Lancet "Clinical Obesity" Deep Dive - Part 4 Conclusions

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!

We’ve finally reached the final part of this series. In part 1 we discussed the authors and conflicts of interest, in part 2 we covered their Executive Summary, in part 3 we discussed the methodology and now, in part 4, we’ll discuss their conclusions (such as they are.)

I’m going to be honest, this has been an absolutely slog in terms of the sheer amount of nonsense. I also know that it’s a lot to read and that there can be a psychological toll attached, including and especially for those who are higher-weight and thus the intended victims/profit centers of the opinions in this piece, so please take care of yourself. I’ve included a TLDR section. Also, some of you mentioned that it was difficult to separate the italicized sections (copied directly from the opinion piece) my commentary, so this time I’ve put the quotes from the study both in italics and in block quotes. You can skip them, shorten the read considerably, miss all the weight stigma inherent in the text, and still get the gist of my critique.

One last shout out to my paid subscribers. I appreciate every single person who is reading this, those who stumbled on it for the first time, casual readers and free subscribers. That said, paid subscribers make it possible for me to take the time required to do these deep dives and I am so grateful!

Too Long Didn’t Read

As we discussed in the methodology section in part 3, the authors are using (mis-using, I would argue) a delphi study to, it seems to me, substitute the agreement of a group of people who profit from (or take money for organizations that profit from) ideas about higher-weight people for actual science. They repeatedly point out that this is one of the most controversial areas of medicine but then gain agreement of 90% or more on every single item? They are spare in their citations to support their claims around causality between being higher-weight and health issues, and the studies they cite make common mistakes (like not mentioning let along controlling for or otherwise dealing with confounding variables). In general, I’ll go back to what I said in the beginning which is that this piece is far more opinion than it is science and we should push back in any way we can against this being used to drive healthcare practice.

Ok, let’s dig into this one. last. time.

Let’s start with the findings of their Delphi Process that we talked about in Part 3. In the final round the authors would have been offered the chance to agree or disagree with a set of statements.

I do want to point out that these votes included both authors who eventually left (including the one who left for a high-level position and stocks at Eli Lilly) and two people who were supposed to be patients with “lived experience of ob*sity” (in truth, as we learned in part one, they both work for astroturf “patient-advocacy” groups that are almost entirely funded by the weight loss industry - you may have heard about groups like this because they were used by Purdue Pharma in its relentless goal of selling Oxycontin.) Beyond that, are two people who are supposed to be representing “patient perspectives” and who claim no medical knowledge really qualified to answer these questions? How likely is it that they got their information from the weight loss industry companies they essentially work for?

Let’s take a look, I’ll include the statement and then the percent of agreement they managed:

Definitions

1. Ob*sity is characterized by excessive adiposity, with or without abnormal distribution or function of the adipose tissue 100%

As will become a running theme here in the definitions section, this is not a definition. This is a claim that, before you could possibly test it scientifically, would require a bunch of actual operational definitions:

What is the definition of “excessive adiposity”?

How are we defining “abnormal distribution”?

How are we defining “Abnormal function”?

The fact that they got 100% agreement from a bunch of people whose careers are pinned to/would be helped by this definition of ob*sity is not surprising, but it’s also not, you know, science.

2. The causes of ob*sity are multifactorial and still incompletely understood. Genetic, environmental, psychological, nutritional and metabolic factors can induce alterations of the biological mechanisms that maintain normal mass, distribution and function of the adipose tissue, thus contributing to ob*sity 95%

They COULD NOT have made this more broad and yet still 5% of people didn’t agree. Do these 5% think that the “causes” of “ob*sity” are unifactorial? Do they think that they are completely understood? Are they still hanging out with the eat less/exercise more crowd like the 45-year-old former members of a high-school football team - their glory days long since passed?

Not for nothing, but why could they not bother with at least the precision of a decimal point or two? 95% of 58 respondents is 55.1 people, said another way, 2.9 people disagreed.

3 Ob*sity can cause systemic, chronic illness (Clinical Ob*sity), independent of the development of other medical conditions by inducing alterations in the function of the whole body and/or its organs and tissues, resulting in distinct clinical manifestations, including specific signs & symptoms or limitations of day-to-day activities 100%

Did all 58 of them miss the day in third grade where they teach you not to put the word you’re trying to define in the definition? Or just the person writing the Delphi rounds?

