S05E81 - Controversies in Body Positivity as Influencers Choose to Slim Down

Discover what happens when the champions of body positivity shift gears toward weight loss, igniting a firestorm of controversy and challenging our views on health and self-acceptance.

Our latest episode features an incisive panel discussion with hosts Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic .

We dissect the fallout from plus-size influencers who face accusations of betrayal after deciding to shed pounds—despite once being icons for embracing their curves. The debate doesn't end at social media reactions; we tackle the implications of weight loss medications such as Ozempic and their role in our relentless pursuit of the 'ideal' body.

This episode isn't just about the drama; it's a deep analysis of the ethical quandaries and health concerns intertwined with our society's complex relationship with body image. We scrutinize the impact of stigmatizing obesity, the allure of fast-track weight loss drugs, and the ethical implications of their accessibility.

As plastic surgeons, our patients provide a unique perspective on the necessity of fostering a society that values well-being and self-esteem over appearance. Prepare for an enlightening discussion that not only questions our cultural narrative of beauty but also advocates for a compassionate and holistic approach to individual health.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic 3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E81 - Controversies in Body Positivity as Influencers Choose to Slim Down

TRANSCRIPT

Dr. Sam Rhee: welcome to Three Plastic Surgeons and a Fourth. We have Dr. Lawrence Tong from Toronto, Canada.

Sal Pacella, Dr. Salvatore Pacella from San Diego, California, and Dr. Sam Jejurikar from Dallas, Texas. And I am Dr. Sam Rhee, and I'm from Paramus, New Jersey. Welcome, everyone. Our first, uh, our topic today is going to be, uh, a headline that was from the New York Times recently about plus size influencers. And basically, these are, these are people that promoted body, body positivity, but then they lost weight.

And the headline reads, do they owe their followers an explanation when their bodies change? So, before we get into it, let's have Dr. Jejurikar go ahead and read our disclaimer.

Dr. Sam Jejurikar: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes [00:01:00] only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care, and never disregard professional medical advice or delay seeking advice because of something in the show.

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Dr. Sam Rhee: And with that, thank you very much. Basically, this is talking about when plus size models or people who promote body positivity suddenly change their body. And this is something that we see more and more as plastic surgeons, especially with the GLP agonists or the ozempics, uh, coming on board and more and more people taking them.

But there was an example of a plus size model, uh, Dron Dronmay Davis, who had a big following on Instagram. A lot of people really loved They've made her feel, they made them feel comfortable in their bodies and they felt like she was a role model. They felt like if [00:02:00] someone could be so beautiful and bigger, they could be bigger and beautiful as well.

And she was a size 16 or XXL. Uh, and a few months, her body shrank. And then a lot of followers felt. That she to change. It felt like a betrayal to them where she was being dishonest with the plus size community, with the, uh, body positivity community. Um, how do you guys feel when you encounter patients or see people who have suddenly changed and then.

what used to be what their trademark image or concept about who they were, suddenly becomes something very different.

Dr. Sam Jejurikar: think there's, those are two different, two different issues. I think seeing people that have suddenly changed, and I think all of us probably in our practice in the past year have seen lots of patients that have suddenly changed in terms of their weight because of the GLP 1 and agonists that are on the market.

But I think it's [00:03:00] different when you're looking at someone who's. public persona is that promoting a certain body image, and then that body image suddenly changes. I think, um, you know, in the particular example that you're citing, this particular plus size model posts a lot of pictures of herself showing off her body in her pre weight loss state, talking about the need to love herself, um, you know, in the body that she's, that she has, which clearly I think all of us Like the idea of people loving themselves and accepting themselves for who they are.

But then when that changes and you are a very public person and you don't explain why that changed, um, I think people have a, have a, uh, uh, sort of a necessary, you know, a very understandable. knee jerk reaction to want an explanation. Um, I think most of us are cynical enough here to believe that that explanation is probably the same medications that everybody else in America seems to be taking right now, but for some reason, some people just don't want to say it.[00:04:00]

Dr. Salvatore Pacella: well, you know, so there is, there's no debate in the scientific community that not being overweight, not being obese, Is associated with better health outcomes, right? So high, high blood pressure, diabetes, hypertension, um, you know, heart disease. And so when you sort of get out there to the, to the community, albeit even the uneducated community, that's not in medicine and you say, well, you know, I'm happy being 300 pounds.

