Oprah Winfrey has a new book: Enough: Your Health, Your Weight, and What It’s Like to Be Free. Its central premise:
“We’ve learned that having obesity is not a choice. It’s not a question of willpower. Obesity is a disease. And it’s treatable.”
Oprah has a loyal following of tens of millions of acolytes, mostly women, whom she has led on a decades-long march toward self-actualization. She role-models overcoming obstacles to success, like poor self-esteem, discrimination, misogyny, poverty, addiction, depression, and bad relationships. She is the ever-transcendent hero of her own journey.
She is the ultimate influencer.
There’s a pop psychology element to many of these motivational books, in the tradition of relentless American optimism. “It doesn’t matter who you are, where you come from. The ability to triumph begins with you – always”, she writes.
Books like “The Life You Want”, that finds the former daytime TV queen inspiring “people to live the highest, fullest expression of themselves,” are a celebration of her personal struggle to break free of constraints.
It’s no secret that Oprah’s bête noire has been weight. Like many women—especially her fellow African-Americans—she’s struggled, embarking on numerous diets and stringent exercise regimens—losing weight, only to regain it.
She’s dabbled with fat acceptance, but under constant, brutal public scrutiny, that hasn’t cut it. She finally got tired of the “shame and blame”. Now, Eureka! She has found it! Yet another obstacle to personal perfection conquered. On reaching 70, in TV interviews she avers: “I’ve never felt better!”
She claims it’s simple: “I have the fat gene!” Weight loss drugs have quieted the “food noise” that made it impossible for her to sustain weight loss after draconian diets. She has actually recanted her previous promotion of “diet culture” as a spokesperson for Weight Watchers.
Is Oprah conflicted? It is that she made $221 million selling Weight Watchers’ stock over the years. But in 2024 she stepped down from the board of directors of Weight Watchers and pledged to donate her stock and proceeds to the National Museum of African American History and Culture. Was it an act of contrition, or a smart write-off?
Maybe her recusal was a savvy reading of the tea leaves. Weight Watchers experienced serious head winds with the advent of new medications that challenged its “willpower” paradigm. In the spirit of “if you can’t beat ‘em, join ‘em”, Weight Watchers began offering prescription weight loss drugs to its clients in 2023 via its acquisition of a telehealth company. But Weight Watchers International is trading at a fraction of its former value—with nearly a billion dollars in debt, it filed for Chapter 11 bankruptcy in May 2025 with its stock losing nearly all value since 2018.
“Enough” makes no mention of (unsubstantiated) allegations that Oprah was briefly hospitalized in 2024 for dehydration shortly after coming out about her use of weight loss medication. The social media rumor mill cranked up, but speculation was quashed by the official version—that Oprah was merely suffering from a severe bout of “viral gastroenteritis” that made it impossible to keep fluids down.
But Ozempic and similar drugs can cause dehydration, primarily due to common gastrointestinal side effects like vomiting and diarrhea, leading to fluid loss, so it’s recommended that users remember to drink plenty of fluids throughout the day. Some users of semaglutide medications report that it can blunt sensations of thirst, making it harder to drink enough.
What eludes Oprah, in spite of the book’s collaboration with a board-certified Yale endocrinologist, Dr. Ania Jastreboff, is that there’s no such thing as an “obesity gene”. It’s a pop science over-simplification.
There exists, undoubtedly, a strong genetic contribution to overweight susceptibility. Identical twins, even if raised separately, show a 30 to 60 per cent concordance in obesity risk. It turns out hundreds—if not thousands—of genes determine satiety, impulse control, food preferences, activity levels and metabolism. They program the brain, muscles, digestive tract, pancreas, liver and adipose tissue to regulate food intake, nutrient absorption, energy expenditure and fat deposition in myriad ways.
No doubt some of Oprah’s followers are relieved to feel unburdened from “guilt and shame” over stalled weight loss progress using traditional behavioral methods. But some may feel whip-sawed by the sudden about-face. Were all those efforts for naught? Does it really constitute “freedom” to be relegated to a lifetime of dependency on pricey drugs with unpleasant, occasionally downright dangerous, side effects? And what happened to the much-vaunted “healthy-at-any-weight” messaging by prior iterations of Oprah?
If Oprah’s readers want absolution from blame over their weight, a more appropriate target might be America’s toxic food environment—by design, it’s not their fault they’re fat. Willpower alone can’t compete with ubiquitous temptation from ultra-processed foods, which are engineered to be addictive. Studies confirm that, by their very nature, ultra-processed foods, formulated to be rapidly scarfed down, with minimal satiety value, cause the average person to overconsume by hundreds of calories daily.
In the final analysis it seems disingenuous for such a lifelong promoter of personal agency to surrender an important life outcome like weight to the caprices of biology. Like most health conditions (e.g. depression, heart disease) that aren’t completely hardwired—unlike inherited sickle cell anemia or Huntington’s Disease—obesity is a complex mix of genes and environment. Where does free will fit in? Instead, summarily declares Oprah, “Enough!”
When medical fixes were absent, obesity was once wrongly considered entirely a moral failing; does the advent of weight loss drugs automatically render it a disease, as Oprah now blandly asserts? It doesn’t have to be binary.
A final word that should resonate especially for Oprah. Arthur Brooks—the so-called “Happiness Guru” who has studied happiness, blending ancient philosophy with modern neuroscience—recently opined on the new weight loss drugs in a Free Press column entitled “Do GLP-1s Make Us Happy?”:
“Don’t get me wrong: These medications are a miracle, transformative for many people. But they take out the struggle . . . Because accomplishing something with a degree of struggle is the way to realize joy. Whatever you do to your appearance . . . will not make you love yourself, if you don’t already do so. That requires work you do on the inside.”