Also, again, this is in the "definitions" section. What kind of definition is this? Do these authors all spend Sundays worshiping at the church of Just Saying Stuff? This is, from a scientific perspective, pure drivel. “Alterations in the function of the whole body and/or its organs and tissues” What does that even mean? What is the definition of alteration here? What are the distinct clinical manifestations, signs, symptoms, and limitations? What are they distinct from, because if they are trying to claim that this completely open-ended non-definition includes things that happen to higher-weight people but don’t happen to thinner people, I think they’re going to struggle to find any.

I cannot stress this enough - it doesn’t matter how many people agree on a survey that being higher-weight can cause whatever issues. Even if this group wasn’t pre-selected because they and/or the organizations they take money from want this to be true, it wouldn’t matter. It means nothing. A causal mechanism must be found scientifically, not through consensus.

Imagine that a group of people who sell hair growth interventions and/or take money from companies that sell hair growth interventions got together and had 100% agreement that baldness causes heart attacks. That is how ridiculous this is.

4 Pre-Clinical Ob*sity is characterized by a state of excess adiposity with preserved function of other tissues and organs. Pre-clinical ob*sity confers an increased risk of developing clinical ob*sity as well as several other non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease, certain types of cancer and mental illness, among others 98%

This is…a lot to try to pack into one agree/disagree statement. But it doesn’t matter since, again, this is something that must be proven scientifically. Their agreement about this means less than nothing.

5 Clinical ob*sity is a chronic, systemic illness characterized by alterations in the function of tissues, organs or the individual, due to excessive and/or abnormal adiposity 100%

Didn’t we do this one already? They can repeat it, they can gain agreement on it, but it still isn’t science.

6 Pre-clinical ob*sity is characterized by excess and/or abnormal adiposity with preserved function of other tissues and organs 98%

For. The. Love. This is a lot of words for “existing while fat.” Still no definition of excess and/or abnormal adiposity, still no actual science here.

7 Remission of Clinical Ob*sity: Consistent with the definition of remission used for other disease states, remission of clinical ob*sity does not imply cure. Remission is defined as the partial or complete resolution (partial or complete remission) of clinical and laboratory evidence of tissue/organ dysfunction associated with clinical ob*sity 97%

Ah, the old “relapsing/remitting” trick. I wrote about this in detail. The short story is that this definition makes higher-weight people lifetime customers of these authors and/or the companies they take money from.

8 Pre-clinical ob*sity can be a state of remission from clinical ob*sity, if treatment of clinical ob*sity induces sustained resolution (at least 6 months) of clinical manifestations of organ dysfunction without requiring ongoing pharmacologic treatment 95%

It would be funny if it wasn’t so harmful. They don’t define anything else, but they define “sustained”? And they define it as 6 months?!?!?! To me, it is obvious that this one was obviously thrown in here for the people/conflicts of interest who sell behavior-based interventions. A 6-month definition of “sustained resolution” is super convenient given that’s about as long as their “resolutions” last before things start backsliding. They are re-defining “ob*sity” interventions that don’t work as “successful” by shortening the time that they have to work. Right now I’m imagining what these people could accomplish if they actually tried to do something helpful instead of being so shameless about doing something so shameful.

9 Co-morbidities: The term “co-morbidities” should only be used to refer to diseases and other conditions that incidentally co-exist with ob*sity, without cause-effect relationship or pathophysiologic overlap 93%

This seems to be to trying to reinforce the claim (without anything approaching adequate evidence) that there are a bunch of health issues for which there is a cause-effect relationship or pathophysiologic overlap. Again here, they are using their “open-ended” technique by opening this up not just to proven cause and effect relationships (which they don’t have) but also to anything that they can claim has a pathophysiologic overlap - which is just a fancy way of saying that people have the clinical and biological features of both health issues, so we’re back to having health issues while fat.

10 The term “ob*sity-related diseases/disorders” (or “associated/overlapping diseases/disorders”) should be used for non-communicable diseases (NCDs) and disorders (eg, type 2 diabetes, certain types of cancer, OSA, NASH, mental illness etc) that typically co-occur with ob*sity because of overlapping etiology and/or pathophysiology 98%

This is…well, I think the technical term is bullshit. It would be one thing if - as they did in 9 - they just made claims about what constitutes “ob*sity-related diseases/disorders” (or “associated/overlapping diseases/disorders”)” It would still be far from the purview of this 58 people to decide, but still, it wouldn’t be as bad as this. Here, they’ve slipped in a list of health issues. Their Delphi item is writing checks that their evidence can’t cash.

