“Here are some things I do now in a bikini that I would not have done at 30: one, wear it; two, eat in it; three, sit down in it.” So said comedian Riona O’Connor in a recent viral video, who then slapped her tummy with a grin, adding: “Throw it on you, nobody cares.”
A joyful and empowering message to other women: weight consciousness is in our heads. I so wanted to believe it. But depressingly, new evidence suggests otherwise. Most people know that richer people tend to be thinner. Less appreciated is that this divide is largely driven by women.
According to data gathered between 2021 and 2023, the poorest third of women in America suffered an obesity rate 14 percentage points higher than the richest third. For men, the gap was less than a percentage point. In Europe the patterns are similar, though the gender differences are less extreme.
This inequality raises the possibility that weight isn’t merely an outcome of poverty, but also a driver of it. If being overweight saps women’s confidence, that could hold back their earning power. Or if employers discriminate against heavier women in particular, being bigger could lower income. Depressingly, one study found that whereas overweight women suffer a pay penalty in occupations involving public speaking, overweight men do not.
The recent GLP-1 drug revolution offers help to women struggling with their size — and economists an opportunity to explore the effects of weight change. A new study by Rebecca Diamond of Harvard University compares women taking GLP-1 drugs for weight loss with women who wanted to but hadn’t yet started. Following these groups over time, she can see whether weight loss boosts their fortunes.
Diamond finds dramatic effects. After 18 months, women using GLP-1 drugs who start off without a job enjoy employment rates 27 percentage points higher than otherwise similar non-users. Women who start off with a job see their employment rate fall slightly, and although the data is too noisy to pick out effects on their earnings, it looks like their household income rises by 10 per cent.
That second effect is a bit surprising, and possibly explained by parallel developments in these women’s love lives. Diamond estimates that GLP-1 drugs give single women a dramatic 29 percentage point increase in their chances of coupling up. On average, their new partners are richer than them, giving their household income a bump. Which could explain why a few of the women losing weight then feel able to drop out of work.
These are extraordinarily large effects, which warrant the caveat that pinning down causality is hard. GLP-1 users could be different from non-users for reasons other than their drug use, including their enthusiasm to turn over a new leaf. Though Diamond points out that the two groups look similar before treatment, and the effects emerge slowly, consistent with the gradual effects of weight loss rather than a burst of motivation.
The study’s good news is that GLP-1 drugs seem to be helping some women. The bad news is just how much of a burden weight is in the first place. (As an aside, Diamond also finds evidence to suggest that whereas women on GLP-1 drugs stick with their partners at the same rate as non-users, male users of the weight-loss drugs don’t seem to be quite as faithful. Sigh.)
Women have worked it out. In the US a survey put the share of women using GLP-1 drugs at 15 per cent, compared with 9 per cent of men. One study found that Voy, a British private-sector provider of weight-loss drugs, makes almost eight in ten of its prescriptions out to women.
What next? As more women take GLP-1 drugs, the size of the obesity penalty could change too. Over the 1980s and 1990s when obesity rates rose, so did the premium associated with increasingly scarce thinness. If GLP-1 drugs mean that being slender becomes completely commonplace, then a reversal of the historical trend means that premium could shrink.
I’d feel more optimistic if it weren’t for another inequality in the weight-loss revolution: so far at least, GLP-1 drugs are disproportionately used by the rich. In Diamond’s study two-fifths of the women paid for the drugs out of pocket, at a median cost of US$275 a month.
Research based on Voy prescriptions shows how, adjusting for relative obesity rates, uptake is skewed towards more affluent areas. If obesity becomes an even stronger signal of economic disadvantage, the stigma attached could grow. FINANCIAL TIMES