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Women planning to join the Aurat Marches, as they are called — Urdu for “women’s march” — have faced countless threats of murder and rape, along with accusations that they receive Western funding as part of a plot to promote obscenity in Pakistan.

Last year, opposition peaked when Islamist groups demonstrated in major cities, accusing the marchers of using blasphemous slogans — a crime punishable by death in Pakistan, accusations of which have provoked lynchings and murders.

The first Aurat March was organized by a small group of women in the port city of Karachi, who hoped to draw attention to the violence, inequality and other challenges faced by women across the country.

“We had held discussions and mobilized women in various communities, collected funds by small contributions from individuals, and wrote a manifesto to articulate demands related to women’s bodily rights to the government and Pakistani society,” Ms. Kermani said.

“Younger feminists who were inspired by a series of global women’s marches took their rage against violence, moral policing and lack of bodily or sexual choices for women and marginalized genders to the streets,” s

powerful figures in Pakistan want the event banned altogether.

the protesters had even highlighted L.G.B.T.Q. rights, a bold move in Pakistan.

Some Islamist parties responded to the marches’ growing popularity by organizing their own “modesty march.” In 2020, conservatives filed court petitions in an unsuccessful attempt to stop the Aurat Marches.

A newspaper published a front-page story that referred to the marchers as prostitutes.

“If the government allows the march, we will use a baton to stop it.”

“Save our daughters.”

“As a minority, we feel increasingly insecure,” Mrs. Masih said. “At the workplace, we fear anyone can harm us on the false allegations of blasphemy, and at our homes, we fear that our daughters could be kidnapped and converted to Islam

They campaigned against the physically intrusive “virginity tests” often inflicted on women who bring accusations of rape, and a court in the northern city of Lahore banned them last year. The government has also passed a measure allowing the chemical castration of convicted rapists, another demand of the marchers.

“We were and are scared, but we know that without putting ourselves in such a dangerous situation we cannot bring change,” Ms. Kermani said.

From the start of the American experiment the language of freedom applied only to a privileged few.

At the time of the Constitutional Convention in Philadelphia, only 2 percent of the city’s population were qualified to vote.

overtake freedom’s meaning entirely, harnessing freedom solely to projects of exclusion, privilege and harm.

In the 20th century, racial segregation was justified as the freedom of white people to control public space and make their own business choices.

It is true the language of freedom was central to emancipation, suffrage and democratic movements of all kinds, but it has also justified violence and discrimination.

more and more laws, caucuses, rallies and hard-right movements use the language of freedom as a cudgel to erode democratic governance and civil rights; these laws expand the creep of authoritarianism.

Slave codes allowed white property owners to possess Black humans — creating what the historian Tyler Stovall called “white freedom,” the “belief (and practice) that freedom is central to white racial identity, and that only white people can or should be free.” This freedom for the white master extended to torture, rape and lifelong control over the humans he (or she) owned.

The ugly freedoms in American politics today increasingly justify minority rule, prejudice and anti-democratic governance. If we don’t push back against their growing popularity, we will have ceded what freedom means to those who support monopolistic rule and furthered the country’s downward slide toward authoritarianism.

The COVID vaccines are, without exaggeration, among the safest and most effective therapies in all of modern medicine. An unvaccinated adult is an astonishing 68 times more likely to die from COVID than a boosted one

Yet widespread vaccine hesitancy in the United States has caused more than 163,000 preventable deaths and counting

Even in absolute numbers, America’s unvaccinated and current-smoker populations seem to match up rather well: Right now, the CDC pegs them at 13 percent and 14 percent of all U.S. adults, respectively, and both groups are likely to be poorer and less educated.

Countries such as Denmark and Sweden have already declared themselves broken up with COVID. They are confidently doing so not because the virus is no longer circulating or because they’ve achieved mythical herd immunity from natural infection; they’ve simply inoculated enough people.

data suggest that most of the unvaccinated hold that status voluntarily at this point

The same arguments apply to tobacco: Smokers are 15 to 30 times more likely to develop lung cancer. Quitting the habit is akin to receiving a staggeringly powerful medicine, one that wipes out most of this excess risk.

