Räsänen and Ahola-Launonen recently offered a commentary on an ethical analysis I co-authored with Julian Savulescu on the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, I continue the discussion by engaging their concerns about the narrow framing of our analysis with respect to the structural determinants of health and the conditions of autonomy, as well as the role of race, class and gender in shaping stigma and access to treatment. I argue that Räsänen and Ahola-Launonen's critique and the conclusion they draw are largely in alignment with our paper and that the absence in our account of a more expansive conception of autonomy and a broader discussion of race, class and gender are fair criticisms. In what follows, I add nuance to these dimensions and caution against critiques of unjust structures that risk reproducing injustice by inadvertently denying the agency, self-respect and inclusion of marginalised groups.