Reader Question: How to Follow the Weight Loss Industry Money

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Reader Kellisa sent me the following question:

I appreciate all the different things you write about, but some of my favorite newsletters are where you show how people and studies are paid for by the diet industry. I know this was a while ago, but I just found the newsletter you wrote about where you figured out that the person behind that “bill of rights” was actually a lobbyist for Novo Nordisk and I decided to ask this question. How do you find this stuff out? Are there any tips you can give to help someone like me “follow the money” as they say?

This is a great question, unfortunately, the answer isn’t cut and dried. Below are some techniques I use. Fair warning, this can be tedious and take time – sometimes a lot of time - finding that lobbyist connection took hours. (This is also where I shout out my paid subscribers  - it’s totally cool if you’re not a paid subscriber for any reason and I appreciate you reading this the same either way! And, the support from paid subscribers is what allows me to spend hours on these pieces, so thanks!)

I can also imagine that someone reading this are asking the question: Why go to all this trouble? For me, it’s because the conversation and research about weight and health has been, and continues to be, driven by the weight loss industry in some ways that are obvious and others that are not (like giving money to doctors who then give interviews to the media, or teach workshops for healthcare providers, etc. who do not disclose these affiliations.)  To me, following the money is part of breaking down weight stigma by understanding how the weight loss industry (which profits from weight stigma) is influencing healthcare research and practice and making sure that higher-weight people are getting ethical, evidence based healthcare, not healthcare driven by what will drive the most profit to the weight loss industry.

So, here are some tools and methods I use. This is not an exhaustive list, please feel free to add tools/methods that you use in the comments!

Open Payments
https://openpaymentsdata.cms.gov/

This is a database that shows payments from drug and medical device companies to US-based physicians starting in 2015 and physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants and certified nurse-midwives starting in 2021. They’ve just added information for the 2023 year.

Per their About section:

“These relationships may involve payments to providers for things including but not limited to research, meals, travel, gifts or speaking fees.”

As always, the existence of a conflict of interest doesn’t necessarily mean impropriety, but it is a red flag both for bad behavior and/or paradigm entrenchment. Research shows that even very small payments do influence providers.

You can query the database by US-based individual provider name, teaching hospital name, or drug/medical device company name.

You can search for a provider or hospital by name and see who made payments to them for each individual year and for all years. You can also search a company by name and see the total they’ve shelled out, as well as the main hospitals and providers they gave it to, and download CSV files with full data.

As an example, I can click to search by “company” and type in Novo Nordisk. I’ll find that there are four different entities making payments to US-based providers: Novo Nordisk AS (Denmark), Novo Nordisk Health Care Ag (Sweden), Novo Nordisk, Inc. US, Novo Nordisk Research Center Seattle, Inc.

I click on each of those, select 2023 and add up general payments and research payments for each. I find out that, just in 2023, and just to US-based healthcare providers, Novo poured out $108,181,514.93 “for things including but not limited to research, meals, travel, gifts or speaking fees.”

ProPublica’s Nonprofit Explorer
https://projects.propublica.org/nonprofits/

In my opinion ProPublica does some of the absolute best investigative journalism out there, and this is an extension of that.

Their Nonprofit Explorer allows you to “Browse millions of annual returns filed by tax-exempt organizations with ProPublica’s Nonprofit Explorer. See details like executive compensation, revenue, expenses and more. Search for an organization or a person, or search the full text of filings.”

It includes the Form 990 for every organization that has been recognized by the US as a tax exempt non-profit. They explain “Every organization that has been recognized as tax exempt by the IRS has to file Form 990 every year, unless they make less than $200,000 in revenue and have less than $500,000 in assets, in which case they have to file form 990-EZ. Organizations making less than $50,000 don’t have to file either form but do have to let the IRS know they’re still in business via a Form 990N "e-Postcard."

This tool can be particularly helpful given that the weight loss industry makes significant use of astroturf organizations. These are organizations that claim to be advocacy groups for higher-weight people but are predominantly funded by, and acting as a lobbying arm for, the weight loss industry.

Research Affiliations and Disclosures

I’ve written before about what I think disclosures should be required to contain. Unfortunately we’re not there yet, but you can get really helpful information from disclosures. If you are reading a study, you can search the text for affiliations (usually at the top of the study connected to the author list) and “conflicts” or “disclosures” (often buried at the bottom or linked to a separate document.) Affiliations will typically tell you where the researcher works. Sometimes it’s super obvious (as in, they literally work for the company funding the study.) Sometimes it’s more complicated, for example, it just says their university affiliation. At that point you can use OpenPayments to see if the hospital gets money from the pharma company and then search the hospital and provider to see if there is a link between that funding and the provider.

If you just have a name, for example a doctor quoted as an expert in a media article, one option is to go to a resource like PubMed and search their name. It should bring up any studies of which they are an author. You can then search those studies for their disclosures.

Website Search

This can, again, but very helpful with astroturf organizations. While you can get good information from their tax filings, they don’t necessarily have to disclose WHO gave them money on the forms from ProPublica’s nonprofit explorer. Using their own website, you can search around the various menus (sometimes you’ll find it in small print on the bottom.) If they have a site search option you can use terms like “sponsor,” “support,” and “corporate,” and names like Novo Nordisk and Eli Lilly. You can also look at any special programs or conferences they put on and see who sponsors those (remember that sometimes they use astroturfs to double dip, for example Novo Nordisk and the Ob*sity Action Coalition might sponsor the same conference)

For example, when I wrote about the OAC in March of 2023, Novo Nordisk’s website showed that their sole “Platinum Partner” (a company that donates more than $100,000 a year.) Now their website shows that Eli Lilly has joined them.

Good Old Google

If you have a name (a person, a university lab, a non-profit etc.) you can google their name together with the names of weight loss companies (Novo Nordisk, Eli Lilly, Weight Watchers, Noom etc.) and see what comes up. This can also be a good way to trace the funders of a supposed “advocacy” group (using the same search terms as above, or the name of the non-profit and the names of weight loss/pharmaceutical companies.

The Wayback Machine

https://web.archive.org/

If you want to see previous versions of a website (like who funded the OAC in previous years, or who funded the AAP or AMA,) The Wayback Machine can be invaluable.

 It can also be helpful as an archival tool. If there’s a webpage that you think might change or be taken down, in addition to getting a screenshot, you can get a browser extension that allows you to save the version of the page that you are looking at to the Wayback Machine.

Those are some options to follow the weight loss industry money. Please feel free to add any other options in the comments!

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More research and resources:
https://haeshealthsheets.com/resources/

*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.