Well, the question becomes, you know, is that healthy to promote to your followers, to not take control of their health if they can? I don't think that's a very responsible way as an influencer or as someone that patients look up to, to set an example. It's, you know, there's one thing about embracing your self image.

But there's another thing with promoting [00:05:00] unhealthiness.

Dr. Sam Jejurikar: Look, just to be clear though, I don't think these influencers are still saying that you should live an unhealthy lifestyle, but I mean, before a year ago, two years ago, when it was really easy for people who had metabolic syndrome or are very difficult for people that have metabolic syndrome or had, um, you know, insulin resistance.

When it was hard for them to lose weight, are you suggesting that they shouldn't have felt positive about their body image, even if they were living a healthy lifestyle, um, even if they were exercising? Cause that's, I think, why people are upset. I don't think anyone thinks that obesity is healthy.

Dr. Salvatore Pacella: No, not at all. I think, go ahead.

Dr. Lawrence Tong: I think what Sal was maybe alluding to is the fact that, uh, that this person's followers sort of got mad or, or felt, uh, betrayed. I'm, you know, all for celebrating body positivity, but at the same time, you know, um, not, [00:06:00] um, you know, not being a normal body weight is a big problem. Obesity. is one of the biggest, um, health problems in North America.

Heart disease, stroke, diabetes, certain types of cancer, all are significantly increased with obesity. So if somebody is heavy, um, it shouldn't be stigmatized, um, but you should look at it. It is, um, you know, obesity is a disease and if somebody has cancer and they get cured of it, people aren't going to get angry, but for some reason, Um, if you're, if you're heavier and you've been celebrating it for body positivity, it doesn't mean that you can't strive to, you know, to become, to become healthy.

Dr. Sam Rhee: I think one of the issues is, is with the advent of the GLP agonists like Ozempic, like Monjaro, this is now becoming a division between the have and have nots. These are expensive [00:07:00] medications and they are not easily available. So when influencer, someone who has hundreds of thousands of followers, and suddenly she says, You know what?

I want to lose weight. Um, I don't want to be fat anymore. Uh, and I'm taking Manjaro, which is what, uh, plus size influencer, they, they mentioned in this article, Rosie Blair did. And she said, I have no remorse or shame. I couldn't wipe my ass two years ago. But then all of her followers are saying, Well, should we all be, how can, we can't take Munjar, we can't afford Ozempic, this, you know, this is something that is different than say, like Sam said a couple of years ago where if you had some of these health issues, there were very little options in terms of dealing with, you know, I mean, PC, you know, polycystic ovary syndrome or other metabolic disorders.

And so these are patients or people out there that are saying. Wow, you are, [00:08:00] you are just totally throwing us under the bus here because you have the means to do so and, and we don't.

Dr. Salvatore Pacella: You know, this, this sort of reminds me very much of several years ago. Let, let me, let me throw this as an analogy. So let's say I'm, uh, you know, putting myself through school. I'm working two jobs. I live in a studio apartment in a big city and all of a sudden COVID hits. And then I'm cruising online on Instagram and I have this, uh, multi billion dollar celebrity sitting in their mansion in Beverly Hills saying, you know what?

You should stay home, stay home, stay home. It's the same thing. You have the means to stay home. You have the means to live in your, your mansion and sit by your pool, but the rest of us have to work. The rest of us live in tiny apartments, right? So it's like, You know, to some extent it's, it's, it's exploiting their, their followers, you know, for,[00:09:00]

Dr. Sam Jejurikar: You know, um, I, I, uh, first of all, I'm incredibly distracted by the large animal head behind Dr. Pacella's head, and I have a hard time focusing on anything else being said right now. That, that being said.