If everyone who is eligible were triply vaccinated, our health-care system would be functioning normally again.

With a vaccination timeline that stretches over years, our patience for restrictions, especially on the already vaccinated, will be very limited. But there is middle ground. We haven’t banned tobacco outright—in fact, most states protect smokers from job discrimination—but we have embarked on a permanent, society-wide campaign of disincentivizing its use.

We should neither expect that every stubbornly unvaccinated person will get jabbed before next winter nor despair that none of them will ever change their mind. Let’s accept instead that we may make headway slowly, and with considerable effort

Long-term actions for COVID might include charging the unvaccinated a premium on their health insurance, just as we do for smokers, or distributing frightening health warnings about the perils of remaining uninoculated

And once the political furor dies down, COVID shots will probably be added to the lists of required vaccinations for many more schools and workplaces.

nother aspect of where we’re headed with COVID. Tobacco is lethal enough that we are willing to restrict smokers’ personal freedoms—but only to a degree. As deadly as COVID is, some people won’t get vaccinated, no matter what, and both the vaccinated and unvaccinated will spread disease to others.

anti-COVID actions, much like anti-smoking policies, will be limited not by their effectiveness but by the degree to which they are politically palatable.

Without greater vaccination, living with COVID could mean enduring a yearly death toll that is an order of magnitude higher than the one from flu.

this, too, might come to feel like its own sort of ending. Endemic tobacco use causes hundreds of thousands of casualties, year after year after year, while fierce public-health efforts to reduce its toll continue in the background. Yet tobacco doesn’t really feel like a catastrophe for the average person.

Losing a year or two from average life expectancy only bumps us back to where we were in … 2000.

We still care for smokers when they get sick, of course, and we reduce harm whenever possible. The health-care system makes $225 billion every year for doing so—paid out of all of our tax dollars and insurance premiums

Hospitals have a well-honed talent for transforming any terrible situation into a marketable “center of excellence.”

But we shouldn’t forget the most important reason that the coronavirus isn’t like the flu: We’ve never had vaccines this effective in the midst of prior influenza outbreaks, which means we didn’t have a simple, clear approach to saving quite so many lives. Compassionate conversations, community outreach, insurance surcharges, even mandates—I’ll take them all. Now is not the time to quit.

Leaders in the deeply conservative Utah say they need the law to protect women's sports. As cultural shifts raise LGBTQ visibility, the lawmakers argue that, without their intervention, more transgender athletes with apparent physical advantages could eventually dominate the field and change the nature of women's sports.

he team is also partially owned by NBA all-star Dwyane Wade, who has a transgender daughter.

The looming threat of a lawsuit worries school districts and the Utah High School Athletic Association, which has said it lacks the funds to defend the policy in court. Later Friday, lawmakers are expected to change the bill so state money would cover legal fees.

The group Visit Salt Lake, which hosts conferences, shows and events, said the override could cost the state $50 million in lost revenue. The Utah-based DNA-testing genealogy giant Ancestry.com also urged the Legislature to find another way. The American Principles Project is confident that states with bans won't face boycotts like North Carolina did after limiting public restrooms transgender people could use. It focused on legislation in populous, economic juggernaut states like Texas and Florida that would be harder to boycott, Schilling said.

Friday's deliberations came after more than a year of debate and negotiation between social conservatives and LGBTQ advocates. Republican sponsor Rep. Kera Birkeland worked with Cox and civil rights activists at Equality Utah before introducing legislation that would require transgender student-athletes to go before a government-appointed commission.

The proposal, although framed as a compromise, failed to gain traction on either side. LGBTQ advocates took issue with Republican politicians appointing commission members and evaluation criteria that included body measurements such as hip-to-knee ratio.

But the ban won support from a vocal conservative base that has particular sway in Utah's state primary season. Even with primaries looming, however, some Republicans stood with Cox to reject the ban.

Ready for more bad infectious diseases news? There's an outbreak of bird flu making its way into U.S. poultry flocks. If the virus continues to spread, it could affect poultry prices — already higher amid widespread inflation. The price of chicken breasts this week averaged $3.63 per pound at U.S. supermarkets — up from $3.01 a week earlier and $2.42 at this time last year, the Agriculture Department says.

