A Registered Dietitian’s Take on Oprah’s ‘Shame, Blame, and the Weight Loss Revolution’ Special

Oprah is back in the headlines with her latest prime-time special, “Shame, Blame and the Weight Loss Revolution.” As a Registered Dietitian, I’m particularly drawn to how she discusses obesity and the latest in weight loss medications. We’ve seen the influence that Oprah has on cultural and dietary perceptions for decades—from her shocking 1988 “wagon of fat” episode to her recent claims about weight loss medications. Today, I want to explore the impact of her views and how they shape our understanding of health and body image. 

This post aims to dissect the special’s key points, evaluate the science behind the discussed medications, and reflect on the societal shifts surrounding obesity—all through a dietitian’s lens. Settle in as we unpack the complex world of celebrity influence and the ongoing evolution of diet culture. Whether you’re an Oprah fan or a skeptic, this conversation about her lasting impact as an OG influencer is something you won’t want to miss.

*Looking for more on weight loss drugs like Ozempic, Wegovy, and Mounjaro? Check out this podcast episode where I cover them in detail.*

Oprah’s Impact on Public Perception of Diet and Health: A Historical and Critical Overview

Oprah Winfrey’s journey from a challenging childhood in rural Mississippi to media mogul has deeply influenced public perceptions of health, wellness, and personal transformation. Her own struggles with weight have been a recurring theme throughout her career, starting with the 1988 “wagon of fat” episode where she showcased her 67-pound weight loss on the Optifast diet. This episode is emblematic of how her personal life influenced public discourse on health and diet.

As her show evolved, Oprah used her platform to discuss various health and diet strategies, often featuring celebrity trainers, dieticians, and personal health stories. Her role as a Weight Watchers shareholder and spokesperson marked a shift toward sustainable health practices, moving away from quick fixes. This role allowed her to shape the company’s direction and public perception significantly, reinforcing her influence on diet culture.

However, her influence is hasn’t been without criticism. Her narrative often echoed the prosperity gospel, implying that determination alone can overcome obesity, oversimplifying the complex interplay of genetic, environmental, and socio-economic factors. Her fluctuating weight and public diet endorsements, including her high-profile partnership with Weight Watchers, have sparked debates about the psychological impact and efficacy of celebrity-endorsed health strategies.

Oprah’s journey reveals the powerful blend of personal narrative and celebrity influence in shaping public health perceptions. While she’s inspired many to lead healthier lifestyles, her story underscores the complexities and responsibilities that come with celebrity influence.  As we examine her impact, it’s crucial to critically assess how her experiences and the solutions she promotes align with a holistic and scientifically grounded understanding of health and wellness.

A Quick Look at Oprah’s Questionable Guests

Throughout her career, Oprah Winfrey has both inspired and stirred controversy through the guests featured on her shows. These figures have significantly influenced public perceptions of health, wellness, and spirituality, often leading to debates about the responsibility held by media figures.

Throughout the years, Oprah introduced several guests whose methods and theories have later been subject to scrutiny and controversy:

  • Dr. Phil McGraw, who first appeared in 1998, would later be criticized for his approach to mental health.
  • Marianne Williamson: First appearing in 1992, Williamson, a spiritual leader, discussed spirituality and health, later gaining notoriety for her views as a COVID-19 conspiracy theorist.
  • Dr. Christian Northrup, an OBGYN known for her unconventional theories linking physical ailments to emotional states, has been a repeat guest and has later faced backlash for promoting COVID-19 misinformation.
  • Dr. Atkins, creator of the Atkins Diet, appeared in 2002, promoting his low-carb diet approach amid rising popularity and controversy over its long-term health effects.
  • Dr. Mehmet Oz: Introduced in 2004, Dr. Oz frequently discussed health tips and medical advice, later launching his own show. His approach to health has often been criticized for lacking scientific rigor.
  • Jenny McCarthy, in 2007, discussed her views on vaccines and autism, contributing to widespread misinformation about vaccine safety.
  • Rhonda Byrne: Featured in 2007, Byrne promoted “The Secret” and the Law of Attraction, which faced widespread criticism for oversimplifying complex life issues.
  • Suzanne Somers: Appeared in 2009, touting controversial anti-aging methods and extensive daily supplements, sparking debate over the safety and effectiveness of such practices.
  • John of God, a Brazilian faith healer, was featured in 2010 and again in 2013. He gained notoriety through Oprah’s platform but was later convicted of multiple charges of abuse. This episode highlights the potential risks of media platforms amplifying unverified and potentially harmful practices.