The 98% (56.84 people) who agreed with this seem to think that even though all of these health issues occur in people of all weights, they are because of body size/amount of adipose tissue in people with higher weight and due to…something else… in people of lower weights. These 56.84 authors are bravely straddling the fence between poor science and anti-science.

Let’s remember, friends, that whether they are being called “ob*sity-related diseases/disorders” or “associated/overlapping diseases/disorders”, what they might actually be is weight cycling related diseases/disorders and/or weight stigma related diseases/disorders.

11“Complications”: Clinical ob*sity may lead to severe organ dysfunction and end-organ damage, causing life-altering and/or potentially life-threatening complications (eg, heart attack, stroke, renal failure) 91%

Please note that this is not, remotely, a definition of “complications” (which you can tell because the word “complications” occurs at the end and they offer only two items for example.) This seems to be just another occurrence of their use of sloppy science and open-ended definitions to try to create the largest possible market for their/their funders work.

12 Ob*sity-related diseases/disorders (or overlapping diseases/disorders) can co-occur with both clinical and pre-clinical ob*sity and should be considered in decision-making about indications to treatment and type of treatment 91%

Sooooo, they make a big deal about creating a distinction between “pre-clinical” and “clinical” ob*sity based on the presence of other health issues, then they, essentially, completely erase that distinction here? And only 9% (5.22 people) thought that was an issue?

So that’s all ridiculous. I’ll move on to the next section but I do want to note that given the fact that there is no evidence to support their claims, this whole section has just gone WAY round the bend.

Clinical assessment, principles of diagnosis, and goals of treatment

13 Epidemiology of Ob*sity and Screening. Traditional measures of ob*sity, exclusively based on BMI (eg, BMI > 30 kg/m², or other age-specific, gender-specific or country/ethnic-specific cut-off points), should be used only as a surrogate measure of health risk at a population level, for epidemiological studies or for screening purposes 98%

“BMI, why can’t I quit you?” ~These Authors, probably

They admit earlier that “Current BMI-based measures of ob*sity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level.” They provide no proof at all that it is a useful measurement at the population level. Maybe they should take some advice from Elsa and let it go.

14 Clinical Assessment of Ob*sity. Requires confirmation of excess/abnormal adiposity by one of the following methods:
a. Direct body fat measurement (eg, by Dual-energy X-ray absorptiometry -DEXA, bioimpedance, etc), or

b. At least one anthropometric criteria (waist circumference, waist-to-hip ratio or waist-to-height ratio) in addition to BMI, or

c. At least two anthropometric criteria (waist circumference, waist-to-hip ratio or waist-to-height ratio) regardless of BMI Note: Validated methods and age- gender- and ethnicity-appropriate cut-off points should be used for all anthropometric criteria 98%

Imagine writing out all these different ways to (supposedly) measure “excess/abnormal adiposity” without having any definition of “excess/abnormal adiposity” They are not so much putting the cart before the horse as they are putting the cart before the existence of the horse, and then trying to will the horse into being via a modified delphi process.

BMI doesn’t work at the individual level, but if you can pair it with another random measure of body size, then you’re golden for a medical diagnosis. Otherwise you’ll need two random measures of body size.

I know, I know, they claim: Validated methods and age- gender- and ethnicity-appropriate cut-off points should be used for all anthropometric criteria” but validated by whom? Validated to what use?

It doesn’t really matter because, regardless of where people fall on all of these various measurements, they all get the same health issues which is why this whole idea is devoid of scientific rigor.

There is no number 15, for which I am eternally grateful.

16 The diagnosis of Clinical Ob*sity requires:
a. Clinical confirmation of ob*sity status by anthropometric criteria or by direct body fat measurement, Plus one or both of the following criteria:

b. Evidence of reduced organ/tissue function due to ob*sity (ie, signs, symptoms and/or diagnostic tests showing abnormalities in the function of one or more tissue/organ system),

c. Significant, age-adjusted limitations of day-to-day activities reflecting the specific impact of ob*sity on mobility and/or other basic Activities of Daily Living (ADL=bathing, dressing, toileting, continence, eating) 100%

So, once again, “Clinical Ob*sity” is simply having health issues or physical limitations (that people of all size experience) while fat. This pathologization of physical limitations/disabilities is particularly craven - first make a world that is built for thin people, then diagnose people as diseased when that world doesn’t work for them. It also subjects people to dangerous and often expensive “treatments” for things that could be solved by weight-neutral means including mobility aids, technique changes, increases in strength/stamina/flexibility etc.

