A few weeks ago, a controversy emerged concerning tennis star Serena Williams’ appearance and apparent promotion of  Ro, a telehealth company that has boomed in popularity due to its ability to prescribe and distribute GLP-1 (glucagon-like-peptide-1) medications. Williams has said that she felt taking a GLP-1 would be the right decision after struggling to lose weight following the birth of her second child. Despite extensive training, she was struggling with joint pain  and blood sugar issues before losing 34 pounds  in a year on a GLP-1. She has also gone on record to say that she had “a lot of knee issues” as a result of excess weight, and that the excess weight “definitely had an effect on maybe some wins that I could have had in my career.” . Tennis is largely comprised of running, which can put “forces 6-8 times your body weight for brief periods,” meaning excess weight can put unnecessary strain on your knees.  It is also worth noting that Williams’ husband, Alexis Ohanian, is also a major investor in Ro.

GLP-1s are the product of Dr. John Eng’s research in the 1990s, where he posited that a component of gila monster venom, Exendin-4, could be the answer to earlier hypotheses in the 1980s concerning the role of gut hormones in regulating blood sugar levels. Exendin-4 mimicked the GLP-1 hormone’s ability to stimulate insulin secretion, thus suppressing glucagon release and slowing gastric emptying. By 2005, the FDA approved Byetta, a synthetic version of Exendin-4, for use as a type II diabetes medication. Today, the FDA has approved semiglutides and high-dosage liraglutides to help treat obesity, or contribute to weight loss. 

There is a lot of discourse surrounding the bodily health of the average American. According to the CDC, 72% of American adults over 20 are overweight or obese, with 40% of that being obese, or having a BMI of 30 or higher. Similarly, they also report that 22.9% of children aged 12-18, 22.1% aged 6-11, and 14.9% aged 2-5 classify as obese. Simply put, a large percentage of the U.S. populous is overweight. This is in large part due to the average American diet; JHU reports that “More than half of the calories that the average American adult consumes are from ultraprocessed foods.” While all foods are processed to a certain degree, ultraprocessed foods are defined in Dr. Carlos Monteiro’s Nova system as “made using industrial methods and ingredients you wouldn’t typically find in grocery stores…[and] often contain additives like flavorings, colorings or emulsifiers to make them appear more attractive and palatable.”  Ultraprocessed foods also tend to be low volume, calorie dense foods that do not keep you full and are engineered to be addictive. The average American is consuming over 3,000 calories per day, with the recommended amount being 2,000 for women and 2,500 for men , and is hardly moving—3,000 to 4,000 steps per day. Adjacent to all of this is the prevalence of Binge Eating Disorder (BED), the most common eating disorder in the United States which is characterized by “binge” episodes where a person overconsumes and restricts cyclically, resulting in weight gain. All of this is relevant as to its core, “Overweight and obesity are the result of excess calorie intake or inadequate energy expenditure or both.” 

The rise of obesity, by and large, is a summation of the failures of many systems in the United States. There is a profound lack of education concerning nutrition unless you are pursuing a career as a dietitian or nutritionist. This is not helped by RFK Jr. ‘s “Make America Healthy Again” declaration that focuses less on moving more or eating more whole foods and more on raw milk and beef tallow. American developments are largely unwalkable and, as you will learn in any environmental science class, cars are the go to for transportation. Food deserts, or “geographic areas where residents’ access to affordable, healthy food options…is restricted or nonexistent due to the absence of grocery stores within convenient traveling distance,” are prevalent across the nation, making it difficult to adequately nurture families in these areas, which tend to be in impoverished areas. Advertisement of highly processed, high-calorie foods is unregulated and targeted at children, and delivery apps such as DoorDash are commonly used on a daily basis in conjunction with multiple trips to drive-thru fast food restaurants. On social media, there is a constant push-and-pull between the fat acceptance movement and the newfangled “SkinnyTok” sphere, with both sides lobbying for their respective body type. 

At the end of the day, I believe the most radical thing you can do for yourself is to be fit and healthy. You do not have to be bone thin to meet the criteria to be healthy, however, it is objectively a negative thing to be pushing 300 pounds and be 40% visceral fat and adipose tissue. Visceral fat, or the fat around your organs, has been linked to an increased risk in “heart disease, Alzheimer’s, type II diabetes, stroke, high blood pressure, and cancer”. I understand and acknowledge the flaws of the BMI; it does not consider bone mass nor muscle mass and thus can classify elite athletes as “obese,” but it has value as a statistical and ballpark measure. I also know that having adipose tissue (body fat), especially as a woman, is essential for your body to function, and it is only in excess that it becomes an issue. Serena Williams’ flippant promotion of a weight loss medication in this atmosphere is rather ill-advised, as her positioning as the easy way out is inaccurate—disregarding the side effects and the potential for the drug to be abused. An emphasis on a primarily whole foods diet and promotion of exercise would be generally more productive and achievable for the average American. However, in the end, I am happy that she disclosed her use of the drug, a step in the right direction in the weight loss landscape, which is often shrouded in miracle cures and secrecy.