Oprah’s influence also shaped health trends through personal endorsements, including her Weight Watchers partnership, which impacted her brand and public perceptions of dieting.

Oprah’s platform has undeniably shaped public discourse on health and wellness, but it has also raised important questions about the responsibility of media figures in disseminating information, especially when it involves health and well-being. The historical context reveals the dual role of media influence: as a source of inspiration and, potentially, misinformation.

How We Got Here

In September 2023, Oprah hosted a panel discussion titled “The Life You Want: The State of Weight.” Experts including Dr. Fatima Cody Stanford, Dr. Rachel Goldman, Dr. Melanie Jay, and Sima Sistani, CEO of Weight Watchers, joined to explore the rising interest in new weight loss medications. Oprah opened up about her 2021 knee surgery and subsequent weight loss journey, which she initially attributed to hiking 3-5 miles daily, drinking a gallon of water, eating her last meal by 4 PM, and following Weight Watchers’ point system.

Despite being aware of weight loss medications, she felt the need to prove she could lose weight through sheer willpower. However, during the 2023 panel discussion, Oprah had an epiphany, as she later told People magazine: “I realized I’d been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control. Obesity is a disease. It’s not about willpower — it’s about the brain.” After releasing the shame she had felt around her weight, she consulted her doctor, who prescribed weight loss medication that she now uses to avoid yo-yo dieting.

The media’s obsession with Oprah’s weight has been a persistent narrative, influencing her public and private life. This sets the stage for a deeper conversation about obesity as a disease. Previously misunderstood as just a lifestyle issue, obesity was reclassified as a “complex chronic disease” by the American Medical Association in 2013. This shift emphasizes that obesity requires more than personal choice and calls for a nuanced, empathetic approach to management and care. It also aims to improve treatment accessibility, insurance coverage, and research funding.

Despite this reclassification, the conversation continues in the medical community over whether obesity should indeed be classified as a disease. With the rising popularity of weight loss medications and recognition by public figures like Oprah, it’s a dialogue that remains important for us to have.

The Science and Efficacy of Weight Loss Medications

GLP-1 agonists, such as semaglutide and tirzepatide, mimic the naturally occurring hormone GLP-1 to help reduce weight. This hormone signals satiety to the brain and regulates blood sugar by enhancing insulin secretion. Before diving into Oprah’s special, let’s break down how these medications work.

Semaglutide was first introduced as Ozempic in 2017 for diabetes management, later finding use in weight management as Wegovy, its higher-dosed counterpart. Its effectiveness in weight loss was recognized due to its impact on appetite and satiety.

Tirzepatide (Mounjaro) combines the actions of GLP-1 and GIP (gastric inhibitory polypeptide), amplifying its effects on blood sugar control and appetite suppression. This medication shows promise in treating obesity, pending further FDA approval.

These medications are administered through weekly injections into areas like the arm, thigh, or abdomen. Although injections can be intimidating, they’re generally well-tolerated, similar to other medical injections.

Common side effects include gastrointestinal discomfort, which can often be managed through dosage adjustments. However, more serious (though rare) risks include potential thyroid tumors and pancreatitis, making medical oversight crucial.

Ideal candidates are adults with a BMI over 30, or 27 if associated conditions like hypertension or diabetes are present. Pediatric use is approved for those in the highest obesity percentile.

When these medications bind to GLP-1 receptors, several physiological responses are triggered:

  • Appetite Suppression: These medications enhance feelings of fullness and reduce hunger, leading to a lower calorie intake.
  • Insulin Release: They stimulate the pancreas to release insulin, helping to lower blood sugar after meals.
  • Slows Gastric Emptying: They slow down the stomach’s emptying rate, prolonging fullness and reducing food intake over time.

These effects collectively help manage body weight, especially when combined with lifestyle changes like diet and exercise. Importantly, these medications are designed to be part of a comprehensive weight management plan that may also include other treatments.

Recapping The Special: ‘Shame, Blame and the Weight Loss Revolution’

The special, ‘Shame, Blame and the Weight Loss Revolution’ initially aired on ABC and is now available on Hulu. It explores the complexities of obesity, the potential of new medications for treatment, and broader societal attitudes toward weight loss.

