Bye-bye BBLs: How Y2K fashion and Ozempic created a new class divide

There’s a chilling irony in the way American culture recycles itself. Just as Y2K fashion—with its low-rise jeans, barely-there camisoles, and belly-button piercings—makes a triumphant return, so too does the body ideal that defined the early 2000s: heroin chic. Except this time, the pursuit of extreme thinness isn’t just about starving oneself or chain-smoking cigarettes; it’s about access. Wealth, more than ever, determines society’s thin ideal.

Enter the Ozempic era, where weight loss isn’t just a matter of willpower or deprivation but rather a prescription (and often a hefty price tag). GLP-1 receptor agonists like Ozempic and Wegovy, originally designed to treat diabetes and obesity-related conditions, have become the diet trend in the quest for a slimmer body. The stark reality? Health—and the thinness that has come to symbolize it—is the ultimate luxury in the United States.

Thinness as a class divide

Heroin chic, that gaunt and hollow look popularized by models like Kate Moss in the ‘90s, was often criticized for glorifying a specific (and dangerously unhealthy) aesthetic. But Ozempic represents a new kind of exclusivity. This isn’t just about a “look” anymore; it’s about access to medical advancements that are literally out of reach for most Americans.

A month’s supply of Ozempic or Wegovy can cost upwards of $1,000 without insurance—far beyond what many can afford.

According to recent studies, commercial insurance covers over 89% of Wegovy prescriptions and 61% of Ozempic prescriptions, while Medicare patients—who make up nearly 19% of Americans—account for just 28.5% of Ozempic prescriptions and a mere 1.2% of Wegovy prescriptions. Medicaid coverage varies dramatically by state, with some states like California offering broad access while others make it nearly impossible to obtain these medications.

There likely won’t be a generic alternative to the drug until 2031, when the maker, Novo Nordisk’s patent for semaglutide, the active ingredient in Ozempic, expires. For comparison, a generic version of the medication could be 90% less: just $100 versus the current $1,000 price tag.

This creates a troubling dynamic: people with legitimate health conditions, such as Type 2 diabetes or obesity, often struggle to access these medications, while wealthy individuals use them off-label to shed a few pounds before a vacation or red-carpet event.

Consider the countless celebrity endorsements and whispers in Hollywood about who’s using Ozempic to maintain their figure. These drugs have become status symbols in their own right, fueling a new wave of body image pressure where thinness is explicitly linked to socioeconomic status. It’s no longer just about being slim; it’s about having the financial means to achieve and sustain it.

The implications are stark. For people living in poverty or without adequate health insurance, weight-related health conditions can be life-threatening. When these medications are being monopolized by those who don’t need them for medical reasons, it highlights a glaring inequality in the U.S. healthcare system: the rich get thinner, while the poor get sicker.

How economic uncertainty fuels body pressure

Historically, cultural and economic uncertainty has shaped beauty ideals, particularly for women. Today’s economic stability mirrors the heroin chic era of the ‘90s and early 2000s, when economic recession and rapid globalization, and the extreme thinness of supermodels symbolized restraint and control in an uncertain world.

Fast forward to today. The COVID-19 pandemic has fundamentally altered the way we think about health, safety, and stability. For millions, it was a period of weight gain, mental health struggles, and loss of control. Y2K fashion’s comeback feels less like a playful throwback and more like a return to restrictive ideals that prey on women’s insecurities during times of uncertainty.

Low-rise jeans and crop tops demand a flat stomach, a feature unattainable for many without significant dieting—or, increasingly, weight-loss medication. These trends, paired with the mainstreaming of drugs like Ozempic, send a clear message: thinness is back, and it’s as exclusive as ever.

The pandemic amplified our collective desire for control, particularly over our bodies. For many women, weight gain during COVID-19 became a scapegoat for broader struggles. This isn’t surprising in a society steeped in diet culture, which equates thinness with worthiness and offers weight loss as the solution to every problem.

The rise of GLP-1 drugs is a testament to how diet culture operates: it creates the conditions for a problem (in this case, pandemic-related weight gain and anxiety) and then markets itself as the solution. This isn’t new. The $72 billion diet industry thrives on our insecurities, constantly shifting the goalposts of what it means to be “healthy.”

Ozempic and its counterparts represent the ultimate intersection of health and consumerism. They’re sold as medical miracles, yet their off-label use highlights how thinness—not health—is often the real goal. The widespread desire for these medications speaks to a deeper truth about American culture: the pursuit of thinness has never been about health, but about conformity, control, and class.

What’s at stake

This isn’t just about individual body image struggles; it’s about the broader implications of tying thinness to wealth. The normalization of Ozempic as a weight-loss tool risks reinforcing harmful beauty standards while further marginalizing those who lack access to healthcare. It’s a reminder that, in America, even our bodies are subject to the whims of capitalism.

We must question whose interests are being served by these trends. Who benefits when ultra-low-rise jeans replace curve-hugging styles, when “heroin chic” displaces the hourglass ideals that dominated the 2010s, and when Ozempic becomes the new Brazilian Butt Lift? The same people who’ve always profited from shifting beauty standards: retailers rushing to stock size 00 again, pharmaceutical companies marketing thousand-dollar miracle drugs, and the wealthy who can afford to chase each new body ideal. Meanwhile, the plus-size community that fought for representation over the last decade, the models who celebrated their curves, and patients who genuinely need these medications are left watching from the sidelines as their hard-won progress erodes.

In reclaiming control over our bodies, we must reject the narrow ideals that seek to define them. True health is about more than a number on a scale, just as true style is about more than fitting into the latest fashion—or body—trends. The real revolution will come when we decouple worth from weight—and when healthcare is a right, not a luxury.

Amy Stretten (she/they) is a Black / Indigenous queer Femme journalist, commentator and the creator of cultural fashion platform The Chief of Style. She was recently featured in queer fashion book DapperQ Style: Ungendering Fashion from HarperCollins. Her work has appeared on CNN / HLN, ABC News, NYPost, United Nations TV, Snapchat News, TYT Network, Aboriginal People’s Television Network, HuffPost Live and ABC / Univision’s Fusion network. You can find her and her on Instagram @ChiefofStyle