Women in South Asian societies have long been obsessed with the idea of ‘reducing weight’. In Pakistan particularly, the emphasis on physical attributes is especially pronounced in the context of finding a partner.

The standards of beauty vary from family to family, but usually women are expected to look a certain way. Even with raging conversations about body positivity over the years, if you pass through the streets of Karachi, you will see a lot of posters advertising treatments promising weight loss in mere days. 

In the quest of having a near-perfect body, women often opt for drastic measures, ranging from restrictive diet plans to treatments that might end up harming their health. 

“I was forced into losing weight at the age of 18. I was not overweight, now that I think about it,” 27-year-old Nashrah, a mother of two who is battling chronic hormonal imbalance, tells Eos.

Women have long been willing to put their health on the line in the quest to lose weight, but fashionable options not meant for weight loss can cause more harm in the long run

“My mother took me to a female doctor, who made a customised diet plan for me,” she continues. “I had to fast for at least 15 hours a day, and she called it intermittent fasting.”

INTERMITTENT FASTING

Intermittent fasting is a technique used to reduce fat in one’s body. It is usually prescribed when a person has an uncontrolled amount of fat, which may end up affecting their liver, causing functional diseases.

However, as a common practice, a lot of ‘diet-conscious’ women use this mechanism to lose weight. It can lead to low oestrogen levels and irregular menstrual cycles, which is caused by ‘nutritional infertility’, as research by PubMed suggests.

“As I grew older, I developed acne and iron deficiency to an extent that, by the age of 22, all my hair had turned white,” Nashrah continues. She also developed alopecia (hair loss) due to mood disorders, and had an irregular menstrual cycle.

“Some months, I would bleed for 10 days straight, and some months I would be fighting deathly cramps with no sign of my period. It was hell,” says Nashrah. 

“It took everything in me to build myself again,” she adds. “I would never ever want anyone to go through this experience.”

Nashrah is currently seeking hormonal treatments for her oestrogen levels, which went low due to her eating disorder and then her two pregnancies. She is also battling anxiety and is simultaneously in therapy to manage her condition.

THE PROBLEM WITH OZEMPIC

Another treatment that women seek to lose weight is Ozempic, which was a drug originally approved by the US Food and Drug Administration, but only for people with type-2 diabetes. The treatment gained worldwide attention after billionaire Elon Musk credited it for his dramatic weight loss. Many celebrities are rumoured to have used Ozempic for their weight loss.

Ozempic is a weekly injection designed to assist in reducing blood sugar levels by stimulating increased insulin production from the pancreas. While not officially sanctioned for weight loss purposes, some doctors prescribe it off-label for weight management. 

It functions by imitating the naturally produced hormone insulin. As the levels of this hormone increase, the molecules communicate with the brain, signalling satiety. Additionally, Ozempic delays digestion, prolonging the time food remains in the body, similar to the impact of bariatric surgery.

Weight loss frequently occurs as a side effect of using Ozempic to manage diabetes. It is intended for extended use.

“I was prescribed Ozempic two years ago by a lady doctor, who also taunted me on my weight,” says 26-year-old Javeria. “I have polycystic ovary syndrome [PCO], which is why it keeps fluctuating,” she explains. “Since my family does not have much knowledge of medicine, we took it as a simple weight-loss supplement.” 

She tells Eos she clearly communicated to the gynaecologist about having PCO, however, she was still prescribed Ozempic. 

It was at the time when she was about to get married and her mother was worried about her weight fluctuations. “I had extreme bloating issues and I was turned down by a lot of families before I got married,” she says.

Javeria says her mother forced her to take the treatment on the suggestion of her aunt, who said it had helped her daughter-in-law to look petite. She adds that she was always suspicious of the injections, “but I really had no choice because I was brutally shamed by my family.”

The treatment played further havoc with her health. “I was already in so much pain due to PCO. My period cycle was a mess, I would never get it on time, and once I started taking Ozempic, my period for the first six months was non-existent,” she explains amidst tears. “I would get cramps, but I wouldn’t bleed.”

THE BURDEN OF EXPECTATIONS

Javeria stayed in excruciating pain for the eight months she took the weekly injections. “I wish my family was more accepting towards how I looked, which was fine,” she says. “I was not size zero, yes, but I realised later in life that I was never obese. I have a genuine disorder and I did not have to go through the torture of changing myself against my will.”

Eos reached out to Dr Kulsoom Shafi, a gynaecologist at Karachi’s Abbasi Shaheed Hospital, who predominantly deals with women facing menstrual disorders, but also women seeking weight-loss treatments.

“This emphasis on weight control may stem from various factors, including the increasing prevalence of obesity, societal pressure for thinness perpetuated by popular media platforms, such as TV, magazines, and the internet, as well as the unregulated weight-loss industry promoting unrealistic standards,” says Dr Shafi. “Consequently, many individuals express a shared aspiration for weight reduction, even without medical necessity.” 

She adds that she deals every day with women and young girls who are forced to diet against their will.

“I am appalled, because they are not even overweight. Their parents force them to control their diet at a time where their bodies are going through major hormonal changes,” she emphasises. “A 14-year-old girl cannot practise intermittent fasting or follow diet plans. Let her grow at her own pace,” she says.

When asked if Ozempic treatment is a good option for losing weight, she vehemently rejected the idea. 

“It is extremely irresponsible of medical health professionals to prescribe such treatments to women, knowing the kind of hormonal changes their bodies go through,” she says.

A treatment solely developed for curing diabetes type-2 cannot be used for losing weight, says the doctor. “It’s heartbreakingly unfortunate that there is no health awareness for women specifically, which is why such incidents happen. I have known women who died right in front of my eyes due to such carelessness,” she says.

Nutritionist Ayla Arshad says weight loss has to be a consistent and balanced process. “Every diet plan is not suitable for every body type, so it is very important to know your own body,” she points out while lamenting the lack of awareness about nutrition, due to which “people just pick up a diet plan that is popular.”

Javeria knows this too well and, to this day, she regrets opting for something which not only gave her physical pain, but also ruined her mental peace. 

“I have a two-year-old daughter and the minute I held her in my arms, I promised myself I would not make her go through what I went through,” she asserts. “I am in so much mental turmoil at this point, which I cannot put in words. I wish I could go back in time and do things differently.”

The writer is a member of staff.
X: @dalchawalorrone

Published in Dawn, EOS, March 17th, 2024