"Real Housewives of Salt Lake City" star Heather Gay has, like many others, started taking the Type 2 diabetes medication Ozempic to lose weight. But unlike many others, Gay opened up about the pressure she felt to do so and the crushing consequences that it had on her self-love and acceptance. 

“I didn’t wanna show up at another party and see all of my friends 20 pounds thinner and just be resentful,” Gay, 49, told ABC News on Friday. After she lost nearly 30 pounds on the medication, Gay said she “started to feel seen for the first time.” 

“Even after being on television, writing a New York Times bestselling book, for the first time, I was being valued by my castmates, by the public in a way that I had never been valued before. And that felt, to me, sad,” said Gay, adding that her co-stars and the general public have called her hurtful names in the past like “Shrek” and “manatee” because of her body size.

Ultimately, Gay feels like she “sold out” by resorting to Ozempic to lose weight, which she said underscores the harsh realities of body positivity.

“It’s disappointing and sad to know that body positivity was all a big lie because it’s better to not be overweight,” said Gay, who added that she doesn’t know how to appropriately discuss the topic of body image with her daughters. 

“I want them to feel empowered, but… it’s a very nuanced razor's-edge,” Gay said. “I don’t want to lie to them and say, ‘It doesn’t matter. What matters is on the inside.’ It does matter. I don’t know why that’s the way it is in the world, but that has been my experience.”

Ozempic and the body positivity movement 

Experts agree that the assumption that using weight loss drugs is the “easy” way to shed pounds has fueled weight discrimination and reversed much of the progress made in the body positivity (or body neutrality) movement. 

Marianne Miller, an eating disorder specialist with a Ph.D. in marriage and family therapy who has recovered from an eating disorder herself, said that even though she has worked for years to cultivate body positivity, she still finds herself contemplating how much easier life would be if she took Ozempic and had a smaller body. The feeling intensifies every time Miller sees another celebrity show off or discuss their Ozempic weight loss without mentioning the challenges involved, she said. 

“My worry is that people question why others are staying in a larger body when they can just take Ozempic,” Miller said. “It's very reductionistic, but weight loss is incredibly complex.” 

Succumbing to that pressure can be a “recipe for disaster” for those with eating disorders, Miller said, because the drugs don’t target the root cause of their problem, which is less about how they look and more about how they feel. 

Victoria Abraham, 23, has been on and off Ozempic for two years to regulate her blood sugar levels. She has been rationing a single box of medication she received three months ago because of a nationwide shortage as more people who don’t need the drug use it for weight loss – a reality she feels has normalized conversations about dieting again as we see more people undergo drastic body transformations.

“We had exited that era of constantly monitoring others' bodies and always consuming weight loss content,” Abraham said. “As a fat person who talks about these issues, I've been noticing more and more hate comments, cruelty and just overall nasty behavior from others.”

As a self-proclaimed fat liberation activist, Abraham is trying to change attitudes around what it means to be fat: “My goal is for people to stop defining their worth with their size. There's always going to be someone thinner, prettier. But as long as you’re at a point where you like yourself, I think that's what matters.

Miller recommends seeking a mental health professional’s help if your body image issues disrupt your daily life. If you cannot access appropriate therapy, Miller suggests taking deep breaths during difficult moments and finding ways to accept and/or love your body. 

Look in the mirror and compliment your outfit instead or try accessorizing in new ways to change your mindset, she said. 

“It's like a train going down the negative body image thought track and then you want to shift tracks,” Miller said. “You want to start thinking about the things you can control because in many ways, we don't have control over what our bodies look like.”

'Nobody is cheating by using Ozempic'

The truth is that there is no “right” way to lose weight. It’s not about natural versus fake, fast versus slow, or disciplined versus lazy. Weight loss is complex and depends on a plethora of factors that can and cannot be controlled. Above all, a balanced diet and healthy relationship with exercise are critical, no matter how people try to lose weight. 

“People try to discount the idea that you lost weight just because you had bariatric surgery or used drugs,” said Dr. Sahar Takkouche, a bariatrician and associate professor of medicine with the Vanderbilt University Medical Center. “But there’s no such thing as fake weight loss. The bottom line is that every case is different and the things that work for some people might not work for others.”

Many people aren’t able to lose weight with changes to their diet and exercise habits alone, Takkouche said, often because of underlying issues such as insulin resistance (Type 2 diabetes) and fatty liver disease, many of which have strong genetic components. Genetics may account for up to 70% of people’s predisposition to be overweight or develop obesity, Takkouche said. 

“Nobody is cheating by using Ozempic. They're using some of today's modern tools to help them achieve a healthier lifestyle, which doesn't mean quote unquote low weight,” Takkouche said. “It means less fat around your body that increases your risk of heart disease, diabetes and other problems. A lot of people today fixate on the number on the scale, but that doesn't always represent the truth.”

Can you lose too much weight on Ozempic?It happened to Sharon Osbourne, but she doesn't regret it.

Studies have also found that the longer people are overweight or have obesity, the harder it becomes for them to lose weight and the greater their need to pursue other measures like surgery and medications, Takkouche added. Weight loss with these medications isn't possible, however, without a healthy diet and consistent exercise regime.

“The truth is, there’s no easy way out of the disease of obesity,” she said. "It is something that patients will have to deal with for the rest of their life whether they had surgery, used injectables, or changed their diet and exercise habits.” 

More:Josh Peck's viral Ozempic joke highlights battle over 'natural' vs. 'fake' weight loss