Overview of It's Been a Minute
This episode of NPR’s It's Been a Minute (host Brittany Luce) examines the cultural and medical conversation around weight, health, and the recent surge in GLP-1 medications — framed through Oprah Winfrey’s new book Enough and her public embrace of these drugs. Guests Dr. Kelly Carter-Jackson (chair, Africana Studies, Wellesley College) and Dr. Mara Gordon (family physician; NPR columnist, “Real Talk with a Doc”) discuss how Oprah’s long public weight journey shapes cultural expectations, the limits of BMI, the medical framing of obesity, and the difference between treating adiposity-related disease and addressing fatphobia.
Who’s in the conversation
- Host: Brittany Luce (It's Been a Minute, NPR)
- Guests:
- Dr. Kelly Carter-Jackson — Chair, Africana Studies, Wellesley College; co-host of This Day podcast. Focus: cultural history and implications of Oprah’s influence.
- Dr. Mara Gordon — Family physician; anti-diet clinician; NPR columnist. Focus: clinical perspective on GLP-1s, obesity as disease, and patient care.
- Context: Oprah’s book Enough (co-authored with endocrinologist Dr. Anya Yastroboff) and her public advocacy of GLP-1s.
Main takeaways
- Oprah’s decades-long public weight narrative has shaped cultural ideas that thinness equals ultimate success—“we are sort of never enough” even when highly accomplished.
- GLP-1 drugs (used increasingly for weight loss) can be medically transformative—improving blood sugar, and protecting heart, kidney and liver function—but they don’t erase social weight stigma (fatphobia).
- Obesity as a clinical label is contested: BMI is an overused, blunt screening tool with a problematic history; many clinicians prefer focusing on “adiposity-based chronic disease” and metabolic health markers instead of weight alone.
- Health is multifaceted and individual. Weight loss can be lifesaving and beneficial for some patients (e.g., advanced diabetes) and harmful or psychologically risky for others (e.g., those with disordered eating).
- Celebrity endorsement (Oprah, Serena Williams) can normalize treatments but may also create aspirational or exclusionary dynamics: expensive therapies risk becoming status symbols and deepen inequities in access.
Key themes discussed
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Oprah’s public history and cultural power
- Her repeated, highly publicized weight loss/gain cycles shaped national conversations about body size, success, and shame.
- Oprah’s book emphasizes obesity as a disease and highlights GLP-1s, but—according to guests—it doesn’t probe deeply into structural causes of stigma.
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Medical vs. cultural framing of fatness
- Medical benefits of GLP-1s: metabolic improvements and disease treatment.
- Cultural problem: fatphobia and stigma persist independently of medical changes to body size.
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Problems with BMI and diagnostic framing
- BMI’s origins (Adolphe Quetelet) and limits: easy to measure but inadequate and stigmatizing.
- Movement toward adiposity/metabolic-focused definitions that assess organ-related fat and health markers rather than weight alone.
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Health as individualized
- “Healthy” means different things for different people—physical, mental, social, and cultural factors must be considered.
- Clinicians should unpack what patients mean by “I want to be healthy” and tailor care accordingly.
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Access, aspiration, and inequality
- High cost of GLP-1s may make them a new status symbol (exclusive, aspirational).
- Celebrity promotion can unintentionally reinforce thinness-as-trophy narratives.
Notable quotes and insights
- “We are sort of never enough.” — Dr. Kelly Carter-Jackson on cultural expectations tied to body size and success.
- “Health is a really complicated word and it doesn't really have a clear definition.” — Dr. Mara Gordon on why weight loss isn’t a universal proxy for health.
- GLP-1s “can be really life-changing medicines… I’m not opposed to their use,” but they don’t automatically address “weight stigma.” — Dr. Mara Gordon
- BMI: “a blunt instrument” with a history of defining the “average man” (Adolphe Quetelet), and inadequate for nuanced clinical care.
Practical implications / recommended actions
- For listeners:
- Separate clinical health measures from cultural body norms. Ask: what specific health outcomes are we aiming to improve?
- Be critical of one-size narratives promoted by celebrities; consider both medical benefit and psychosocial effects.
- For clinicians and health systems:
- Use BMI as a screening tool, not a sole diagnostic or stigmatizing metric. Focus on metabolic markers and organ-specific adiposity where relevant.
- Unpack patients’ goals around “health” to avoid inappropriate or harmful weight-focused counseling, especially in patients with eating disorder histories.
- For policymakers and advocates:
- Address access and affordability for effective medications so benefits aren’t limited to the well-resourced.
- Promote public education that combats fatphobia even as medical treatments evolve.
Why this conversation matters
The episode highlights a pivotal cultural moment: GLP-1 medications are shifting what’s possible medically, while celebrity framing (Oprah) shapes public meaning. Without careful distinction between treating disease and combating stigma, we risk medicalizing social problems or creating new forms of exclusion. A nuanced approach—clinically, culturally, and politically—is needed to ensure health gains are equitable and that social harms like fatphobia are addressed alongside biomedical advances.
Produced by NPR’s It's Been a Minute; featuring expertise from Dr. Kelly Carter-Jackson and Dr. Mara Gordon.