Review: Vivien Horler
Enough – Your health, your weight and what it’s like to be free, by Ania M Jastreboff and Oprah Winfrey (Bluebird)
When the new treatments for type 2 diabetes – with brand names we’ve become familiar with, such as Wegovy, Ozempic and Mounjaro – were discovered to help people who did not have diabetes lose weight, there was indignation.
People who did not have diabetes were taking them, causing a shortage among patients who depended on them. This was outrageous.
Fat people should just control themselves and their urges, and leave the life-saving treatments for those who really needed them.
Well, this book might help change your mind.
Anyone with a passing knowledge of American contemporary culture knows that media star Oprah Winfrey has struggled with her weight over the years. In a preface to this book, Oprah writes that for more than five decades much of her life would be dedicated to fighting her weight.
Once she went to see a World Heavyweight Championship and heard the announcement that Mike Tyson’s fighting weight was 218 pounds (98.8kg). She also weighed 218 pounds. “I swallowed my shame. I accepted that I’d brought this on myself. The cycle continued.”
In 2018 she heard that people were taking a drug meant for diabetics that helped them control their weight. She declined to try the drug – firstly it was meant for people with diabetes and she did not have diabetes, and secondly, “everyone would say I took the easy way out”.
She discovered that back in 2013 the American Medical Association had recognised obesity as a disease – it has also been recognised by the WHO as “a chronic, relapsing disease”.
After realising this, she called her doctor and went on the meds. She noticed a change within days. She had been used to eating two English muffins at a time, one with jam and another with honey. Now she couldn’t finish a whole one.
But Enough isn’t simply a case history, although it contains many of them. The bulk of the book is written by Ania M Jastreboff, a medical doctor who did a PhD studying the neurobiology of obesity. She became the founding director of the Yale Obesity Research Center, leading landmark trials investigating new obesity medications, and conducting research to better understand the biology of obesity.
Nearly half of Americans have obesity while two thirds are overweight or have obesity. She writes: “Obesity is not a choice; it’s confused biology.”
And the reason is that while we evolved to have fat stores to tide us over in times of famine, we live in a very different environment today, but our bodies are still storing extra energy in the form of fat, just in case. So while some people – those who do not have obesity – can eat a meal and feel sated, people with obesity never feel they have had enough.
Obesity is not just a disease in itself – it leads to the development of other life-threatening health risks, such as heart disease and various cancers. These risks are compounded even further in people with diabetes, and nearly 90% of people wíth type 2 diabetes have obesity.
At least 13 types of cancers are obesity related, including post-menopausal breast cancer, colon cancer and pancreatic cancer.
Jastreboff says: “So let’s imagine a world “where we can safely and effectively treat obesity and, in so doing, potentially prevent, mitigate or treat downstream diseases, in effect saving lives.”
She adds: “We don’t have to imagine such a world; we are living in that world. We have safe and effective treatments.”
So we now can make a crucial shift from blame and shame to science and treatment. Because people can no more control their obesity as a matter of will than they can control their blood pressure or their insulin production.
And when it comes to whether people who do not have diabetes should be taking drugs initially developed for people with the condition, Jastreboff points out that if you can get someone’s weight down, they are much less likely to develop type 2 diabetes in the first place – the medication actually prevents the condition.
This a complex subject and a complex book with a lot of science in it. Jastreboff details the history of treatments of obesity, and the various medications that have been prescribed over the years, along with the science of how the new medications work. They are not magic drugs, she emphasises, and they have side effects that effect people differently.
But they offer a beacon of hope.
Jastreboff says when she studied medicine there was not a single presentation about obesity during her years of undergraduate study. Now the treatment protocols are rapidly transforming.
The book represents a snapshot of the situation in 2025, she says. Now scientists are discovering other ways the new treatments can affect human behaviour – there was recently a piece in the Guardian suggesting some studies show they could affect the treatment of alcoholism too.
People who have been effectively treated speak about “freedom” – enjoying food without the emotional turmoil, walking into a clothes’ shop and finding something that fits, being able to “hear my thoughts now that the food noise is gone”, and even small things like tying their shoelaces and crossing their legs.
It looks like a medical revolution.