Dr. Salvatore Pacella: our listeners and for our, our, our viewers, this is a fake Bison hit. It's fake. I've always wanted

Dr. Sam Jejurikar: fake

Dr. Lawrence Tong: backyard before

Dr. Sam Jejurikar: I don't even understand this. Like,

Dr. Salvatore Pacella: Because I would never have a dead animal in my den, but it adds a little bit of color and mystique. Plus, I'm from Buffalo. I wanted a bison, you know? Buffalo.

Dr. Sam Jejurikar: Fair, okay, alright,

Dr. Salvatore Pacella: I mean, what's hanging behind yours?

Are you in a sushi, are you in a, are you in a sushi bar?

Dr. Sam Jejurikar: Uh, no, I'm in, I'm in my study. It's a, it's a painting, uh, called Shipwreck. I can show it off a little bit more. It's an abstract piece of art. But anyways. I digress. [00:10:00] Going back to what you guys were saying about these medications.

So, you know, uh, Terzapatide has gotten a new FDA indication for obesity. It's now been rebranded as ZepBound. Um, um, Semaglutide or Semaglutide, no matter how you say it, has been rebranded as Wagovi. So, although there are some scarcity issues, which are getting better. Eli Lilly is actually like building new production facilities and they think by the end of the year, they're going to be on board with actually getting, um, you know, more of this medication out there.

Um, with, you know, with health insurance and with, um, appropriate documentation for morbidly obese people, these medications are not as expensive as you make them sound. So I think the analogies of multi, you know, multi millionaires telling people not to work may not be exactly the same.

Dr. Salvatore Pacella: Well, I don't, I don't know. Do you really believe that? Do you really believe that, uh, health insurers are going to bend over backwards to cover these medications?

Dr. Sam Jejurikar: I'm seeing it already. We're seeing it

Dr. Lawrence Tong: going to happen because,

Dr. Sam Jejurikar: we're seeing it

Dr. Lawrence Tong: prevent. What [00:11:00] is

Dr. Sam Jejurikar: I mean, so, so, I mean, Eli Lilly's market cap is about to hit a trillion dollars. Trazepatide is on its way to be the number one selling medication of all time. Um, those are things that are just happening. Viking Pharmaceuticals just saw their, their stock like triple last week because they just have a new, GLP 1 like medication.

There's all these new GLP 1 medications

Dr. Salvatore Pacella: right, but you're, you're talking, you're talking

Dr. Sam Jejurikar: but hold on, hold on. Let me finish. Let me finish. Let me finish. So, so if you don't have chronic kidney disease, uh, if you don't have amputees happening because of diabetes complications, if you don't have heart disease, these medications in the long run from preventative aspect will actually save insurers.

Thousands and thousands of, hundreds of thousands of dollars over the lifetime of their insured. So I do believe that they will pay for that, particularly as the price of these medications come down. And I'm seeing it in my own patients. I've seen, already seen 3 patients in the last month who've gotten approval for ZepPounds.

Dr. Salvatore Pacella: [00:12:00] I, I've seen just the opposite actually here. Maybe it's California. We're the land of, uh, of waste not, want not. The um, many health insurers, at least three I know about, have, have removed them from their formularies because they're being over prescribed. Okay. Um, certainly if you have diabetes, that's an indication, but for general weight loss, they're being withheld.

And so insurers are not interested in covering these things until it's documented that they save lives long term. So I think there's going to be a big turnover that this is really growing on the sales side, people paying out of pocket. I mean, it's not happening out here.

Dr. Sam Jejurikar: yeah, definitely, definitely is happening here. And again, I think it's, I mean, I don't know what their BMI cutoff is. I imagine it's not 30, it's probably 35, but for morbidly obese people, I'm seeing it. I'm definitely seeing it being improved.

Dr. Sam Rhee: The other issue is, is that one, I don't think that medications are going to be the [00:13:00] solution for people who are unhealthily obese.

