The Truth About That New Diet Drug

This post was previously published in my newsletter, Food Psych Weekly, and was updated on August 3, 2022 to reflect the most recent payment amounts.

This week’s question is from a reader named Heather, and just a quick content warning for the O-word in the question and in some quotes below. Heather writes:

"I saw a New York Times article about new drugs that are being tested to treat obesity and it talked about how obesity could be treated like a chronic medical condition, like diabetes, and how if these drugs are successful at helping people lose weight it could end fat stigma.

My question is: are these new drugs and the idea of fat as a disease just another form of fatphobia and diet culture? They are still trying to get rid of fat instead of getting rid of the stigma around it, so it seems suspicious to me. But I know it will sound good to a lot of people. I don’t like the idea of fat being classified as a disease."

Thanks for this great question, Heather, and before I answer, just my standard disclaimer:

These answers are for informational and educational purposes only, aren’t a substitute for individual medical or mental health advice, and don’t constitute a provider-patient relationship.

The short answer is yes, you’re absolutely right: diet drugs and the idea of fat as a disease are products of diet culture. They’re incredibly weight-stigmatizing no matter how you spin things—and spin this article did.

By the way, I edited the link out of your question because I wanted to give the article some context before people click through. This Times piece is incredibly problematic for a number of reasons, as I’ll explain below. But I know some readers will be curious and haven’t seen it yet, so please only click on this link if you’re in the place to deal with some really tricky anti-fat bias masquerading as compassion for people affected by weight stigma, along with weight numbers, lionizing descriptions of diet drugs, and liberal use of the O-word.

I will use the name of the new drug here, since it’ll be hard to reference otherwise: It’s called semaglutide (brand name Wegovy), and it’s a weekly injectable originally used for diabetes, manufactured by the pharmaceutical company Novo Nordisk, which also makes other weight-loss products.

First and foremost, framing a diet drug as the ticket to reducing weight stigma is disingenuous at best. Telling a stigmatized group that the way to end the discrimination they face is to change something fundamental about themselves, rather than to change society and put an end to bigotry, is highly problematic. Many of us would never accept that logic when it comes to any other human trait, like race, sexual orientation, gender identity, or disability—so why should we accept it when it comes to body size?

Some people might argue that unlike those other characteristics, body size is within our control—but that’s not really true. Sure, some people might be able to lose weight and keep it off for a year or two, but numerous studies over the past five or six decades have shown that up to 98 percent of weight-loss efforts fail within five years—and up to 2/3 of the time, people end up gaining back more than they lost. Even bariatric surgery results in significant weight regain for the majority of people, as I discuss in my first book, Anti-Diet.

Diet drugs, meanwhile, generally only suppress weight while a person is taking them—and many of them turn out to be unsafe for long-term use, meaning that they really aren’t a permanent “solution” for weight loss. There are a number of examples, but the most infamous one might be the diet pill fen-phen, which became wildly popular in the early 1990s and then was pulled from the market after 5 years because it was found to cause heart-valve defects. Interestingly, the writer of the recent Times piece about semaglutide, Gina Kolata, was much more nuanced and critical when she covered fen-phen’s rise and fall for the paper back in 1997 (CW: weight numbers, weight-stigmatizing language).

More recently, in 2020, the FDA asked the manufacturer of another diet pill (Belviq) to withdraw it from the market, citing cancer risks. The agency had originally given Belviq the green light in 2012, making it one of only a few diet drugs to be approved for long-term use. But after further study, the FDA found that the risks posed by the drug outweighed its supposed benefits. The agency advised patients to stop taking Belviq immediately and dispose of any unused pills, and told doctors to stop prescribing and dispensing the drug.

Cases like this show how risky diet drugs can be for long-term use—risks that don’t become evident until the drugs have been studied for years. In the 1997 fen-phen article, Kolata paraphrased the director of the psychopharmacology clinic at New York Hospital-Cornell Medical Center: “approving a drug for long-term use when clinical tests lasted only a year is inadequate. …Drugs for depression, he said, are now being tested for five and even seven years.”

