The GLP-1 generation
New drugs could revolutionize women’s health — but only if care keeps up.
When Dr. Fatima Cody Stanford realized she wanted to specialize in obesity, she was working overnight in the pediatric ICU. She had just intubated another young patient — a harrowing task made more difficult in larger bodies. The opening to the airway hides beneath layers of soft tissue and every second of searching is painfully long.
At 2:30 a.m., in the glow of a computer screen, she typed “obesity fellowships” into Google. To her surprise, there were just two in the entire country. It was a long shot, and a big pivot, but she applied anyway.
Dr. Stanford’s decision was shaped long before that night. She grew up a Black woman in the South, aware of the contradictions surrounding her. In her neighborhood, Black women were outpacing every other group in educational attainment — yet they also faced the nation’s highest rates of obesity and metabolic disease.
The disparity was everywhere she looked, present in her neighbors, her family, her friends. And her experiences working in community health revealed that for most people lifestyle changes only worked to a degree.
“We just weren’t seeing major shifts in body composition,” she told me. “I knew there had to be more to this piece of the puzzle.”
Dr. Stanford learned very little about weight or nutrition in her initial medical training but she understood intuitively what medicine had long missed: that obesity was not a failure of willpower but a disease of biology — shaped by genetics, hormones, and environment.
Eventually, she became an expert in obesity medicine and her conviction earned national attention. In 2013, she delivered a rousing keynote at the American Medical Association’s annual meeting; the next day, the AMA voted to recognize obesity as a disease.
This was a watershed moment in public health — and the beginning of a new way to see patients whose bodies have too often been misread as moral statements instead of biological ones.
From surgery to Semaglutide
Our metabolism impacts every system in the body, influencing how we age, reproduce, and recover. Yet its relationship to our outward appearance also lives in a murky space between the clinical and the cosmetic — a place where women have historically borne the brunt of society’s scrutiny and trends. As table stakes, 45% of American women are on a diet on any given day (compared to 25% of men). But medicine’s tools for weight loss have pulsed to the rhythm of societal beauty standards, erratic and ever-changing.
During Dr. Stanford’s training, gastric bypass surgeries reigned supreme. By the 2000s, they dominated both medical journals and daytime television — the only intervention that seemed to truly work. But surgery carried risks, and for many women, it represented a final resort.
A decade earlier, in the 1990s, the same hunger for control had taken another form: fen-phen. The combination pill promised effortless appetite suppression and spread through clinics like a whispered secret — until it left a trail of damaged hearts and lawsuits. Nearly six million Americans had taken it; most were women.
For half a century, women’s bodies have carried the hopes and harms of every “miracle” weight-loss breakthrough. GLP-1 drugs, when they arrived, seemed destined to repeat that cycle — until they didn’t.
Dr. Stanford pinpoints the inflection to the year 2021, when tolerable, once-weekly injections of Semaglutide became available. Suddenly, weight loss wasn’t fleeting. Patients sustained results, maintained lower blood sugar, and showed measurable improvements in inflammation and hormonal balance.
This time, something else was different too: visibility. Before-and-after reels and social media testimonials amplified what had once unfolded quietly in exam rooms. As of today, roughly one in eight Americans have tried them. Most of them are women.
Bodies, biology and the burden of proof
Dr. Holly Lofton also grew up a Black woman in the South. She and Dr. Stanford are from nearby towns. They shared the same Georgia summers and even attended the same dance camp as children.
When Dr. Lofton was twelve years old, her family enrolled in a community-based weight management program. With support, what had once been a routine of fried food and drive-thru dinners gave way to balanced meals and long walks.
In a stroke of fortune, Dr. Lofton lost a remarkable amount of weight. When she returned to school, two things were immediately clear. “One, the cheerleading uniform that I had gotten fitted for completely fell off, and they had to make a new one. Two, I was treated very differently by the students and the teachers,” she told me. “It changed my life.”
That change in how she was regarded, and the prejudices they exposed, stayed with her. Years later, she also applied for one of the only two obesity fellowships in the country and today she leads the weight management program at NYU Langone. Most of her patients are women — women she follows for years, through fertility challenges, pregnancy, postpartum recovery, and menopause.
We live in a world where women’s bodies are endlessly scrutinized, yet their biology is too often overlooked.
She didn’t set out to focus on reproductive life stages, but in practice, that’s exactly what she does. Often, she’s the first to name what others have missed — a diagnosis of PCOS, insulin resistance, or another form of metabolic dysfunction hiding in plain sight. For women, whose hormonal cycles are in constant dialogue with metabolism, weight management and reproduction are often two sides of the same coin.
We live in a world where women’s bodies are endlessly scrutinized, yet their biology is too often overlooked. But if metabolism and reproduction are as intertwined as the science increasingly shows, then — as clinicians like Lofton and Stanford argue — a focus on women in this new era of metabolic health care isn’t bias. It’s good medicine.
