But if Maggie was sheltered from the onslaught beyond her small town, her mother was not. Erika has also struggled with her weight her entire life and feels the experience defined her; she has done everything she can to reassure Maggie that she is beautiful as she is and to protect her from the casual cruelty of people she encounters. But she also knew from the time her daughter was young that there was something different about her. In a small, dark part of herself, Erika feared that, because of her parenting or her habits or her own history with food, she was the one at fault. Even now, after all the interventions — the doctors, the fighting with insurance companies, the overhaul of the family fridge — this worry has not left her. It has only evolved, because Erika knows her neighbors and people in the world beyond have things to say not just about Maggie’s body but about the treatments she has chosen for it, too.

For people who are dealing with those conditions, Ozempic appears to create a path toward a healthy relationship to food. For those who aren’t, it might function more like an injectable eating disorder. As the side effects make clear, it’s not a casual thing to drastically alter your body’s metabolic process, and there is no large-scale data about the safety of these drugs when taken by people who are mainly interested in treating another chronic condition, the desire to be thin.