The benefits of GLP-1s for women no one is talking about

GLP-1s are racking up health wins beyond weight loss: They show promise for helping with heart disease, kidney disease, arthritis and sleep apnea, among other conditions. But there’s one benefit nobody’s talking about. By finally putting weight loss within reach, GLP-1s are a tool for upward mobility, especially for women.

We live in a world where a woman’s weight affects her life in ways that extend beyond health. According to a new paper by Harvard economist Rebecca Diamond, “A large economics literature documents that heavier women earn less, work less, and are less likely to marry or cohabit.” (The paper is still a preprint, and it hasn’t been peer-reviewed.)

I spoke with her about it and asked how sure we can be that the obesity drives the lack of opportunity. We know that overweight women tend to be poorer and less educated, so it’s hard to know which way the dynamic goes. She concedes that “we don’t have A-plus evidence,” but what we have makes a strong case that weight matters. She pointed to studies that use fictitious résumés, altering only the photos of the applicant to manipulate their weight. The result? Fat women get fewer callbacks. And if you’ve ever been on a dating site, you’ll believe Diamond when she says that “dating is one of the places it’s more socially acceptable to be outright about physical appearance.” Other researchers have also concluded that obesity drives the lack of opportunity, rather than the other way around.

If you’ve ever set foot in the real world, particularly as an overweight woman, you won’t doubt it. Thin women get better jobs, better partners and better chances. It’s hard to overstate the importance of reducing the risk of the diseases that attend obesity: diabetes, heart disease and some cancers, among others. But obesity can make you miserable long before it makes you sick, and the alleviation of that misery is just as important, if not more so.

You can hate that women’s appearance matters so much. I certainly do. But none of us can reasonably deny that this is how the world works. Appearance is a primary driver of how we’re perceived, and weight, in our society, is a major component of attractiveness.

Diamond’s study was an attempt to quantify the social benefits of being thinner. She looked at women who took GLP-1s like Ozempic and Wegovy specifically for weight loss and compared them to women who would like to, but hadn’t started. After a year and a half, the unemployed women on the drugs were 27 percent more likely to be employed, and the single women were 29 percent more likely to be married or cohabiting than the control group. (Another recent working paper about people with diabetes who took GLP-1s found smaller gains for women.)

The study by Diamond is by no means definitive. It wasn’t randomized, and the women who took the drugs were different from the ones who didn’t: better educated, more affluent and with some indicators of better mental health. Diamond matched the control group to correct for these differences, but when two groups of people are different in such important ways, they are likely to be different in other ways, as well.

Diamond’s findings, though, are consistent with the other evidence on the price women pay for being fat. (Men also pay a social penalty for being overweight, but women have it worse.)

The idea that GLP-1s are a tool for upward mobility touches on something that many public health authorities have been reluctant to talk about. While the health benefits of weight loss are real and substantial, some of the most important benefits have nothing to do with health and everything to do with appearance. “The whole focus has been very much on health,” Diamond said, “because that’s an easier conversation to have.”

I think we should have the hard conversation. I have firsthand experience with how much appearance matters, because I used to be fat.

From college up until I was about 35, I weighed as much as 50 pounds more than I do now. (Full disclosure: my BMI is about 21, and at my heaviest it was almost 30.) While I was just under the definition for obesity, I was heavy enough to feel like — and be seen as — a fat girl.

I haven’t been overweight in 30 years, but I vividly remember the indignities, the insults, the insecurity. In those three decades, I’ve written a lot about obesity, and I’ve talked to many women who struggle with their weight. The running theme of those conversations has never been health. It has been confidence.

Many years ago, a woman in her 20s who had lost over 50 pounds told me that, at her heaviest, she felt so insecure that she couldn’t offer an opinion on even the most innocuous of topics, like what kind of music she liked. Her constant awareness of her weight was paralyzing. Time after time, women told me that the fat version of themselves wasn’t the “real” version, and weight loss enabled them to be themselves.

Being fat doesn’t make everyone unhappy! I know women who are comfortable being overweight, who don’t let their bodies sap their confidence, and my hat’s off to them. It takes a special kind of strength to be able to do that in the face of societal opprobrium, and I admire everyone who has made body positivity work for them.

It never worked for me. I am my body’s harshest critic. Even at my thinnest, I see its flaws. “Fat girl” etches itself into your identity. It is soul-crushing, because it comes to define you. To this day, if I catch a glimpse of myself in a mirror or a window, my first thought, unbidden, is, “Huh — I’m not that fat.”

I know this is a response to unreasonable demands our society places on women, but it was never a choice I consciously made. While I’ve always been confident in my ability to think, to talk, to reason and to write, I’ve never been confident in my physical presence. I have felt ugly for my entire life, and a prefrontal-cortex belief that the expectations are unreasonable is no match for lizard-brain insecurities.

This is why I care so deeply about obesity, and it’s a big part of why I’m so enthusiastic about the new drugs. While the weight-loss evidence is robust, and other benefits seem to be better established every day, we only have glimmers of upward mobility so far. Given the increasing uptake of the meds, and the success so many people are having with them, there’s good reason for optimism.

I’m thrilled that these drugs are helping women (and men) lose weight. They will undoubtedly be healthier. But they might also be happier. Better jobs, better partners and better chances just might be within reach.