Syncing two clocks
For decades, fertility specialists imposed strict BMI cut-offs to qualify for treatment. This required turning away women of size deemed too high-risk for in-vitro fertilization. The rationale was well-intended—egg retrievals must happen under general anesthesia, which requires safe access to the airway. But the effect was exclusion. “We were eliminating about ten to fifteen percent of people seeking care,” one reproductive endocrinologist, Dr. Wendy Vitek of Boston IVF, told me.
Now, GLP-1 medications are helping to bridge that divide. Clinicians like Dr. Vitek describe them as mirrors to IVF. “GLP-1s for weight management feel like IVF for infertility,” Dr. Vitek told me. “They work in ways we don’t completely understand, but can’t deny.”
Metabolism is not a side story in reproductive medicine. It’s the foundation.
Motivated by her desire to help more of her patients access IVF, Dr. Vitek sought a new board certification in obesity medicine, and she created new, highly precise protocols: she uses GLP-1s to improve and stabilize metabolic markers before egg retrieval; pauses one week prior to avoid aspiration risk; resumes once embryos are safely frozen; and pauses once again two months before an embryo transfer (GLP-1s are contraindicated during pregnancy and while breastfeeding). In essence, she is working to time together two biological clocks that, for many women, have long run out of sync.
The implications reach beyond conception. Improved metabolic health can reduce pregnancy complications, ease postpartum recovery, and fortify women through perimenopause. Many of these potential uses remain off-label, but they reflect a profound truth: metabolism is not a side story in reproductive medicine. It’s the foundation.
Yet as enthusiasm swells, so do concerns about shortcuts. Take the bus, stand on a city corner, or scroll through Instagram, and you will be besieged by direct-to-consumer ads for GLP-1s. The path to these prescriptions often looks very different from the closely-moderated partnerships of Dr. Vitek, or Dr. Lofton, or Dr. Stanford’s offices—in fact, nearly 1 in 5 GLP-1 prescriptions come from platforms that don’t even provide an appointment with a doctor. Yet all of the experts I’ve spoken with tell me that for these drugs to fulfill their potential, they must not just be offered as pills to be taken alone, but as gateways to systems of care that consider the full context of women’s lives.
When the body becomes the self
To provide care—and not just pills—context is everything. In the brave new world of GLP-1s, science may be able to recalibrate how your body looks but it can’t easily account for how the world responds to it.
Dr. Aleesha Grier, a clinical psychologist trained in addiction, first entered obesity medicine by accident. At Yale in the early 2010s, as bariatric surgery ballooned in popularity, she was asked to design psychiatric evaluations for candidates. The work revealed something few had articulated: weight loss doesn’t just change a body. It changes a life.
“When I started doing these evaluations, I used to warn clients — you’re going to see changes in your relationships,” she told me. “Most didn’t believe me. But when you’re no longer the heaviest person in your circle, people start comparing themselves to you, even if they never say it out loud.”
Now as a member of our clinical team at Maven, Dr. Grier counsels patients through transformations that often resemble reproductive journeys — milestones, setbacks, a body that doesn’t feel like your own. “Aside from being pregnant,” she said, “this is the second time in your life people will feel entitled to talk about your body — and sometimes touch you — without asking.”
As both a former IVF and bypass patient herself, Dr. Grier knows that these journeys are never just physical. They are existential. When you achieve your dream body and your dream pregnancy in the same calendar year, how do you develop the emotional toolbox to reassure yourself you will lose the weight again some day?
Weight loss, like fertility, is rarely just about the body. It is about belonging—to ourselves, to others, to the world that reflects us back in mirrors both literal and social. In a sense, GLP-1s are miraculous, and the clamoring for access isn’t an overreaction. Few drugs since the advent of Penicillin appear as poised to transform human health at its foundation.
But in the unique paradox of our current system—one wherein women are our highest health care utilizers and yet their bodies remain most misunderstood—we have a chance to correct history. What if, for once, we distributed a so-called “miracle drug” with a bend to those who need it most? And what if we did it not just as the promise of a prescription, but of partnership? The real test of these drugs won’t be what they can do for the body but what medicine chooses to do with them and for whom.
What my team is reading, building, and thinking against:
GLP-1s and the cultural moment: Few medications have captured the zeitgeist like GLP-1s — perhaps not since the COVID-19 vaccine. Jia Tolentino proves the perfect observer, unpacking what these drugs reveal about our society and the impossible expectations we place on women. A brilliant appetizer for the larger conversation.
Policy shifts at the top: Just as this piece dropped, the White House announced exclusive deals with Eli Lilly and Novo Nordisk to lower GLP-1 costs for Medicare recipients — a move that could eventually ripple into commercial markets, though how much and how soon remains uncertain.
The science behind the surge: Though GLP-1s may seem like an overnight phenomenon, they’ve been in development for over a decade. We’re only at the first crest of the wave. This article surveys what’s next: more daily pills, gentler molecules with fewer side effects, and versions that promise a slower weight-loss plateau.
The weight of bias in care: To be a pregnant Black woman in the U.S. healthcare system is to endure relentless indignities — compounded further by weight bias. Every essay in
’s Thick is worth reading, but this excerpt, in particular, stops me cold. A reminder of our opportunity — and responsibility — to design care rooted in empathy.