Key Statistics:

  • In the United States, obesity affects 41.9% of adults, up from 30.5% in 1999-2000.
  • Obesity is linked to serious health conditions such as heart disease, stroke, type 2 diabetes, and certain cancers, leading to higher medical costs and premature deaths. The annual medical cost of obesity was $173 billion in 2019, with adults with obesity incurring $1,861 more in healthcare costs than those at a healthy weight.
  • Obesity prevalence is highest among non-Hispanic Black adults (49.9%), followed by Hispanic adults (45.6%), non-Hispanic white adults (41.4%), and non-Hispanic Asian adults (16.1%).
  • By age, obesity rates are 39.8% among adults aged 20-39 and 44.3% among adults aged 40-59.
  • The relationship between obesity and socioeconomic status is complex. Individuals with college degrees generally have lower obesity rates compared to those with less education. Obesity prevalence varies among income levels and genders.

Oprah visits the Cleveland Clinic and meets with Dr. Butsch, the director of obesity medicine. Dr. Butsch explains that obesity is influenced by genetics, changes in the food environment, lack of sleep, and alterations in the microbiome due to processed foods. He highlights the “set-point theory,” which suggests that after weight loss, the body slows metabolism and increases hunger, pushing people back to their previous weight.

This physiological response reveals why addressing obesity through calorie restriction alone often fails. The special emphasizes that obesity is a chronic disease that requires comprehensive, long-term management.

Oprah introduces Dr. Amanda Velazquez, Director of Obesity Medicine at Cedars Sinai’s Center for Weight Management and Metabolic Health. Dr. Velazquez explains the mechanics of GLP-1 medications and their impact on reducing “food noise”—the constant preoccupation with food—making it easier to maintain a healthy diet. She notes that these medications are promising because they address both the physiological and psychological components of one’s relationship with food.

For a more detailed explanation of how GLP-1 medications work, listen to episode 89 of my podcast.

Oprah then asks the question on everyone’s mind: “Do you need to take these medications for life?” Dr. Velazquez states that current data suggests continued use is necessary, as research shows weight typically returns once patients stop the medication.

The special then features personal stories to underscore the impact of these medications, beginning with Amy. Amy lost 160 pounds, transforming her life through these medications. She shares her struggle with weight, which stemmed from childhood and deepened due to hardships like the premature birth of her son, the death of her father, and isolation during COVID-19. At her heaviest, she weighed 300 pounds and was diagnosed with diabetes when her A1C exceeded 10%.

After losing 160 pounds, her bloodwork returned to normal, and the constant food noise that once controlled her thoughts quieted. She no longer feels dominated by food. Amy describes how people’s treatment of her has changed since losing weight, underscoring the judgment often faced by those struggling with obesity.

The special then shifts to Maggie’s story, exploring the obesity epidemic among children and the ethics of prescribing weight loss medications to kids. In 2023, the American Academy of Pediatrics recommended obesity medications for adolescents over 12. Maggie represents the challenges faced by young people struggling with severe obesity. At 11, she weighed nearly 300 pounds, significantly impacting her quality of life. Her mother Erica recounts that even as a baby, Maggie had an unusually large appetite. Family members often commented on her eating habits, and her pediatrician suspected a genetic issue contributing to her obesity.

At age 13, Maggie underwent bariatric surgery. Despite this, her doctors felt the weight loss was insufficient and prescribed Victoza, a liraglutide used for Type 2 diabetes but also effective for weight loss in some patients. Maggie was one of the first teens in the U.S. to use such medications for weight management. Before surgery and medication, she was prediabetic with fatty liver disease. Healthcare professionals warned that she could reach 500 pounds by age 16 and face an early death without intervention.

This urgency drove her parents to pursue surgery and medication despite backlash. They believed that without action, Maggie would face dire consequences. The combination of surgery and medication proved transformative, as she has since lost 108 pounds. Now 16, she is an active member of her school’s cheerleading team and has an active social life.

The special shifts to Weight Watchers, with Oprah noting that she left the board to avoid any perceived conflict of interest. She invites Sima Sistani, CEO of Weight Watchers, to discuss the organization’s evolution from a diet company to one incorporating weight loss medication through their “Sequence” program. Sequence provides access to GLP-1 medications for weight loss. Sistani explains that Weight Watchers now acknowledges the need for a biological approach since some individuals require medication due to their biology.

The special then briefly discusses the side effects of these medications. Dr. Jennifer Ashton, ABC News’ chief medical correspondent and a board-certified OBGYN and obesity medicine specialist, offers historical context. She explains that GLP-1 medications were initially FDA-approved for Type 2 diabetes nearly 20 years ago. She emphasizes the importance of weighing the risks and benefits of taking or not taking these drugs, given the health risks of untreated obesity, which include heart attacks, strokes, and cancers.