The trial for semaglutide/Wegovy lasted only a year and four months. It was also funded by the drug maker (as many early-stage pharmaceutical studies are), which is known to be a significant source of bias in research.

That brings me to perhaps the most disturbing thing about Kolata’s semaglutide piece, which is how far it strays from the rigorous reporting of her earlier work. Parts of it read like a press release for Novo Nordisk, which is surprising to see in a publication of the Times’s caliber—normally journalists are supposed to question corporate talking points and offer critical perspectives. (Full disclosure: I’ve previously written a couple of freelance opinion pieces for the Times, and had a great experience with the editors I worked with there.)

But somehow, out of the five sources quoted in the semaglutide piece, four of them have each been paid tens of thousands of dollars by Novo Nordisk (and the fifth has received that much from other pharmaceutical companies). And, what do you know, none of them are critical of semaglutide—or of diet drugs in general.

The first of those doctors is Caroline Apovian. Kolata does acknowledge in a parenthetical that “Dr. Apovian, like most leading obesity researchers, consults for several drug companies. She is on the advisory board of Novo Nordisk, the maker of semaglutide, and is paid for attending advisory board meetings.” Apovian was paid more than $105,000 by Novo Nordisk from 2013 to 2022.

But Kolata fails to note that three of this article’s other sources have also made big bucks consulting for the company. Louis J. Aronne, “an obesity specialist at Weill Cornell Medicine” who is quoted touting both semaglutide and another experimental Novo Nordisk drug, was paid more than $92,000 by the company from 2013 to 2022.

Scott Kahan, whom Kolata IDs as “chair of the clinical committee for The Obesity Society, a scientific membership organization” (which is supported in large part by pharmaceutical and diet-industry sponsors) was paid roughly $315,000 by Novo Nordisk from 2013 to 2022.

And Robert F. Kushner, ID’d simply as “an obesity researcher and clinician at Northwestern University,” was paid close to half a million dollars by Novo Nordisk from 2013 to 2022.

Everyone has to make a living, of course, and health professionals all have their own philosophies and areas of specialization for which people might seek them out and pay them. But when doctors go beyond simply selling their services to individuals and start collecting paychecks from pharmaceutical companies, why should any journalist—or any reader—trust them to speak in an unbiased way about those companies and their products? At the very least, shouldn’t we always be told about these conflicts of interest?

Kushner, by the way, was my debate partner at two dietitians’ conferences in 2018 and 2019, where we debated the relative merits of Health At Every Size (my side) and weight management (his side). (He’s an MD, not an RD, but he was tapped for these two RD conferences.) There he did disclose his work for Novo Nordisk, as well as for two diet companies. He was perfectly pleasant to me before and after the debates, but we certainly didn’t see eye to eye on the whole weight thing.

In my opening presentation, I started by laying out the evidence that weight stigma and weight cycling are harmful to health, and then explained how the weight-management paradigm often creates weight stigma and weight cycling, thereby jeopardizing people’s well-being. In his rebuttal, he said something along the lines of “I’m not sure why you spent half your talk on weight stigma—I agree with you that it’s bad!” (He’d spent most of his talk arguing that high weight itself is bad, and I don’t remember him mentioning weight stigma once.)

But in the years since, he and others in the diet industry seem to have caught on that weight stigma is something they explicitly need to address, as awareness of its harms is increasing. Now the industry is trying to sell its weight-loss drugs as the solution to anti-fat bias via the argument that higher weight is a “disease,” and therefore people shouldn’t be stigmatized for it—they should just take drugs to “treat” it!

Except at some level, diet-industry denizens must know that calling body size a disease is stigmatizing in and of itself. As Kushner himself says in the article, although he might tell the general public that being larger-bodied is a disease, he deliberately avoids using that word with his patients.

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Thanks again for this question, Heather, and I hope this helps you think through some of the issues with this article—and with diet drugs in general.

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