17 BMI remains a valuable screening tool to help identify subjects with potential excess/abnormal adiposity. However, clinical confirmation of ob*sity status requires verification of excess/abnormal adiposity by either direct body fat measurement or at least one additional anthropometric criterion, using age, gender, and ethnicity-appropriate cut-off points 97%

Nope. BMI remains a problematic-does-not-begin-to-cover-it measurement for the unhelpful practice of “identifying” people based on the pathologization of body size. In truth, the use of more measurements (an open ended number of measurements based on their agreements) just means more potential to “diagnose” more people.

I’m going to take 18-23 together because they are all basically the same nonsense

18 All people with excess adiposity should be assessed for clinical ob*sity by evaluation of the person’s medical history, physical examination, standard laboratory tests and additional diagnostic tests as needed 100%

19 Standard laboratory tests for assessment of people with confirmed excess adiposity should include at least the following: full blood count, glycemia, lipid profile, renal and liver function tests 98%

20 Specific blood tests may be necessary if clinically indicated to rule out “secondary” forms of ob*sity (ie, hypothyroidism, cushing syndrome, etc) 100%

21 Additional diagnostic tests should be performed as appropriate if the patient’s medical history or physical exam and/or standard laboratory tests suggest the possibility of one or more ob*sity-induced organ/tissue dysfunction (clinical ob*sity)

and/or the presence of other ob*sity-related diseases and disorders 100%

22 People with both clinical and pre-clinical ob*sity should be regularly monitored and screened for type 2 diabetes and other diseases and conditions that are frequently associated with ob*sity 100%

23 People with clinical ob*sity should have access to comprehensive care and evidence-based treatments with the aim to induce improvement (or remission when possible) of clinical manifestations of ob*sity and to prevent progression to end-organ damage 100%

I feel the need to remind us once again that they don’t actually have a definition for excess adiposity, or proof of the actual causal mechanism for the health issues they are trying to tie to the diagnosis of “clinical ob*sity” which they have made up. They are also being awfully vague about “treatments,” again leaving that open-ended other than to say that whatever they are should be paid for.

Regardless, if these ideas are enacted it’s going to be astronomically expensive for both individuals and the healthcare system (the costs of which will be blamed on “ob*sity” and NOT on the authors of this nonsense.)

Also, just when you thought healthcare providers couldn’t be more distracted by body size - this is likely to cause even more patients’ actual complaints to be ignored when, after chasing the patient around with a tape measure or dunking them in water, the physician orders roughly 457 tests for a patient who came in because they sprained their wrist.

I predict that this would, in turn, lead to massive delays in higher-weight patients seeking care as well as disengaging from care complete due to the (sadly) common frustration that healthcare providers don’t listen to them and, instead, become obsessed about their size.

Also, remember that their definition of “clinical ob*sity” is incredibly broad and also open ended, meaning that these tests could be nearly endless and every time they find literally anything it’s “EUREKA, it’s clinical ob*sity!” (insert eyeroll here.)

In part 2 we talked about surveillance bias (quick reminder: Very simply put, it refers to differences in disease incidence between two groups that are due to the fact that one group is tested earlier/more often/differently.) This, right here, is exactly how to create surveillance bias.

24The choice of intervention for clinical ob*sity (ie, lifestyle, pharmacological, psychological or surgical) should be based on individual risk/benefit assessment and available clinical evidence that the intervention has reasonable chances to improve clinical manifestations and quality of life or reduce risk of disease progression and mortality 100%

Who, pray tell, is performing this risk benefit analysis? What is the definition of a “reasonable chance”? Given that we already have treatments for all of these health issues for thin people, let’s admit that we don’t actually need special treatments for higher-weight people and that this is just a way of trying to rebrand/justify weight loss treatments that have either a track record of abject failure and/or life threatening side effects.

25 People with pre-clinical ob*sity should receive science-based health counselling and have equitable access to care where needed to reduce the individual’s risk of developing clinical ob*sity and other ob*sity-related diseases and conditions 100%

I didn’t think we could get more ridiculous, but here we are. Remember that so-called “preclinical ob*sity” is just existing in a higher-weight body and so-called “clinical ob*sity” is just existing in a higher-weight body and having health issues. They offer no proof that what they are claiming are “ob*sity-related” conditions aren’t actually weight-cycling and weight-stigma related conditions. They offer no proof that there is any science-based health counseling that would make higher-weight people immune to getting these health issues (just like there is no science-based health counseling that would make thin people immune from getting health issues.) Stop this train, I wanna get off.

