Over the last four years, GLP-1 agonists such as Ozempic, touted by many as miracle weight-loss drugs and popularized by celebrity culture, have seen a 700% increase in use among patients without diabetes. Their use for weight loss has more than doubled since early 2024. On November 6, 2025, the Trump administration announced that the cost of these drugs would be dramatically reduced and that they would now be covered by Medicare. On March 21, 2026, The Lancet published a feature article, “Making treatment for obesity more equitable,” extoling the virtues and promise of greater access to GLP-1 drugs. With their popularity, newly expanded access, and increasingly widespread use, we identify two concerns that deserve attention from bioethicists and healthcare providers, neither of which has received much, if any, discussion in the surrounding literature. One concern is medical. The other involves questions about the relationship between a person’s body size and their perceived rationality.
The popularity and widespread use of these weight loss drugs could influence the way doctors come to perceive, judge, assess, make recommendations for, and even treat overweight patients, similar to (though far more ubiquitous than) what happened with bariatric surgery and other weight-loss drugs like fen-phen in the past.
Losing weight and meeting lower BMI cut-offs are already requirements to be eligible for various surgeries and other medical procedures. This requirement (regardless of whether it is medically justified), combined with easier access to GLP-1 drugs, will make it even harder for fat people to get healthcare (especially since it will now be made more widely available due to the price drops and to being covered by Medicare). Since (as we’ve long known) most diets don’t work, GLP-1s could increasingly become a precondition for getting many surgeries and procedures (in addition to those where this is already the case), further normalizing the often harmful requirement that patients lose weight before receiving additional care and further entrenching the idea that health is necessarily and directly correlated with weight.
From the patient’s perspective, these medical consequences are of serious concern. They become even more alarming given the ease of access to GLP-1 drugs and the ways that they are reshaping what is considered to be a “healthy” weight. These rapidly changing norms increase the burdens and obligations placed on patients who are not considered thin. As bioethicist Jada Wiggleton-Little wrote in her blog, “When a clinician recommends Ozempic to a patient who does not have a weight-related morbidity that would make prescribing Ozempic medically justified, what gets conveyed is not only an obligation to take the medication—which can come with a host of gastrointestinal side effects—but it also conveys an obligation to not be fat.”
These related issues – changing norms about ideal/healthy weights; pressure from both the medical world and popular culture to adhere to those norms; normalizing the use of weight-loss drugs for cosmetic (not medical) reasons – and the requirements they place on patients should concern us. For many patients – and contrary to medical and social norms – being fat itself often poses no intrinsic health dangers. Rather, what is often most dangerous and poses more direct and daily health harms for many fat people is not their fat body, but rather the anti-fat bias they face in society, specifically in medical contexts that have devastating psychological and other effects. In a society that stigmatizes fatness, GLP-1s will become a cure that can distract from the actual conditions many patients face, or as a prerequisite to receiving care, preventing needed care until the condition has been satisfied by the patient.
In short, take a GLP-1, or else…
Our second worry has to do with the complicated way that rationality attaches to body size. With the growing popularity of GLP-1 drugs, combined with the medical-social duty to be thin, fat patients who are prescribed such drugs to lose weight and who opt out of taking them will likely be perceived as irrational. This claim must be understood against the backdrop of the harms that fat patients already experience in medical contexts. On average, physicians spend less time and build less rapport with fat patients; fat patients are generally presumed to be unhealthy on account of their weight (even when they are not) and as such, experience microaggressions and macroaggressions from healthcare professionals, resulting in fractured trust. For many healthcare professionals, all negative health issues experienced by fat patients tend to be attributed to their weight (even when they are unrelated). Additionally, many essential medical devices and equipment (like blood pressure cuffs, CT scanners, and even hospital beds and hospital gowns) do not fit them. Overall, fat patients receive worse care than patients who are not considered to be fat. Compounded by these harms – and what we’d like to focus on here – is the less immediately obvious, but no less serious epistemic harm (viz., harm suffered as a knower) that fat patients experience in the wake of the rise of GLP-1 drugs.
Given the background social and medical norms about thinness, combined with the duty to be thin and the new, purportedly “easy” path to thinness offered by GLP-1 drugs, fat people who choose not to take those drugs are likely to be seen both by doctors and by society as irrational, as bad knowers, or as not being knowers at all. That is, their rationality and credibility as fat people will be viewed as deficient or nonexistent. Fat patients who are prescribed GLP-1s to lose weight for whatever reason and who decide not to take them will be regarded as not responding appropriately to reason, and as a result, will be regarded as being prone to making wrong decisions and having the wrong priorities (such as not valuing their health). In short, in a world that stigmatizes fatness and where GLP-1s are (in principle) available to everyone, fatness itself becomes evidence of irrationality. If it’s bad to be fat, and if you can stop being fat by taking this drug, then choosing to not take the drug is proof that you are irrational and thus, prone to making bad decisions.
Why should this concern us? And why is this epistemic harm just as serious as the medical harm described earlier? We respond by offering a few big picture answers, followed by some normative suggestions for healthcare professionals.
First, if you are regarded as irrational, then it is easier to ignore you when, for instance, you describe your symptoms or rate your pain, thereby exacerbating the medical harms described earlier. Second, if you are considered to be irrational on account of your fatness, then it also becomes easier to disregard or disbelieve you when you describe non-medical things. If fatness is an indication that a person is generally irrational and not credible, then why should anyone believe what fat people have to say about anything at all? Finally, and zooming out, if fat people as a group are taken to be irrational (because they are fat in a world where GLP-1s are, in principle, available to them), then individual harms become systematic and thereby oppressive – no longer just a matter of individual mistreatment but of injustice.
Lauren Freeman, PhD is a Professor of Philosophy at the University of Louisville
Barrett Emerick, PhD is a Professor of Philosophy at St. Mary’s College of Maryland