Saying no to weight-loss drugs: The paradox of the ideal patient-consumer and stratified biomedicalization

Discourse around the usage of weight-loss drugs (semaglutide, GLP-1 agonists, Ozempic, Wegovy) center around how people are precluded from access, a phenomenon understood as stratified biomedicalization. However, this research project finds people reject weight loss drugs even as they are generally invested in biomedical solutions to weight loss, due to reasons beyond lack of access. This paper expands the concept of stratified biomedicalization by attending to a case of agentic disengagement regarding weight-loss drugs. Here, agentic disengagement refers to the individual or collective refusal of a biomedical intervention (i.e. weight-loss drugs) in favor of prioritizing a longer-standing approach to weight loss, specifically one that stems from self-discipline and surveillance (i.e. WeightWatchers). This, I argue, can be understood as a bottom-up manifestation of stratified biomedicalization. Drawing on over 100 h of ethnographic notes at WeightWatchers meetings and 20 interviews with members, I outline three dimensions which demonstrate how agentic disengagement may factor into stratified biomedicalization through: 1) A cultural logic which emphasizes slow and social health interventions, 2) A focus on transformation and capacity building, and 3) An understanding of pharmecutical interventions as burdensome and risky. These dimensions of agentic disengagement are especially informed by the race, gender, class, and age of the participants in the study. Paradoxically, the emphasis that processes of biomedicalization places on a hyper-responsible and informed ‘ideal patient-consumer’ is part of what emboldens people to disengage with weight-loss drugs.