The latest data from the USDA show 59 confirmed sites of avian flu across commercial and backyard flocks in 17 states since the start of the year. That figure includes chickens, turkey and other poultry. The USDA identified a case of avian flu in a wild bird in mid-January, the first detection of the virus in wild birds in the U.S. since 2016. Wild birds can spread the virus to commercial and backyard flocks. By Feb. 9, the virus had been identified in a commercial flock in Indiana.

The last major avian flu outbreak in the U.S. was from December 2014 to June 2015, when more than 50 million chickens and turkeys either died from highly pathogenic avian influenza (HPAI) or were destroyed to stop its spread.

Whether the 2022 avian flu will affect the price of eggs and poultry depends on how widespread it becomes, says Ron Kean, a poultry science expert at the University of Wisconsin-Madison Department of Animal and Dairy Sciences. "In 2015, we did see quite an increase in egg prices," Kean told Wisconsin Public Radio. "The chicken meat wasn't severely affected at that time. We did see quite a loss in turkeys, so turkey prices went up. So, we'll see. If a lot of farms contract this, then we could see some real increases in price."

For producers who suspect their flock may be affected by avian flu, the USDA has a guide to the warning signs, including a sudden increase in bird deaths, lack of energy and appetite, and a decrease in egg production. If a flock is found to be infected by bird flu, the USDA moves quickly — within 24 hours — to assist producers to destroy the flock and prevent the virus from spreading.

A new Virginia state law prohibiting mask mandates in public schools does not apply to 12 students with disabilities whose parents challenged the law, a federal judge has ruled. Last month, the parents of 12 students across Virginia asked the court to halt enforcement of the law, saying it violated their rights under the federal American with Disabilities Act. The law, signed by newly elected Republican Gov. Glenn Youngkin, went into effect March 1; it gives parents a say over whether their children should wear masks in school.

The group of parents have children whose health conditions range from cystic fibrosis to asthma that put them at heightened risk for COVID-19.

The American Civil Liberties Union, which was one of several legal organizations that filed on behalf of the plaintiffs, said the injunction served as a "blueprint."

In a statement, Virginia Attorney General Jason Miyares said the ruling affirms that "parents have the right to make choices for their children."

When Judge Katanji Brown Jackson entered the Senate chamber this week to face questions on her readiness to join the Supreme Court, she did so as the first Black woman in the nation's history to be nominated to that position. For many Black law students and professionals, including a group of 150 who traveled from across the country to watch the historic hearing, Jackson's rise to likely associate justice gives a message of profound hope for what they too might one day be able to accomplish.

Dudley was one of 100 law students selected nationwide to attend a series of events and watch parties for Jackson's nomination, hosted by the progressive organization, Demand Justice. The group also included 50 public defenders — a nod to Jackson's own background in that field. "I see a lot of myself in her. I see a lot of my friends in her, and I wanted to be there to support," Dudley said, calling Jackson "overly qualified to sit on the Supreme Court."

The cohort of legal professionals cheered on Jackson as she faced questions from Republicans about her past cases, particularly those relating to child sex abuse, and on what school of thought she would bring to determining the constitutionality of high-profile cases. Republicans had vowed to oppose President Joe Biden's nominees to the court, and when news of Justice Stephen Breyer's imminent retirement broke, the GOP quickly mobilized to attack potential nominees who might replace the longtime liberal justice on the bench.

Particularly, some sentencing decisions in child pornography cases drew GOP fire. But Jackson's measured responses throughout the three days of questioning solidified the support of many onlookers, who reveled in what it would mean to have a Black woman sit on the bench for the first time in the court's 233-year history. "The fact of the matter is that I'm the father of three black girls, right? And to be able to tell them that finally, someone who is Black — female nonetheless — is finally on the precipice of a mountain that has never been climbed before by any other Black woman, is huge," said Edrius Stagg, a third-year law student at Southern University Law Center in Baton Rouge.