Dr. Sam Jejurikar: He's gonna start talking about CrossFit. So,

Dr. Sam Rhee: about unhealthy means. How did people usually before deal with obesity or even the fear of becoming fat? Disordered eating, anorexia, bulimia? I mean, there were many, many, many women, uh, and other people who were seriously hurting themselves because they had obsessions with being thin. And I honestly think that these medications are going to drive that obsession of thinness, equaling beauty even farther, because it's not just very obese, medically problem, you know, people who have real medical problems taking this medication, you know, we're all seeing the person who's maybe 10 or 15 pounds heavier and they want the quick fix or they're eating, you know, so they're taking this medication.

So they're getting even [00:14:00] skinnier. Those are the people which are driving this narrative that being skinny is good. And there is a huge problem culturally still in our country that if you are fat, You are lazy. You don't work hard. You're ugly. You're not attractive. And so, I don't believe that that's true.

We don't know what everyone's individual story or issue is, but the fact that these medications are starting to drive even more of a bias towards skinniness being equating either ability to afford drugs, ability to, um, you know, pay for drugs. that, that's a problem. I think that's a huge problem in our society.

Dr. Sam Jejurikar: so what are you saying then? Are you saying that we should limit access to these medications? I'm not clear what you're, what you're saying.

Dr. Sam Rhee: I don't think that these medications are the be all and end all. And we, [00:15:00] and I know patients who have not been able to tolerate these medications, period, for whatever reason. Or patients who have lost so much weight on these drugs that they actually have to stop them, okay? Or patients who, um, And who knows what these long term medication effects are going to be?

We really don't know that. I mean, we've only had these medications widely used for maybe 2, 3, 4 years at this point. So, and we've all seen major problems that come up in the 5, year mark after chronic use of medications. So, I just feel like there is a huge issue when you see all of these people who are promoting body positivity Starting to get killed for losing weight.

I don't think that that is healthy for our society and I actually feel like Um, we need to be a little more tolerant about everyone I agree that we need to be tolerant about the people who do lose weight or manage to do so But I don't feel like where we should automatically say. Yes. This is a good thing [00:16:00] This is a good thing.

I, I think we should be able to look at all, you know, all patients, whether they're able to lose weight or not lose weight and sort of still have them have a healthy self esteem regardless. I don't think making someone feel crappy about the fact that their BMI is 30 or 35 is in any way going to help them achieve a healthier lifestyle.

because people are shaming them, or body shaming them, or fat shaming them, or making fun of them. And so, there is an important role, I think, for body positivity, and I think that that could be attacked here, um, more and more as, as these medications become more widespread.

Dr. Salvatore Pacella: So, you know, the, the psychology of this is very interesting. You know, when you're talking about these influencers, right? So they've, they've created a whole persona, a whole cash cow, a whole, um, deposit history of capitalizing on this, um, with their followers, right? But then they just kind of turn on [00:17:00] it when they.

When they're, you know, doing the exactly the opposite. So, you know, I, I'm curious to what extent the careers of the influencers. are going to change based on this, or is it just going to be turned into the next controversy, you know what I mean?

Dr. Sam Rhee: I mean, influence, they, they, they live on controversy. So you're right, they're going to have to find something else to sort of highlight in their lives. And whether it is the hate that they receive for, um, being accused of being ableist or, um, turning their back on body positivity, I don't know. I think that

Dr. Salvatore Pacella: Like, Sam,

Dr. Sam Rhee: been written.

The

Dr. Salvatore Pacella: King? Sam and Dan laugh

Dr. Lawrence Tong: liver king?

Dr. Sam Rhee: liver king, the liver king is this dude on the internet who is jacked beyond belief. Like, he looks like Sal with [00:18:00] muscles. Like a, like a crap load. He looks a lot like Sal, but with just like a crap load of muscles. Okay.

Dr. Salvatore Pacella: Tell him what, tell him what, tell him what he ate during his, uh, During his, uh, clips,

Dr. Sam Rhee: well,

Dr. Salvatore Pacella: eat raw,

Dr. Sam Rhee: he, yeah, he just claimed he ate what? Raw

Dr. Salvatore Pacella: raw, raw animal parts. Bone marrow, bones, liver, spleens. He would just eat them right on, on the internet. And say, this is why, this is why, um, uh, I, I, I live an ancestral diet. Okay?

