Reader Question - How to Stop the Weight Centric Backslide? Part 1

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I’ve received a lot of reader emails like the one below from reader Jeannie.

I feel like I’m seeing so many people, including dietitians and doctors, who used to be staunchly non diet getting back on the weight loss bandwagon. Suddenly they’re all “you can fight weight stigma and promote weight loss” and “o-word is a metabolic disease” - and “use people first language” and it’s like they were claiming to be non diet but it was only because they didn’t think they could shrink us but now they think these drugs can and they are showing their true (anti fat) colors and people (including doctors) I thought respected me and believed in non diet care are showing me that they’ve always thought I would be better thin, or that my fatness is a disease, they just didn’t think they could make me thin (or not “diseased”) and now they do. Is there anything we can do to fight against this?

First of all thanks to reader Jeannie and to everyone who has emailed to ask me similar questions. I absolutely understand what you are saying and I’m noticing this as well. It can be any combination of frustrating, hurtful, painful, enraging, and harmful.

In Part 1 we’ll look at the basics and in Part 2 we’ll take a deeper dive into some options to help stop this weight-centric backslide.

A few things to note before we get started. Much of this backlash seems to be happening because of the massive marketing efforts of the companies selling GLP-1s for weight loss. GLP-1s are a solid Type 2 Diabetes drug and may have other actual health benefits (though the research must be very closely analyzed because there are currently serious issues.) The research around weight loss is even more troubling. In their 2015 annual report, Novo Nordisk announced a 10 year plan called “Ob*sity Care - Creating the Market from Scratch” in which they noted they their primary goal was to “convince” healthcare providers that “ob*sity” is a disease and that 5-10% weight loss created health benefits (a very questionable claim that I’ve written about before) so that their then weight loss GLP-1, Saxenda could reach its “full potential.” They’ve been systematically working on this for over ten years with an almost unlimited budget training patients and providers, influence peddling at the policy and institution level, so it’s not a surprise that some people have been swept into the backslide. That said, real harm is being done and so we have to stay vigilant. What can we do?

Set the goal

A lot of what is happening is beyond our (immediate) control. That doesn’t mean that we can’t push back and it doesn’t mean that pushing back can’t be successful, but it can take time and victories can be small, few, and/or far between. I’ve been thinking a lot about Dr. Art VanZee who was an early-and-often whistle blower on Purdue Pharma’s strategy and bad behavior around opioids - strategy and behavior that Novo Nordisk and Eli Lilly are using as a roadmap to market their GLP-1s for weight loss and other uses besides T2D. Dr. VanZee was harried, harassed, called an alarmist and a quack by everyone from other doctors to industry lobbyists, to powerful members of congress. But he was right, and he just kept telling the truth and pushing back until it all came out.

I try to consider activism to be a self-care practice. There is injustice and pushing back against it is one of the ways that I care for myself. Framing it like this helps me avoid burning out. Part of that is making the work itself the goal - I can’t control the outcome of my work, all I can do is do the work. When we make our work itself the goal, we can celebrate those more frequent victories which can help us keep going psychologically. So if we make the goal to pushback - against the weight loss industry talking points, against the diseasification of fatness and the backslide of people/providers who identify as weight-inclusive into diet culture, then we can celebrate the success of doing the work which can help support against the frustration, pain, and harm of what’s happening.

Let’s talk about the issue and what we can do about it.

Float above the flood

The weight loss industry, and in particular the pharma companies that are selling these GLP-1 weight loss drugs, are using a version of the political tactic known as “flooding the zone.” They have pockets that are almost unfathomably deep and they are using that money to push out a torrent of trials, studies, and media articles and to pay a gaggle of doctors to do the same and, in other cases, to pay food and beverage costs for “trainings” that amount to indoctrination. Here again they are following the playbook that worked incredibly well for Purdue Pharma and their sales of Oxycontin.

In 2024 alone OpenPayments shows that Novo Nordisk (including Novo Nordisk AS Denmark, Novo Nordisk Health Care AG Switzerland, Novo Nordisk Inc New Jersey, and Novo Nordisk US Research and Development Massachusetts) made $28,352,315.12 in general payments and $51,074,166.16 in research payments. Novo Nordisk Inc in New Jersey didn’t just make $25,453,923.72 in general payments, they made 494,195 separate payments - that’s a lot of influence being thrown around and, again, that’s just in a single year.

So they make up a definition for existing in a higher-weight body (aka “ob*sity”) as a chronic, lifelong, relapsing, remitting disease, they foist inappropriate “person first” language on higher-weight people and call it “anti stigma,” and then they use their massive budgets, media machine, and astroturf “patient advocacy” organizations (all of which create significant influence) and it seems like overnight we are seeing this language everywhere, leading a lot of people to believe that it’s settled science when, in fact, it’s neither settled nor science. Even for those who are not convinced, it creates a situation where providers fear judgment/harm to reputation/looking like quacks if they don’t get in line or if they speak out or push back.