Sen. Joe Manchin of West Virginia — whose break from Democrats on a number of politically fraught votes had worried some as to whether he would support Biden's nominee — announced on Friday he would vote in favor of Jackson's confirmation, all but assuring her path to join the bench.

For some, the optics of seeing Jackson — a Black woman — defend her credentials to a group of largely white, predominantly male detractors, was a familiar scene. It has played out, students said, in workplaces the world over and across the socioeconomic spectrum.

Booker called the attacks on Jackson's record "dangerous" and "disingenuous," noting the complexities of cases that had been boiled down to their basest points in order to damage Jackson's image.

"I'm not gonna let my joy be stolen," he continued. "Because I know, you and I, we appreciate something that we get that a lot of my colleagues don't." And while Jackson's opponents peppered her with politically polarizing questions, her supporters grew even more convinced that Jackson was qualified for the job. "To see her hold her composure and just answer the questions just to the best of her capabilities was just really great to see," said Jasmine McMillion, a third-year law student at Florida Agricultural and Mechanical University College of Law.

“No one believed me that working for Elon was the way it was until they saw how he operated Twitter,” Bernal said, calling Twitter “just the tip of the iceberg on how he operates Tesla.”

In April 2019, at a showcase dubbed “Autonomy Investor Day,” Musk made perhaps his boldest prediction as Tesla’s chief executive. “By the middle of next year, we’ll have over a million Tesla cars on the road with full self-driving hardware,” Musk told a roomful of investors. The software updates automatically over the air, and Full Self-Driving would be so reliable, he said, the driver “could go to sleep.”

Investors were sold. The following year, Tesla’s stock price soared, making it the most valuable automaker and helping Musk become the world’s richest person

To deliver on his promise, Musk assembled a star team of engineers willing to work long hours and problem solve deep into the night. Musk would test the latest software on his own car, then he and other executives would compile “fix-it” requests for their engineers.

Those patchwork fixes gave the illusion of relentless progress but masked the lack of a coherent development strategy, former employees said. While competitors such as Alphabet-owned Waymo adopted strict testing protocols that limited where self-driving software could operate, Tesla eventually pushed Full Self-Driving out to 360,000 owners — who paid up to $15,000 to be eligible for the features — and let them activate it at their own discretion.

Tesla’s philosophy is simple: The more data (in this case driving) the artificial intelligence guiding the car is exposed to, the faster it learns. But that crude model also means there is a lighter safety net. Tesla has chosen to effectively allow the software to learn on its own, developing sensibilities akin to a brain via technology dubbed “neural nets” with fewer rules, the former employees said. While this has the potential to speed the process, it boils down to essentially a trial and error method of training.

Radar originally played a major role in the design of the Tesla vehicles and software, supplementing the cameras by offering a reality check of what was around, particularly if vision might be obscured. Tesla also used ultrasonic sensors, shorter-range devices that detect obstructions within inches of the car. (The company announced last year it was eliminating those as well.)

Even with radar, Teslas were less sophisticated than the lidar and radar-equipped cars of competitors.“One of the key advantages of lidar is that it will never fail to see a train or truck, even if it doesn’t know what it is,” said Brad Templeton, a longtime self-driving car developer and consultant who worked on Google’s self-driving car. “It knows there is an object in front and the vehicle can stop without knowing more than that.”

Toward the end of 2020, Autopilot employees turned on their computers to find in-house workplace monitoring software installed, former employees said. It monitored keystrokes and mouse clicks, and kept track of their image labeling. If the mouse did not move for a period of time, a timer started — and employees could be reprimanded, up to being fired, for periods of inactivity, the former employees said.

Some of the people who spoke with The Post said that approach has introduced risks. “I just knew that putting that software out in the streets would not be safe,” said a former Tesla Autopilot engineer who spoke on the condition of anonymity for fear of retaliation. “You can’t predict what the car’s going to do.”

Some of the people who spoke with The Post attributed Tesla’s sudden uptick in “phantom braking” reports — where the cars aggressively slow down from high speeds — to the lack of radar. The Post analyzed data from the National Highway Traffic Safety Administration to show incidences surged last year, prompting a federal regulatory investigation.