Rolanda, an audience member, shares her experience with severe nausea and vomiting, leading her to discontinue the medication and seek emergency care. Dr. Amanda Velazquez responds, arguing that most side effects are mild to moderate and manageable with proper support. While acknowledging rare concerns about pancreatitis, gallbladder issues, and thyroid cancer, she emphasizes that these risks haven’t been conclusively proven in human studies.

Oprah then interviews representatives Negelle Morris from Novo Nordisk and Rhonda Pacheco from Eli Lilly, who highlight the challenges in securing insurance coverage for obesity treatments. Oprah questions why insurance companies are hesitant, suggesting skepticism over obesity as a legitimate disease. Morris notes Novo Nordisk has long recognized obesity as a disease and advocates against stigma to improve access. Both representatives recognize growing demand for weight loss medications, but also note that many healthcare providers aren’t adequately informed about them, which can hinder access for patients. 

Oprah ends the special by acknowledging different perspectives, saying,  “For people who feel happy and healthy and are living life in a bigger body and don’t want the medications, I say bless you… and for those that believe diet and exercise is the best and only way to lose excess weight, bless you too…and for the people who think this can be the relief, support, and freedom you’ve been looking for your whole life, bless you because there is space for all points of view.” She encourages those who want to learn more about these medications to visit www.oprahdaily.com


In reflecting on Oprah’s special about weight loss medications, it’s clear that her journey with weight and diet is a microcosm of the broader societal conversations around these topics. Oprah has always been a mirror to the cultural zeitgeist influencing and being influenced by it. She is, for all intents and purposes, an OG influencer.

Her impact on how we perceive health and wellness is undeniable. She has the power to sell out products with her compelling storytelling, making her a go-to for those seeking advice. Yet, her personal struggles with weight have always been a focal point, and she remains both a victim and a contributor to society’s obsession with it. The infamous moment when she wheels out a wagon of 67 pounds of fat on her prime-time show is a prime example of how she’s navigated her weight loss journey in the public eye, sometimes echoing problematic narratives that equate weight loss with success.

Her weight was regularly exploited by the media, but she also played into that narrative by constantly talking about her weight and influencing others with whatever the diet du jour was on her show, with very little care for fact-checking.

The special, while informative in some ways, had significant gaps. The absence of Registered Dietitians and therapists as expert commentators was glaring. Though the participating physicians disclosed their affiliations with the drug companies, selecting experts not financially tied to the pharmaceutical industry would have strengthened the argument for these medications.

Eating disorders were not addressed at all, a significant oversight given their relevance to the conversation. An eating disorder specialist could have offered valuable insight into considerations for individuals struggling with disordered eating and contemplating these medications.

The special also lacked discussion about the misuse of weight loss medications by those trying to lose only 5-10 pounds, often obtaining them from med spas with compounded versions of the drugs. Furthermore, the oversimplified approach to solving obesity missed the opportunity to explore the social determinants of health and barriers to accessing these medications, whether availability, cost, or insurance coverage.

Lastly, the brief mention of side effects and the historical context of Oprah’s previous weight loss endeavors raised concerns about the long-term sustainability of these solutions. It’s a reminder that while these medications can be powerful tools, they’re not a magic bullet and their effectiveness and impact must be evaluated over time.

No one should dictate how Oprah or anyone else manages their own body. As a Registered Dietitian in a small, straight-sized body, it’s not my place to judge. While the special provides an inroad for us to have important conversations about the role of these drugs in the treatment of obesity, it sometimes felt like an infomercial, advocating these medications as the primary treatment without emphasizing lifestyle or behavioral changes.

This is a complex issue with no one-size-fits-all solution. As we continue to navigate the ever-evolving landscape of obesity treatment, we must approach these topics with empathy, understanding, and critical analysis. Whether through medication, lifestyle changes, or a combination of approaches, the most important thing is finding out what works best for you and your body.

If you’re considering these drugs, seek the guidance of a knowledgeable healthcare professional, including a Registered Dietitian who can provide personalized recommendations based on your unique needs and health history.

If you want to learn more about weight loss medications, listen to the following episodes of my podcast:

Let’s Talk About Ozempic

Medication as a Tool for Weight Loss

Oprah, Ozempic and The Obesity Conversation