Dr. Sam Rhee: And then it turned out that he was juiced on like every known substance. known to man and was shown to be a fraud and it wasn't the liver that he was eating it was the juice he was injecting so yes the cycles he was on uh i think he's still huge i just don't think uh you're right he isn't as popular as he once was I don't know.

Is that the same as this? I'm not sure.

Dr. Lawrence Tong: think these, I [00:19:00] think these drugs ultimately will prove to be a good thing. I know that, of course, you have to be cautious because they're new and you don't know all the stuff. Long term side effects, but obesity is a big, big problem, and there has not been any way to solve it previously. Any previous drugs have at best got you maybe like three to five percent body weight, uh, reduction and probably not even on a long term basis.

Bariatric surgery would get you, what, I don't know, 25, 30 percent. These drugs are giving you Those, you know, uh, percentages approaching bariatric surgery without undergoing, uh, the surgery. And if it can, um, you know, childhood obesity is a huge problem in the United States. Um, you know, a lot of these children, um, are going to have really, you know, uh, shortened lifespans and lots of chronic diseases if, uh, if they keep going in this direction.

So I think that [00:20:00] the fact that, um, yes, body, body positivity is. is good. You should not stigmatize somebody who's obese, but on the other hand, you should not be upset at anybody who, you know, um, is able to lose weight. Like I said before, if you, if you could cure your, uh, diabetes, is somebody going to get mad at you for that?

If you could reduce your, you know, having a heart attack, why, why is obesity treated differently? Obesity is a disease, uh, but because there's, there's this, um, know, stigma associated with it. It's, it's usually thought of as, you know, you don't have the will to, you know, you just eat too much, you're lazy, you don't eat, but it is really a disease.

It's, it's, uh, these drugs have changed the physiology of, uh, how people, um, feel in terms of, um, satiation and, uh, the, um, you know, how, how the [00:21:00] food moves through the gut and it just, it works and some people just don't have That type of physiology to stay thin. And I think that in the end, these, these drugs can make a very big difference in

Dr. Sam Jejurikar: Yeah, I agree with Larry. I think on the whole, these, these drugs are going to have huge health benefits for our population. In addition to even what he's saying, you know, people are now showing that it may help with addiction. People like alcoholics are craving alcohol less and drug abusers are craving it less.

We're seeing benefits in, in, um, you know, non alcoholic cirrhosis where you're actually, or non alcoholic hepatitis, where we're actually seeing improvements in the state of the liver. So there's all these new indications for it. Yeah. Well, like what Sam was saying, there are definitely side effects that people need to know about, and not everybody can afford them.

And so I think there's two different, you know, I think there's two different issues. There's, are these drugs on the whole good, or are they on the whole bad? I believe they're good, and I think they're going to have huge benefits, but there are side effects, and not everyone can get them, you know. What I'm seeing with [00:22:00] some patients is not what Dr.

Pacella is seeing, and even with that, some people may not have health insurance. And so, these medications should not come at, you know, You know, at the exclusion of body positivity, people should still be allowed to promote positive self image because self image and obesity are two different issues, and I think a lot of times we view them interchangeably as being synonyms, but ultimately.

You know, we need to allow people to feel comfortable in their own skin. And if they can get health benefits and lose weight, great. But if they can't, you know, they should still feel comfortable with who they are.

Dr. Sam Rhee: I just feel like as these drugs become more prevalent, fat stigmatizing and fatophobia and fat shaming is going to Become more pervasive in our culture. I do believe that as well.

Dr. Sam Jejurikar: I mean, it's, I mean, I mean, it has been very pervasive in our culture for a very long time. I don't know if it can be any worse, but we'll see.

Dr. Sam Rhee: Well, thank you very [00:23:00] much, gentlemen. I think that was a really interesting and stimulating discussion about this. Um, and if you have any questions, if you are interested, please comment on our YouTube videos. Um, you see all of our Instagram handles, uh, next to our names, uh, on our videos. And they're also, uh, on our website, uh, 3plasticsurgerypodcast.

com. Uh, please check it out and, uh, thank you gentlemen until next time.