Has Ozempic brought back ‘heroin chic’?
Key Takeaways
GLP-1 medications like Ozempic and Wegovy are effective at promoting weight loss, but some have argued it may come at the expense of body positivity.
Popularized in the '90s, the ultra-skinny "heroin chic" look is now back in fashion (potentially related to widespread use of GLP-1s) which is raising concerns about the potential negative impact on body image and health.
Experts stress the drugs should only be used when medically appropriate, and that cosmetic outcomes should not be a reason to prescribe them.
According to some fashion outlets, dubious trends from 20 years ago (think Uggs and low-rise jeans) are making a comeback, coinciding with rising popularity of the ultra-skinny, "heroin chic" look from the 1990s and early 2000s.[]
While some may argue this is the result of the cyclical nature of fashion, others are attributing the renewed popularity of heroin chic to the widespread use of GLP-1 medications. So, is Ozempic really driving this trend?
The fall of the body positivity movement
GLP-1 medications are popular, so much so that Novo Nordisk, the manufacturer of Wegovy, has issued a statement acknowledging that demand is exceeding supply.[][] In January 2024, the company pledged to double the amount of lower-strength doses available in the US market, as well as increase overall supply throughout 2024.
But not everyone is thrilled by the surge in popularity of the drugs. Some say that increased access to drugs like Ozempic and Wegovy has negatively impacted the body positivity movement.[] And if “heroin chic” really is back, there are problems ahead.
“I remember the ‘lollipop’ look that many actresses had in the ‘90s and 2000s. It was definitely concerning. If it’s making a comeback, we are in serious danger of many food/eating disorders in the making,” Dana Hunnes, PhD, a senior clinical dietitian at the UCLA Fielding School of Public Health, tells MDLinx.
“We shouldn’t be so hyperfocused on ‘thin.’ What is far more important is health. When the focus is on thin, there is higher risk for lower feelings of well-being and psychiatric health,” Dr. Hunnes says.
Weight bias
In the US, nearly 1 in 3 adults are overweight, and more than 2 in 5 live with obesity. Severe obesity affects 9% of adults in the US.[]
And in the age of GLP-1 medications, experts say it’s more important than ever to be aware of how weight bias can negatively impact people.
“We still have work to do, especially in healthcare and wellness services, to make sure that all patients and persons regardless of their size are treated with respect and dignity,” says Renee Rogers, PhD, a senior scientist at the University of Kansas Medical Center. "This starts with not assuming that every person carrying excess body weight wants or needs to lose weight."
"Just because there are effective obesity medications now, that does not mean that everyone should, needs to, or wants to use these to look a certain way."
— Renee Rogers, PhD
The National Eating Disorders Association notes that questions still remain about the impact these drugs have on systemic societal issues concerning weight stigma, race-based health inequities, and disparities in healthcare for those who live in a larger body.[]
“While these drugs do have a medical use, many are seeking them for weight loss only," Doreen Marshall, PhD, CEO of the National Eating Disorders Association, tells MDLinx. "I think if we look at why some are arguing that ‘thin is in,’ we will see it is not based on health, but rather, on weight bias. This bias does not only exist in society, but it can exist in medical settings as well."
Changing the conversation
According to experts, when used appropriately and for the right reasons, GLP-1 medications have many positives. One is that they are changing the conversation around weight and obesity.
“[The availability of GLP-1 medications] has the capacity to move the field to stop thinking about being overweight as solely a choice. It legitimizes what those of us in the field have known for a long time—that bigger-bodied people are not lazy, or weak, but that in some cases are biomedically limited from losing weight and maintaining weight loss,” says Sarah Adler, PsyD, a clinical associate professor of psychiatry and behavioral sciences at Stanford.
In 2021, the FDA approved Wegovy for weight management in people who are overweight and obese who also have at least one health condition related to their weight.[]
Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, shared his experience with the new drugs with MDLinx. “From my experience in our clinic, the majority of people who are seeking this medication are truly seeking it to improve their health. They're having health issues because of their weight, and they've tried other methods and haven't been successful. And right now, aside from surgery, this is the most effective way to help people with weight loss.”
GLP-1 medications are not approved for weight loss for cosmetic reasons or for those who do not meet the medical requirements. Experts say that is a crucial distinction.
“If we continue to promote the misuse of these medications for cosmetic weight loss, rather than for helping those persons with obesity in need of medical/medication support, this sends us down a path of viewing obesity treatment as a cosmetic need rather than one of health,” Dr. Rogers says. “We have much more work to do to make sure that the medications are in the hands of the people that need them, and importantly, that we are not viewing obesity treatment through the lens of how someone looks.”
What this means for you
GLP-1 medications are rising in popularity, and some experts have expressed concern this could inspire “heroin chic” body trends to return. GLP-1 medications are not approved for weight loss for cosmetic reasons. The focus of weight management should not be on achieving a thin appearance, but on overall health.