She says she finally solved the problem by taking a class of drugs known as GL-1s, like Ozempic and Wagovy, that reduce hunger, slow down digestion, and make patients feel fuller.  These semaglutides also reduce the “noise”  in the brain that cause the obese to obsess about food and their next meal.

It was a revelation to her that not everyone battled with this problem “All these years, I thought all of the people who never had to diet were just using their willpower, and they were for some reason stronger than me,” the Queen of All Meda said. “And now I realize, y’all weren’t even thinking about the food! It’s not that you had the willpower; you weren’t obsessing about it!”

Her main message was that obesity must be treated as a chronic and complex disease, not a lack of willpower. In that way, she delivered a powerful message for shifting mindsets surrounding obesity.

Oprah also wants to end the shame and guilt about taking these medications to treat the disease. But she was cagey about her own experience, never mentioning which drug or drugs were key to her own weight loss and helping her maintain that loss.  

If she wants us to stop judging the use of the drugs as the “easy” way out, why won’t she talk about which one she was on?

What made me uncomfortable about the show was that it glossed over possible side effects and the lack of availability for people who can’t pay out of pocket for drugs.

I  also wasn’t thrilled that two of the main doctors she relied on are both “consultants” (i.e., being paid) by drug companies. When she did ask Dr. Amanda Velazquez, the head of the obesity clinic at Cedars-Sinai, about side effects like vomiting, the doctor responded that these sorts of reports are “overhyped.”

Though she rarely dove into such a personal subject, this much-promoted one-off special sported the exact same format as the old syndicated “Oprah Winfrey Show" that ended in 2011.

But this one had a much richer looking set and a bigger audience. In fact, everything about it was bigger, better lit and more luxurious -- almost as if it were sponsored by, say, a pharma company possessing an elevated design sense.

It was not. Both Weight Watchers and Noom paid for placements (WW ran two spots.)

But the drug companies did get a ton of free airtime.  It really got out of hand when Oprah promoted an upcoming interview with representatives from Novo Nordisk and Eli Lilly “appearing here together for the first time in 100 years!”  It was brief and seemingly scripted—hardly a Yalta Conference.

 Much of the show was devoted to an overview of how these weight loss drugs have transformed lives, including that of a teenage girl who was 13 when she started taking them after and has now lost over 100 pounds and is “going to Prom!”  (Still relying on the old mindset of becoming more popular if thin?)

It also included much time devoted to Oprah standing in the middle of the raised empty proscenium, a lone figure, dressed beautifully in a powder-blue couture pant suit and boots, preaching at and throwing questions to the audience, who physically had to look up at her, like Oprah the oracle.

Nowhere was this power imbalance creepier than when she spoke to the CEO of Weight Watchers, Simi Sistani.

Why Oprah suddenly divorced herself from Weight Watchers in late February, after 10 years of being an investor, very public ambassador, and board member, is still a mystery that did not get resolved. 

 “I recently made the decision to not continue serving on the board of Weight Watchers,” said Oprah from the stage. “I made that decision because I wanted no perceived conflict of interest for this special.” She said the same thing in late February. 

But given Weight Watchers’ purchase of its own pharma-prescribing platform, I still don’t get it.

What’s more, Oprah’s questions, asked while physically looming over Sistani, (literally “speaking down” to her) seemed to put the CEO on the defensive, as if she had to apologize and get on the Oprah train, after the media mogul’s departure dampened business and destroyed the stock.

And SIstani did. “We are the most clinically tested, evidence-based, science-backed behavior change program, but we were missing the third prong, which was biology,” Sistani told Winfrey. “There could be somebody who needs medication because they have that biological underpinning, and … [we want] to provide that care and also help people release the shame.”

Mostly, the special made me wonder what Oprah is setting the groundwork for. A massive pharma partnership? An educational organization dedicated to ending obesity?

The "shame game" seems like it will go big, and Oprah’s positioned to make the most of it.