In a just society, with a rational allocation of resources, I would not be anywhere near the front of the line to obtain a medication that is prohibitively expensive and, at least until recently, in short supply. (Now, you have to go hunting for Wegovy.) Neither would the attractive folks in the Oscars audience — nor many of the other people I know who are taking it. If you can’t be too rich or too thin, it turns out, you might have to be rich to be thin. The racial disparities — in obesity and access — make matters even worse.

And we are only starting to consider questions about what constitutes appropriate use. For the seriously obese, the case seems clear. Leaving aside the important questions of cost, and prices will come down, certainly as patent protections expire, where to draw the line? If this medication is safe and effective, why not prescribe it for the merely overweight, even without an associated medical issue? And why not for the bride who wants to drop 10 pounds before her wedding day? She might gain the weight back, but would it really be so terrible?

Still, to take up the other side of that argument: What role does this leave for instilling habits of self-discipline, encouraging healthy eating and incorporating exercise? The experts can preach about the importance of accompanying use with a program of diet and exercise; we know what will happen in the real world.

[This is one of the most comprehensive essays I’ve seen on Ozempic and other semaglutides in the market being used explicitly for weight loss, as opposed to Type II diabetes. Marcus discusses her own painful journey with weight as part of this analysis, but it covers a lot of ground. I recommend reading it all. Full disclosure: I take a related med, Trulicity, as a Type II diabetes med, and I’ve lost over 40 pounds in the last six years because of it. — Ed]