Dream, painting by Robert William Buss / WikiArt

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January 25, 2023