The data showed reports of “phantom braking” rose to 107 complaints over three months, compared to only 34 in the preceding 22 months. After The Post highlighted the problem in a news report, NHTSA received about 250 complaints of the issue in a two-week period. The agency opened an investigation after, it said, it received 354 complaints of the problem spanning a period of nine months.

“It’s not the sole reason they’re having [trouble] but it’s big a part of it,” said Missy Cummings, a former senior safety adviser for NHTSA, who has criticized the company’s approach and recused herself on matters related to Tesla. “The radar helped detect objects in the forward field. [For] computer vision which is rife with errors, it serves as a sensor fusion way to check if there is a problem.”

Musk, as the chief tester, also asked for frequent bug fixes to the software, requiring engineers to go in and adjust code. “Nobody comes up with a good idea while being chased by a tiger,” a former senior executive recalled an engineer on the project telling him

Musk’s resistance to suggestions led to a culture of deference, former employees said. Tesla fired employees who pushed back on his approach. The company was also pushing out so many updates to its software that in late 2021, NHTSA publicly admonished Tesla for issuing fixes without a formal recall notice.

Tesla engineers have been burning out, quitting and looking for opportunities elsewhere. Andrej Karpathy, Tesla’s director of artificial intelligence, took a months-long sabbatical last year before leaving Tesla and taking a position this year at OpenAI, the company behind language-modeling software ChatGPT.

One of the former employees said that he left for Waymo. “They weren’t really wondering if their car’s going to run the stop sign,” the engineer said. “They’re just focusing on making the whole thing achievable in the long term, as opposed to hurrying it up.”

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

As for our continuing distress, the standard explanation is a uniquely American loneliness. The surgeon general, Vivek Murthy, declared it an epidemic in its own right.

The truth, however, is there’s no good evidence that Americans are lonelier than ever

a major recent poll shows that older Americans are now significantly less lonely than they were three years ago; a recent peer-reviewed study reports that middle-aged Americans describe themselves as less lonely than they were 20 years ag

Loneliness is more pervasive among younger Americans, but there too, the rates have also plummeted since 2020

Logically, we should be feeling better. Why can’t we shake this thing?

loneliness was never the core problem. It was, rather, the sense among so many different people that they’d been left to navigate the crisis on their own. How do you balance all the competing demands of health, money, sanity?

The answer was always the same: Figure it out.

while other countries built trust and solidarity, America — both during and after 2020 — left millions to fend for themselves.

For millions of Americans, distrust feels like the most rational state.

The very different people I spoke with that year all had one thing in common: a feeling that in the wake of Covid, all the larger institutions they had been taught to trust had failed them. At the most precarious times in their lives, they found there was no system in place to help.

four years later, the situation is, if anything, worse.

Nursing homes across the country, where poor labor conditions were linked to higher Covid mortality levels, remain understaffed, leaving old, frail residents more vulnerable than they should be. Hunger and food insecurity remain wrenching emergencies.

Students haven’t fully returned to school. Congress passed the Child Poverty Reduction Act of 2021, one of the most effective antipoverty measures in decades. Then a year later, Congress ended it, pushing some five million young people back down into extreme financial need.

When everything was uncertain and everyone’s future was on the line, we walked right up to the precipice of a moral breakthrough, and then we turned back.

Look at the way we all accustomed ourselves to the term “essential worker,” an ostensible term of respect that instead condemned people to work in manifestly dangerous conditions. The adoption of that term made visible something we now cannot unsee: In the United States the people we rely on most to keep our world functioning are the people we treated as disposable.

we might call the bigger problem structural isolation: abandoned by employers, deprived of shared purpose, denied care. The combined effect sent a strong message that individual lives weren’t worth as much anymore.

People treated one another accordingly. We all remember the viral videos of people screaming at one another in supermarkets and on public transportation. Violent crime spiked. Even reckless driving surged — but it happened only in the United States.

The reasons for that American exceptionalism become only more urgent in an election year, when, as in a public health crisis, presidents can try to bring people together or try to turn them against one another.