26 Health counselling, level of care and type of intervention for pre-clinical ob*sity (ie, lifestyle, psychological, pharmacological, surgical) should be based on individual risk/benefit assessment, considering the severity of excess/abnormal adiposity and the presence/absence of other risk factors and co-existing ob*sity-related diseases/disorders 96%

I call this item the Weight Loss Industry Profit Preservation Program. They pretend that they are reducing the number of people eligible for expensive treatments by dividing them into these nonsense pre-clinical and clinical categories, but then reserve the right to “treat” people (at a profit!) who were subjected to a massive battery of tests that found nothing.

27 Ob*sity (Pre-clinical or clinical) can contribute to the development of type 2 diabetes (T2D) and adversely affect diabetes control and progression. For this reason, the treatment of both pre-clinical and clinical ob*sity should be part of the management of type 2 diabetes 98%

First of all, they offer no proof for their claims here. Second, we are supposed to believe that thin people with type 2 diabetes should be treated for type 2 diabetes. But higher-weight people with the same diagnosis and presentation should be treated for type 2 diabetes and for existing in a higher-weight body? This is just a naked cash grab by the weight loss industry.

28 Clinical assessment of ob*sity – as well as related medical advice, interventions, and care – must be provided by qualified healthcare professionals 100%

Without an actual definition of “qualified healthcare professional” this was just a waste of everyone’s time. You don’t suppose they mean the kind of healthcare professionals that so many of the authors are do you?

This next section is called Weight-based stigma and public health statements

29 Weight-based bias and stigma present a major obstacle in efforts to effectively prevent and treat ob*sity. Tackling stigma is not only a matter of social justice but a way to advance prevention and treatment of ob*sity and reduce associated illness and mortality 100%

This is a beautiful demonstration of why these people have no business talking about weight stigma. Let’s translate this - weight-based bias and stigma make it more difficult to eradicate higher-weight people from the earth. Bummer.

This is an example of the attempted co-option of true anti-weight stigma work by people who want to manipulate it to be a tool to sell weight loss (and people who get money from the companies who want to do that.)

I previously published a handy guide to testing if something is true anti weight-stigma work or if it’s diet industry propaganda. I’ll save you the trouble and just tell you that, no surprise, this whole piece is on the propaganda side.

30 Academic institutions, professional organizations, media, public health authorities, patients’ associations, and governments should encourage education on weight stigma and facilitate a new public narrative of ob*sity, consistent with modern scientific knowledge 98%

The institutions should encourage education on weight stigma from weight-inclusive, size-affirming educators and never from people who seek to pathologize, prevent, and eradicate fatness and certainly not from people who are trying to profit from that attempted pathologization and eradication.

Here’s a quick test - if they are using the word “ob*sity” they are not actually anti weight-stigma.

32 Policymakers and health authorities should ensure that individuals with pre-clinical ob*sity have adequate and equitable access to diagnostic assessment of individual health risk as well as monitoring of health impact of ob*sity over time, and to appropriate care where needed to reduce risk of developing clinical ob*sity and other associated diseases and conditions 100%

All this despite no real evidence for any of their claims and no definition of “excess adipose tissue” which is the foundation for this whole house of cards? This is just the latest in a long line of attempts by the weight loss industry to infiltrate and manipulate not just healthcare, but also public health, and government policy.

33 Public health strategies to reduce incidence and prevalence of ob*sity at population level must be based on current scientific evidence rather than unproven assumptions that solely blame individual responsibility for the development of ob*sity 100%

You can’t be anti weight-stigma and be trying to reduce the incidence of higher-weight people existing. The current scientific evidence says that about a century of trying to reduce incidence and prevalence of higher weight people has utterly failed and only left higher-weight people stigmatized and harmed. If we followed the science, public health strategies would focus on affirming that bodies of all sizes are valuable and worthy of care, separating weight from health, and supporting health directly for people of all sizes.

The next section is called “statements from people living with ob*sity” but they don’t say where these statements actually came from and hey, what do you know, they sound exactly like what the weight loss industry says. Given that these astroturf organization have bragged about training patients to give weight-loss industry preferred answers, I’m not going to bother going through these items.

The section after that is the most ridiculous (which, obviously, is saying something.) The short story is that they first went through and made up a list of “organs, tissues, or body systems” that they claim are connected to “ob*sity” and then they literally voted on what the diagnostic criteria should be. The point of a Delphi study is to achieve consensus among experts. This group of people (which include two leaders of weight-loss industry funded organizations who are not expected to have any medical knowledge) cannot be expected to be experts in all of these types of medicine, but they went ahead and agree/disagreed themselves into diagnostic criteria. That. Happened. And was published in a peer reviewed journal.

