Drugs like Ozempic can target and erase our desire for food – and perhaps other cravings too. This pathologises desire as something that exists outside of us, to which we passively submit. But in losing our desires, we risk losing valuable parts of our experience – instead, argues Uku Tooming, we should view desire as an attitude that we shape with our imagination, and use our imagination to harness it to better ends.
Most of us aspire to improve our minds in various ways, from enhancing our intellectual capabilities to becoming more emotionally attuned to the needs of our significant others. For many, this aspiration is especially salient in their efforts to lose weight, as it requires getting their food cravings under control. Imagine, for instance, Eugene who, whenever he is exposed to delicious treats, such as chocolate cakes or ice cream, experiences a strong desire for them. As a result, he has difficulties controlling his weight. For Eugene, weakening his appetitive desire would arguably count as significantly improving his mind.
In recent years, the discovery that the antidiabetic medicine Ozempic—a brand name for semaglutide, a synthetic hormone that mimics glucagon-like peptide type 1 (GLP-1)—is highly effective in reducing food cravings (and considerably reducing weight as a result) has garnered a lot of attention. By having for the majority of people only minimal side effects, semaglutide—now also sold under the brand name Wegovy as a medicine explicitly targeted for weight loss—has been seen by many as a cure against weight problems that people like Eugene face. It looks like it is now possible to manage our desires with a simple injection while this used to be possible only through effortful self-discipline.
___
Desire expresses the person’s evaluative and engaged perspective on the world. The medicalised approach seems to overlook this aspect of desire entirely.
___
The medicalisation of desires may seem unappealing to some, as it implies that desire is an alien force or disease to be managed. This does not ring true of desire, insofar as we understand it as an intentional attitude that one inhabits and that possesses a diverse array of features. When someone desires a particular outcome, then she is motivated to bring that outcome about, to attend to considerations that are relevant for it, and to feel positively when thinking about the prospect of that outcome and when the outcome is achieved. To have a desire for something is one of the primary ways of relating to things in the world, while the desire itself does not seem like a thing among others but is instead the medium through which things are presented to the individual agent and through which she can care about them. Consequently, desire expresses the person’s evaluative and engaged perspective on the world. The medicalised approach seems to overlook this aspect of desire entirely.
However, for someone like Eugene who is striving to lose weight, cravings can indeed feel like an external force that must be confronted. At first glance, therefore, using injections like Ozempic or Wegovy might appear to be the appropriate course of action.
There are additional issues with the medical approach to appetite reduction and weight loss, however. First, although the immediate effect of Ozempic on weight loss is significant, one must continue taking it; otherwise, the effect quickly wears off. Second, there are risks associated with an injection that rapidly reduces cravings. Here, I delineate only one. Anyone considering weakening their appetitive desires should carefully weigh what they might lose in the process. For instance, if Eugene values gustatory pleasure, using Ozempic poses a risk, as he may not fully understand what he stands to lose.
Injection of Ozempic or Wegovy might not only entail the reduction in cravings by quickening the sense of satiety. It also can inhibit the desire to savour and take pleasure in the food that one is eating. For many, this pleasure is an essential component of a flourishing life. This is not to say that medical treatment for excessive appetite is never reasonable. However, in situations where a person has a complex set of desires, including pleasure-oriented or hedonic ones, their weakening can be a significant loss. If the desire for enjoyment is lowered considerably, the world is likely to lose much of its appeal, because such desire, after all, is an attitude through which things in the world are presented to the subject as appealing and valuable. Thus, one shouldn’t be too hasty in lowering one’s appetite through medical treatment. A more nuanced approach is needed.
Are there any alternative ways to shape desires? Here’s one. Desires can be strengthened or weakened by vividly imagining what it is like to satisfy them. When Eugene imagines eating chocolate cake in a positive light, by focusing its appealing aspects such as its luxurious flavor and smooth mouthfeel, his desire is strengthened; when he imagines its negative aspects such as its effects on his health, his desire is weakened. He can also weaken her desire by creating imaginative scenarios that reveal the object of desire in negative light. As a somewhat extreme example, he could even weaken the desire by imagining that the cake is filled with cockroaches or that he would have an awful migraine while eating it. That said, he should exercise caution when he misrepresents the satisfaction of his desire too radically. This is because, unless he deceives himself, he can’t help but be aware that the satisfaction would be entirely different from the way in which he imagines it. Such awareness would then inhibit the effectiveness of his imaginings on his desire.
That desires are robustly sensitive to vivid and detailed imaginings is also empirically well-grounded. Evidence for such sensitivity comes from research on how imaginings shape pro-social motivation and pro-environmental motivation, alcohol cravings, and desire to smoke. In all those cases, imaginings of the content of desire can shape the strength of desire in question, depending on how the imagining is elaborated by the agent. Most significant in the present context is that the effect of imaginings on shaping the desires for food is also well documented. For instance, there is a robust correlation between vividness of food imagery and the intensity of food cravings, suggesting that the there is a mental mechanism for controlling the strength of cravings through imagery. This mechanism has already proven to be effective in functional imagery training where subjects vividly imagine the positive aspects of achieving their long-term goals to reduce the short-term cravings.
What are the advantages of shaping desires through imagination over intervening in desires medically? At first glance, the latter is arguably much more efficient in that it has immediate effect on one’s craving, while the former is effortful and often unsuccessful. We should be careful here, however, when we talk about efficiency, given that although drugs like Ozempic and Wegovy reliably reduce the appetite, one needs to continue taking them in order to keep the weight loss. With imagination and through imagery training in particular, on the other hand, it is possible to achieve more long-lasting changes in one’s appetitive dispositions, i.e. tendencies in what one finds appealing and unappealing.
SUGGESTED VIEWING
How medicine ignores our bodies
With David Healy
Another advantage of using imagination is that it allows one to focus on the merits and demerits of the object of desire, by clarifying the evaluative perspective that desire offers. Through imagining, an agent can mobilize her background knowledge and other desires that are relevant for evaluating the object, and thereby bring to light the implications of satisfying the desire for her life and well-being—implications that might otherwise remain unexamined. Consequently, the agent can better determine whether the object of desire is worthy of desiring or not.
Let’s return to Eugene. By imagining the prospects of his eating or not eating the cake, he can assess what he stands to lose or gain by relinquishing his desire. He can evaluate the merits of the object of desire, including its pleasurable aspects and their significance for what he considers a flourishing life. Furthermore, in this process, he need not treat the desire as an alien force to be managed but as an expression of one’s evaluative perspective on the world. And, even if Eugene ultimately decides, through imagining, that the object of desire is not worth wanting and opts for the Ozempic injection, he can at least be more confident that his decision is well-informed.
Join the conversation