JUANA SUMMERS, HOST:
Oprah Winfrey - a woman so powerful, so influential, there's no need to use her last name. She's simply Oprah. And during the more than two decades that her talk show was on the air, Oprah became firmly woven into the fabric of America.
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OPRAH WINFREY: Open your boxes. One, two, three. You get a car. You get a car. You get a car. You get a car. You get a car.
SUMMERS: Throughout those two decades and beyond, another thing about Oprah was firmly woven into the cultural fabric - her relationship with weight. And everyone, including comedian Joan Rivers, felt comfortable commenting on it.
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JOAN RIVERS: 'Cause you went into beauty contests. They told me you're a beauty contest winner.
WINFREY: Yeah, 50 pounds ago or so.
RIVERS: Yeah. But - so what did you win?
WINFREY: Well, I won the Miss Fire Prevention Contest. Was that a hoot.
RIVERS: Miss what?
WINFREY: Fire Prevention.
RIVERS: So how did you gain the weight?
WINFREY: I ate a lot.
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RIVERS: 'Cause - no, no, no, no, no, no, you said 50 pounds. You shouldn't let that happen to you. You're...
WINFREY: I'm so...
RIVERS: ...Very pretty.
WINFREY: You know what?
RIVERS: No, I don't want to hear.
WINFREY: Let me tell you...
SUMMERS: Oprah did lose weight after that. Sixty-seven pounds, to be exact. And she shared that experience on her talk show.
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WINFREY: A lot of you already know that what I did was I fasted for - without cheating - for a solid six weeks.
SUMMERS: She illustrated that dramatic weight loss by pulling a wagon full of 67 pounds of meat fat onto the stage. She later said she regretted it. Oprah continued to gain and lose weight, and she continued to be public about those changes in her body. In 2015, she married the personal and the professional.
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WINFREY: I love bread. I have bread every day. That's the genius of this program.
SUMMERS: She bought a major stake in the decades-old weight management company Weight Watchers. Now in 2023...
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UNIDENTIFIED PERSON: She stunned in the curve-clinging dress with a modest slit.
SUMMERS: ...As she walks the red carpet promoting the release of a new version of the movie "The Color Purple," Oprah is showing off another weight loss. And once again, she is sharing how she did it through an unnamed weight loss drug. Oprah told People magazine last week that she's using one of the weight loss drugs that are commercially known as Ozempic, Wegovy or Mounjaro. CONSIDER THIS - a new class of drugs is changing weight loss and the way Americans think about weight. Is this the magic bullet people have been waiting for or just another fad?
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SUMMERS: From NPR, I'm Juana Summers. It's Wednesday, December 20.
It's CONSIDER THIS FROM NPR. She's been up. She's been down. And she has used a host of strategies and fads to get to that storied goal weight. And now Oprah Winfrey, like so much of America, says she is using a weight loss drug. Weight Watchers, a company that has preached counting calories, counting points and using self-control as a means to a healthy weight is helping its customers access those drugs. And the company, which Oprah owns a large part of, is betting big on the pivot. I talked to Weight Watchers CEO Sima Sistani about all of this last week, shortly after Oprah revealed that she was taking a weight loss drug.
Oprah's fluctuating weight in her body and the treatment she's received because of it has been a topic of public discussion for as long as I can remember, and Oprah is also the kind of person who clearly does not suffer from a lack of grit and resilience and determination. I want to start by asking you, what example does her latest revelation that she is using these class of medications give people who are struggling with weight loss on their own?
SIMA SISTANI: Look. I think it's really important that we acknowledge that there has been a decadeslong narrative that has painted weight loss as a mere test of willpower, and it's perpetuated this sense of shame and misunderstanding around what it means to live with overweight and obesity. So for some, different solutions like these new, clinical interventions are really needed.
SUMMERS: At the same time, I mean, listening to Oprah talk about the liberation that she feels, the ability to better manage her weight, to take a dose of one of these drugs before Thanksgiving, when, you know, like many of us, she's going to have a big dinner, it's a powerful message, but she is also someone who's invested in your company. Do you think that dilutes the power of the message that she's giving to people who are facing similar struggles?
SISTANI: Well, look. Miss Winfrey, along with the rest of our board, stands by our business vision and our program offerings. But we all know that her story has been one that has been a generational story and one that mimics so many people who, on a day-to-day basis, struggle with the same shame and bias, where weight loss has been associated with a preoccupation around thinness. And what we're trying to do is reshape that conversation around weight health. It's not a matter of vanity. This is about the degree to which weight impacts your health and your quality of life. And for decades, we've discussed weight and dieting and obesity in terms that isolate people and often demotivate them.
SUMMERS: So does that mean that the advice that Weight Watchers gave people - including myself, I should note. I'm one of those people who turned to Weight Watchers at various points in my own journey, struggling with my own weight. Was the advice that we were given for years about what it takes to lose weight, that focus on determination and resilience and willpower - was that advice just wrong?
SISTANI: I'm going to say, as somebody who was very humbled to take this role because Weight Watchers also worked for me - yes, that advice was wrong because we said it was choice, not chance. And the truth is that this is a chronic condition. And ultimately, for every one person that we helped, there was one person who our program did not work for because they were dealing with a chronic, relapsing condition with biology and genetics and environmental underpinnings. And so in order for us to reintroduce ourselves, we need to acknowledge the part that we had in the past.
SUMMERS: There are some real questions out there about how much we don't know right now about the long-term effects of medications like Ozempic and Wegovy, examples of the GLP-1s that we've been discussing. How does this program answer and speak to some of those concerns?
SISTANI: Well, GLP-1s are not new. The indication for obesity is new, but they have been prescribed for decades for people living with diabetes. So that gave us a lot of comfort in embracing this clinical pathway.
