What happens when a medical drug escapes the clinic and enters popular culture? In her prize-winning thesis Pharmaceuticalizing Thinness: The Social Construction of Ozempic, Rahel Koch explores how a diabetes medication came to embody contemporary ideals of thinness. Drawing on an interdisciplinary approach, she unpacks the social, cultural, and political forces shaping the public meaning of Ozempic—and the broader implications for body norms and health.
When was the moment you realized that the story of Ozempic was not just about medicine, but about something much broader in society?
That realization came quite quickly, actually. Even before I started my thesis, Ozempic was already being widely discussed in public discourse. I vividly remember encountering it through a YouTube video by a fashion commentator a few years ago. She was talking about the return of early-2000s fashion trends, which are strongly associated with an ultra-thin body ideal, often referred to as “heroin chic.” In that context, she explicitly mentioned Ozempic as a tool people were using to achieve that look.
So, like many others, I was not first introduced to Ozempic as a diabetes medication – its original purpose – but almost immediately as a weight-loss drug, and more specifically as a cosmetic weight-loss drug. That framing already indicated that something more than a medical story was going on.
Which parties were responsible for reframing Ozempic shifted as a weight-loss drug?
In my research, I analyzed a wide range of actors and interest groups, including the pharmaceutical industry, regulatory agencies, medical journals, patient organizations, celebrities, TikTok users, and the media. What became very clear is that the reframing of Ozempic was not merely initiated by the pharmaceutical industry, but that this industry also used its substantial economic and political resources to actively influence–and one might even say engineer–a largely homogeneous discourse in its favor.
It is important to understand that this reframing was not something that simply happened by accident. While the weight-loss effects may initially have been discovered in a clinical context, the subsequent emphasis on weight loss was strategically pursued in the commercial interests of the pharmaceutical industry.
You chose the United States as your primary case study. Why that specific context?
Partly for pragmatic reasons: this is a very complex case with an enormous amount of data, so focusing on a single national context made the project manageable. But the United States was also particularly interesting substantively. It has been reported to have exceptionally high rates of Ozempic use, and at the same time there is extensive research showing that American culture exerts especially intense pressure to lose weight—while also having a very high prevalence of obesity.
That tension made the U.S. a compelling context in which to study the reframing of Ozempic. Moreover, trends in the U.S. often have global repercussions. Much of the media we consume internationally originates there, and studies show that celebrity body practices in particular strongly influence how people elsewhere perceive their own bodies. In that sense, the U.S. is not only a case study, but also an actor that actively shapes global discourse.
A central concept in your thesis is “pharmaceuticalization.” How would you explain this concept, and why is it so relevant here?
Pharmaceuticalization refers to the process by which human conditions, capacities, or variations are reframed as opportunities for pharmaceutical intervention. This can happen for different reasons and through different mechanisms.
One pathway is for medical or even medicalized reasons, which is when a human condition, capacity, or variation becomes reframed as a medical issue, such as fatness becoming defined as a disease that requires medical and then later specifically pharmaceutical treatment. Another pathway is enhancement, such as using drugs for aesthetic reasons. A third pathway is health promotion, which frames pharmaceutical intervention as a way to reduce future health risks, even in the absence of present illness.
In the case of Ozempic, pharmaceuticalization helps explain how weight loss itself became constructed as a legitimate and desirable target for pharmaceutical intervention. Importantly, Ozempic is not the first weight-loss drug, but it is widely perceived as revolutionary because it is seen as both highly effective and relatively safe. That perception has been crucial in normalizing the idea that weight loss through medication is not only possible, but responsible and even the obvious choice.
Is Ozempic really as safe as it is often portrayed?
It is generally considered relatively safe, but that does not mean it is without risks. There have been reports of gastrointestinal issues, potential links to pancreatitis, and cases of depression and suicidal ideation. There are ongoing lawsuits related to adverse effects.
What is important to emphasize is that Ozempic is still a relatively new drug. Some risks only become apparent when medications are used by very large populations over longer periods of time. At this stage, it is more accurate to say that adverse effects exist and that uncertainty remains, rather than to claim definitive safety.
What role do social media and celebrities play in the construction of Ozempic’s public image?
They are all part of the same network. While celebrities, influencers, and social media users may appear independent, there is evidence of pharmaceutical companies funding prescribers, patient organizations, and influencers to promote the drug. This is not a novel tactic but has been observed in previous marketing schemes of other drugs. While I could not definitively trace all financial connections, the discourse across these groups was strikingly homogeneous. This strongly suggests coordinated influence, even when direct financial trails are at times difficult to establish.
You show how new groups of people are increasingly framed as patients. What are the broader societal implications of this shift?
This is a very ambivalent development. On the one hand, framing certain conditions as medical issues can provide access to treatment and reduce individual blame. For example, if obesity is understood as a medical condition rather than a personal failure, that may alleviate some stigma.
