Sickly Thin is Back In—If You Can Afford It

Image via The Scientist

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To preface, this article will be talking about infectious diseases, drug use, eating disorders, and GLP-1s. Some of these topics might be triggering to some readers. 

It is undeniable that the rising prevalence of GLP-1s, such as Ozempic or Wegovy, is changing the definition of the “ideal body.” It is easier than ever to drop the pounds if you are overweight or obese. However, there is a phenomenon in which people of a healthy weight still use these medications to achieve their ideal bodies, leading to both shortages in the medication for those who need it, particularly those with Type 2 Diabetes, and a rise in those using it to fuel their eating disorders.

First and foremost, this article will not be speculating on the health or medical history of any famous individual. Many have argued that society should have learned from the case of Chadwick Boseman when it comes to judging the appearances of people you are not personally connected to. You never know what an individual is going through, so you may want to think again before assuming that someone is taking a weight-loss drug because you believe they have “Ozempic face.” 

This new rise of “thinness” may feel like a fundamental shift from the “body positive” era of the 2010s. This is especially salient when considering how “body positive” influencers and celebrities have begun to lose weight, with some attributing it to GLP-1 use. However, for the last 250 years, beauty has been closely associated with being slender. Before the 18th century, curvy women were seen as having the optimal feminine physique. In fact, this seemed to be true across cultures throughout human history, from France to Greece to China and beyond. 

This all changed in the 1700s with the rise of tuberculosis, an infectious disease that spread across America and Europe. Believed to be caused by “bad airs,” and later confirmed to be a highly contagious bacterial infection, the effects of this illness were romanticized late into the 19th century. The thinness and pale skin were caused by lack of appetite and anemia, while the sparkling or dilated eyes, flushed cheeks, and red lips were caused by a frequent, low-grade fever. 

This quickly became the standard of beauty, known as “consumptive chic.” Women who were not infected engage in extreme dieting to lose weight and go as far as using toxic makeup to achieve the “fair but flushed” appearance. Eventually, this illness, known at the time as “consumption” for how victims seemed to waste away, would kill most of those infected. While members of every class were affected, lower or working classes were far more at risk of contracting the illness, while upper classes were far more likely to romanticize it.

The cause of tuberculosis was ultimately found by Robert Koch in 1882, and cures were later developed throughout the 20th century. However, the beauty standards the disease created stayed behind. The 1920s were famous for the thin, androgynous “flappers.” Later, the 60s and 70s saw a rise in diet, exercise, and eating disorders. The 80s were defined by the rise of supermodels with lean, athletic physiques. The 90s built upon this supermodel trend, but with thinner, waif-like bodies, primarily caused by drug use, particularly heroin. Like the times of tuberculosis, this appearance was idealized, leading to the term “heroin chic.” 

This era saw a drastic rise in anorexia nervosa, with the highest rate of mortality in the 90s among all other mental disorders. Paradoxically, this period was also defined by a rise in obesity. Throughout all forms of media and all walks of life, thinness was celebrated, while larger bodies were warned to be unhealthy and, ultimately, unappealing. 

The 2010s fought back with body positivity. Celebrities and entertainers were no longer chastised on the front of tabloids for being anything more than a size 0. Diverse body types were not only accepted but celebrated. But something still lurked in the background. Social media allowed models to live on a person’s phone, and the idea of body positivity constantly battled the persistent notion of an “ideal body.” 

In 2020, there was still a rise in the number of plus-sized models. Things were looking up for body positivity – until GLP-1s were approved for commercial use. In the last year, 97.1% of models on the runways during the last season were US sizes 0 to 4. In February 2024, 5.8% of American adults were on GLP-1s; as of October 2025, this number had increased to 12.4%. 

Curvy women were once viewed as the ideal because they had access to food and the ability to have healthy children. Tuberculosis was more commonly contracted by the working class, but was more favorably viewed amongst the upper class. “Heroin chic” was only achievable to the fabulously wealthy or fabulously beautiful, while the common man only had access to cheap or fast food. GLP-1s are incredibly expensive and often are not covered by insurance, leaving them primarily accessible to the rich and famous, or even just the moderately rich and comfortable. The “ideal body” has always been tied to class, and this new round of perfection will be just as limited as it has been in the past.

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This article was edited by Hayley Dunn.