SUMMERS: I do want to address the question of access and cost here. Many people can't afford to take these drugs. People talk about spending hundreds, if not more than $1,000 to access prescription drugs like Wegovy and Ozempic if they're not covered by insurance. And I would imagine then that there are more who can't afford to take these medications indefinitely. Do you worry at all that this sets people who are eager for solutions and eager to lose weight up for long-term frustration?
SISTANI: Well, I think you're bringing up a really important cultural conversation, which is these medications right now are incredibly expensive, and they should be covered. It is criminal, in my opinion, that they aren't covered. And they are put in the same category right now as, you know, medications for hair loss and erectile dysfunction. This is a reflection of our healthcare system being based on a disease model versus thinking about preventative measures for weight health. And so we are having that conversation at a policy level as well, so that we can make sure that everyone can have access to support and care that they need.
SUMMERS: Something I think about a lot that I'd love to get your take on is whether you worry about people out there who might see medications as a quick fix for something that can be so complex and so individual.
SISTANI: There are no quick fixes. Even these medications - ultimately they don't replace lifestyle intervention. And I think the focus that we want is to acknowledge the chronic condition so that we can change the bias in the conversation for what is ultimately a very lonely experience for many.
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SUMMERS: Weight Watchers CEO Sima Sistani.
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SUMMERS: This was a pivotal year that saw so many developments in the use of this new class of obesity drugs. Joining us now to discuss those is consumer health correspondent Yuki Noguchi. And, Yuki, can you just start by reminding us how exactly these drugs work?
YUKI NOGUCHI, BYLINE: Yeah. I mean, you mentioned earlier three brands - Ozempic, which is originally a diabetes medication, and Wegovy, which is a higher dose of that same drug, and then there's a different one called Mounjaro. But what's new about all these drugs is how they act on both the brain and the gut. They increase hormones that slow digestion and make us feel full. And the breakthrough is that these drugs act on the brain.
You know, we might think of obesity as being driven by the body, but it's the brain that signals to us that we're hungry or that we're full. And so people using these drugs often say they're freed from this sort of constant gnawing hunger. And, you know, ideally, what that does is enable them to make other sort of healthier lifestyle choices - right? - like smaller portions and - or, you know, eating more fruits and vegetables and, as they lose weight, getting more exercise.
SUMMERS: We heard Weight Watchers CEO Sima Sistani make the case that obesity is a disease, and it should be treated the same as other diseases by covering the drugs that treat it. But how popular is that point of view?
NOGUCHI: So a couple things. I mean, our understanding of obesity and, frankly, even among doctors is really just starting to shift toward thinking about obesity as a disease. It's been a decade since the American Medical Association declared obesity a disease. And, in fact, obesity itself is considered disease. But it's also tied to many other ailments, like heart or liver or kidney diseases or even, you know, problems with mobility and things like that. But even though it's now considered a disease, whether to treat it and, you know, more practically, how to pay for it is still kind of controversial. Medicare actually currently prohibits coverage of weight loss medications. So, you know, Congress would have to change that in order to open up insurance coverage more generally.
And, you know, how popular is the idea of insurance covering this stuff? Well, you know, there, you just can't talk about that without talking about the high cost of these drugs. You know, out of pocket, these medications cost well over $1,000 a month. And treatment is long-term, maybe even life-long. So that's a lot of money over potentially a long time for insurers or taxpayers if you're talking about, you know, public insurance like Medicare. And right now only those with great insurance or people with money like Oprah are able to get them.
You know, but at the same time, the cost-benefit analysis really isn't that simple because, you know, two-thirds of Americans struggle with excess weight or obesity, and the rates are higher among minorities. And because so many diseases are linked to obesity, you know, the lifetime cost of not treating obesity ultimately could cost more than these drugs, right? Like, heart surgery or dialysis - these things cost a lot of money.
SUMMERS: And we should just be clear here. Companies like Weight Watchers and others are also trying to make a profit. These drugs are new, and some of the long-term risks are not yet known. So, Yuki, given that, I mean, who are consumers to trust? What is the risk-benefit calculation for people?
NOGUCHI: Well, you know, that's just it, right? Think of everything the weight loss industry has peddled over the years - you know, diets and fads and even other medications. You know, even the Weight Watchers CEO is now saying, sorry; we had it wrong, you know, because science now tells us diets actually tend to drive regain of even more weight. And quite understandably, many people feel burned. Like, why should I believe you now? And especially if it's a costly drug that they're supposed to be on maybe forever, you know, some people don't even tolerate them well. They get nauseous or whatever or lose coverage and then can't afford them. And then what we know is that stopping these drugs tends to pack the weight back on. It's not a long-term fix. But, you know, at the same time, for many people, this is not about, you know, looking thinner or losing weight. It's - you know, medically they're in a dire situation. And so this might be the best available life-saving option to treat conditions due to severe obesity.
SUMMERS: Yuki, in all of your coverage of obesity and the advent of these new drugs, what's your big takeaway?
NOGUCHI: You know, what's astonishing to me is that obesity has been so grossly misunderstood despite, you know, being so common. And it's misunderstood in harmful ways, like physically and emotionally. You know, we've talked about weight in terms of shame and not really science. And generations of people were told to do or not do things that were, you know, counterproductive. And what I hope is that we can find a way forward that's based more on science and less influenced by judgment or pure profit motive. But, you know, for all the reasons that we just talked about, that turns out to be harder than it sounds.
SUMMERS: NPR's Yuki Noguchi. Thank you.
NOGUCHI: Thank you, Juana.
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SUMMERS: It's CONSIDER THIS FROM NPR. I'm Juana Summers.
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