On the other hand, many scholars argue that medical labels often do little to reduce stigma in practice. We live in a self-optimization society that strongly values (the appearance) of good health. Even when obesity is medicalized, people may still be judged for supposedly failing to take responsibility for their health.
Some scholars go further and argue that labeling fatness as a disease can worsen weight stigma, because it frames fat bodies as pathological in need of a cure and thereby in need of eradication. That logic reinforces associations between fatness, deviance, and deficiency.
Public reactions to Ozempic range from enthusiasm to outrage. What struck you most about the public debate?
The extreme polarization. On one side, there are highly celebratory narratives emphasizing Ozempic’s transformative potential, particularly regarding its ability to treat the obesity epidemic. On the other, there is strong moral outrage and criticism of its cultural implications, like the return of normative thinness.
In my dataset, celebratory accounts dominated, but more recently we are seeing growing backlash–both in a culturally constructive as well as in a senselessly destructive manner. For instance, there are increasing reports of Ozempic users who share positive experiences online receiving large volumes of hate comments and being subjected to cyberbullying. The controversy is still ongoing and evolving.
What do you hope policymakers, researchers, and the general public will take away from your research?
There are two main takeaways. First, while the pharmaceutical industry undeniably provides life-saving medications, it also wields immense power that remains insufficiently regulated. The Ozempic case shows how economic and political resources can be used to advance commercial interests that do not necessarily align with what is in the best interest of public health. In particular, stealth marketing, such as undisclosed influencer endorsements, requires stronger regulation.
Second, the rise of Ozempic coincides with a troubling cultural shift away from body positivity and toward renewed enforcement of thinness as the dominant norm. Weight stigma is not merely a health issue; it is a social justice issue. It is deeply entangled with other forms of systemic oppression rooted in colonial racial capitalism, which historically construct white, male, able, thin bodies as superior. The reframing of Ozempic as a weight-loss drug reinforces these norms and sustains a system that fails to recognize and value the diversity of human bodies.
Your thesis has been praised for its precision and for the care with which it engages with existing literature. How do you, as a researcher, balance critical analysis with doing justice to the work of others?
For me, it comes down to adhering to a fairly straightforward but rigorous scientific approach. I try not to bend my data to make it neatly fit existing theories or arguments, even when those frameworks are influential or widely accepted. Instead, I aim to represent the work of other scholars as accurately and respectfully as possible, and then clearly indicate where my findings align with or diverge from theirs. In my view, such divergences are not a weakness but an important result in their own right.
I do sometimes find it challenging when the empirical reality I am working with turns out to be far messier than the clean arguments one would ideally like to make. In those moments, I remind myself that nuance is not a flaw but a strength. Social reality is rarely black and white, and good research, I believe, lies in making those complexities and ambiguities explicit rather than smoothing them away.
What was the greatest methodological challenge in this project?
The sheer size of the dataset. Tracing the discursive construction of an artifact requires engaging with a very large empirical corpus because it seeks to untangle complex networks of real-world actors influencing an innovation. There are always more actors you could include, more facets you could analyze. The challenge was managing this volume of material without getting lost in the details.
And how did you cope with that?
Honestly, it was very hard. I tried to work extremely systematically and to constantly remind myself to focus on patterns rather than getting lost in minutiae. I also work very visually: I print out annotations, use different colored pencils, and literally map themes by hand. It probably looked like a detective movie scene, but it helped me see connections and structure.
How important was an interdisciplinary approach for your thesis, and did that influence your choice for Maastricht University?
Interdisciplinarity was essential to my thesis and, more broadly, to my entire academic trajectory. I have consistently found that real-world problems simply do not fit neatly into single disciplinary frameworks. Approaching them from multiple perspectives therefore feels both necessary and intellectually productive.
That was a major reason for choosing Maastricht University. Unlike universities in in my home country, Maastricht offered a genuinely open model that allowed students to combine insights from different fields into a coherent, self-designed academic profile. That flexibility suited both my research interests and my way of thinking.
What are your future plans? I would very much like to pursue a PhD at some point. At the same time, I am quite concerned about the current state of academia, both internationally and in the Netherlands in particular. Significant budget cuts have made academic careers increasingly precarious. I have seen close friends invest enormous amounts of unpaid time, what is sometimes referred to as “hope labor”, into developing highly sophisticated proposals for postdoctoral or assistant professor positions, only to be rejected because there are simply many more qualified applicants than available positions.
So while an academic career remains a serious ambition, I feel like it could be pragmatic to first gain some work experience outside of academia to fall back on if necessary at a later stage. So at the moment, I am primarily applying for positions in think tanks and NGOs, drawing on my background in Science and Technology Studies. In particular, I am interested in organizations working at the intersection of digitalization and (threats to) human rights.
