Ozempic or Bust

America has been trying to address the obesity epidemic for four decades now. So far, each new "solution" has failed to live up to its early promise.

- Daniel Engber

IN THE EARLY SPRING of 2020, Barb Herrera taped a signed note to a wall of her bedroom in Orlando, Florida, just above her pillow. NOTICE TO EMS! it said. NO VENT! NO INTUBATION! She'd heard that hospitals were overflowing, and that doctors were being forced to choose which COVID patients they would try to save and which to abandon. She wanted to spare them the trouble.

Barb was nearly 60 years old, and weighed about 400 pounds. She has type 2 diabetes, chronic kidney disease, and a host of other health concerns. At the start of the pandemic, she figured she was doomed. When she sent her list of passwords to her kids, who all live far away, they couldn't help but think the same. “I was in an incredibly dark place," she told me. "I would have died."

Until recently, Barb could barely walk at least not without putting herself at risk of getting yet another fracture in her feet. Moving around the house exhausted her; she showered only every other week. She couldn't make it to the mailbox on her own. Barb had spent a lifetime dealing with the inconveniences of being, as she puts it, "huge." But what really scared her and what embarrassed her, because dread and shame have a way of getting tangled up-were the moments when her little room, about 10 feet wide and not much longer, was less a hideout than a trap. At one point in 2021, she says, she tripped and fell on the way to the toilet. Her housemate and landlord a high-school friend-was not at home to help, so Barb had to call the paramedics. "It took four guys to get me up," she said.

Later that year, when Barb finally did get COVID, her case was fairly mild. But she didn't feel quite right after she recovered: She was having trouble breathing, and there was something off about her heart. Finally, in April 2022, she went to the hospital and her vital signs were taken.