This is beyond bad science, I don’t even know a word for how egregious an affront to science this is. We are definitely in #lolsob territory here.

Finally, they do make attempts to defend their claims of causality around what they are calling “ob*sity” and disease risk. These sections are characterized by a lot of claims followed by citations to one or two studies. To save on repetitiveness, here are the issues with these studies:

None of these studies make the distinction between the impacts of weight stigma, weight stigma, and healthcare inequalities and the so-called impact of simply existing at a higher-weight and or having some amount of adipose tissue.

There are a number of references to the concept of inflammation but all fail to discuss the issues that Dr. Zed Zha and I covered in our four-part series about that.

These exact same health issues happen to people of all sizes, of all amounts of adipose tissue. Whatever definition they make up for “ob*sity” there will be people who do not fit that definition who have these health issues.

Even if higher-weight people are shown to have higher rates of these issues, we have to rule out the impact of those confounding variables (weight stigma, weight cycling, healthcare inequalities) and surveillance bias.

Being “not ob*se” (or not “clinically ob*se” or not “pre-clinically ob*se” or whatever other name they make up to try to prop up a massively profitable weight loss industry) cannot be a sure preventative or cure for health issues that happen to people who are not in these categories.

One example of this “science” is

Genetic, molecular and physiological mechanisms involved in human ob*sity: Society for Endocrinology Medal Lecture 2012 by Sadaf Farooqi

This Lancet opinion piece cited this study 11 times!

If the sole author of the piece looks familiar, it’s because he is also one of the authors of this piece. As a reminder, he disclosed “personal consulting fees from Rhythm Pharmaceuticals, Eli Lilly, Novo Nordisk, SV Health, Nodthera Therapeutics, and Goldman Sachs”

This study starts off on extremely shaky ground, making the statement

“The recent rise in ob*sity prevalence is largely driven by increases in energy intake associated with the availability of inexpensive, highly palatable foods and a reduction in energy expenditure associated with reduced voluntary physical activity.”

He offers no citation - no evidence to back this up, so we’re back to Just Saying Stuff. Again, you can do that, but it’s not science. One thing one would need to consider before boldly making such a claim are the ways in which a century-long history of weight loss interventions, recommended earlier and more often, have seen the vast majority of people weight cycling, with up to 66% regaining more weight than they lost with each attempt and doing damage, possibly long-term to their metabolisms and bodies. (To be clear, I’m not suggesting that their weight or weight gain is the issue, I’m saying that knowing that higher-weight people have, for a century, been prescribed weight loss interventions that, in many cases, leave people fatter, and then ignoring those weight loss prescriptions and blaming the fact that people are fatter on something else as if it’s a fact does not give me a lot of trust in the scientific rigor of this paper.

Beyond that, this paper focuses on ways that relatively rare genetic variations may lead to people being higher-weight. The conclusion includes “these common variants, even in combination, are not sufficient to explain the genetic susceptibility to severe ob*sity, which is more likely to be driven by rare variants that are more highly penetrant.”

Inexcusably, there is a before and after picture of a child with a congenital leptin deficiency who lost weight secondary to having the deficiency (which is the actual health issue) treated. In his before picture this child is fully nude with just a black censor box covering his genital region. In the after picture he has a swimsuit and, it appears, a tan. Remember this same author was asked for his “expert” opinions on weight stigma for the Lancet opinion piece.

Moving on, even if we believe that this article represents good science (and I’m not saying we do!) they are discussing rare cases, but the Lancet piece’s authors cited this eleven times? It is, in fact, it is the sole citation used to support their sections on hypothalamus, Nucleus of the solitary tract (NTS), Nucleus accumbens (NAc), Ventral tegmental area (VTA), Amygdala, Hippocampus, and Prefrontal cortex.

So that’s that. If you’ve made it this far, thank you for reading. I know this has been…a lot. A lot to read, a lot of weight stigma, a lot of gaslighting, a lot of weight loss industry manipulation.

This is their most recent attempt at this and while I deeply hope it will be unsuccessful, it certainly won’t be the last. As we’ve seen, they will go to any length, so we have to remain vigilant and push back in any and every way that we can.

Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:

Liked the piece? Share the piece!

More research and resources:
The Research Post

The Resource Post

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.