And it’s not just research. The combination of widespread anti-fatness and industry marketing made GLP-1s a hot topic from media outlets to influencers, almost guaranteed to get the views and clicks they need. I subscribe to a massive number of medical and healthcare trade publications and and almost every one includes at least one article about GLP-1s. Many of these stories are “supported” with quotes from “experts” who are on the weight loss industry’s payroll, but aren’t disclosing that. (Remember when the NYT ran a piece basically lobbying for insurance coverage of these drugs and every expert quoted had taken money from the drug manufacturers but none of that was disclosed? I do.)

All of this can lead to people thinking that there is “so much evidence” that the weight loss industry’s claims must be true, or they simply hear weight loss industry talking points so often that they internalize and regurgitate them. ‘

There is also a confirmation bias issue - if people want these drugs to create weight loss (and not create adverse events/deaths) then they may, consciously or subconsciously, glom on to the first talking point they hear that relieves their stress about the critiques of and concerns about these drugs (and, of course, these talking points are developed and disseminated by the weight loss industry for exactly this purpose!)

To push back against this (and help keep ourselves from becoming sucked into it!) it is imperative that we stay skeptical and curious. We can make a point to know who is creating the information and what they stand to gain, to follow the money, to point out weight loss industry influence, and ask questions that help others do the same. Leave comments on media articles and in social media comment sections:

Who funded that study?

What were the conflicts of interest among the researchers?

What is the evidence for that claim?

Is that doctor who is quoted in that article taking money from the weight loss industry or are they part of the weight loss industry such that their quote/interview is in their profit interest? Was that fully disclosed? (Anytime I see a doctor making claims that align with the weight loss industry, I look them up on the OpenPayments database!)

Who funds that “patient advocacy” organization?

Is the person claiming to be giving a “patient perspective” actually trained by the weight loss industry and/or deeply financially involved with the weight loss industry (as we saw in the Lancet Commission’s “study” on ob*sity)?

Peel the spaghetti off the wall and inspect it

We are watching the weight loss industry try a lot of different claims, arguments, and even names to try to get healthcare providers and others onboard.

We hear that “ob*sity” is a “lifelong, chronic, relapsing remitting disease” (a definition made up by the weight loss industry to make up for the shortcomings of their interventions.) But we’re also told that “ob*sity” is a “brain disease” or maybe it’s a metabolic condition? Maybe it’s Adipose Based Chronic Disease (going pretty far for the acronym ABCD because if you say it fast if sounds like “ob*sity”?) or maybe it’s weight-related health conditions or they are ob*sity-related health conditions?

And diet drugs are now weight loss medications, or weight management medications, except when they are “anti-ob*sity medications.” (Often the same people claiming that they are “anti weight stigma’ are peddling anti-ob*sity medications which strikes me as what you would call a medication if you wanted to engage in the most possible weight stigma.) So “now anti-ob*sity medications” are part of “ob*sity care”?

This is well and truly ridiculous, but it’s also effective. They meet people where they are and then lead them to where they want them to be. Maybe they aren’t comfortable saying “anti-ob*sity” medications, but they are willing to buy into Adipose Based Chronic Disease. Claiming (based on some seriously questionable evidence) that fatness causes disease isn’t as good for the weight loss industry as claiming that fatness is a disease, but it still sells their interventions and it’s a step in the right direction for their current and future profits.

We’ve seen this same effect happen with diets themselves - they try different names to see what resonates and to try to distance themselves from legitimate critiques and/or to try to conflate the ideas of weight loss and health improvements, even though they are two different things.

One thing we can do is to call things what they are - I continue to use terms like weight loss interventions to keep the intention plain and to fight this conflation. I’ve already written about the issues with so-called “weight-related” (or “adipose based”) health issues and there would need to be significantly better evidence before I would buy into this.

Insist that people be clear - if the goal of the intervention is body size change then it’s a weight loss intervention. If the goal is some health benefit then that’s what the intervention (including medication) should be about (and what it should be dosed and titrated for) with no mention of weight loss.

Hold the line on weight stigma

Perhaps one of the most massive and insidious campaigns that the weight loss industry is currently involved in is co-opting decades of actual anti weight stigma work by true anti weight stigma activists in order to sell weight loss. Their goal is to claim that anti weight stigma work should be about insisting that “ob*sity” is a treatable disease.

Now, if you tell people that their body is bad and it’s their fault, and then you tell them that their body is bad but it’s not their fault, you may reduce some weight stigma. But if you make it clear that their body was never bad, you’ll can eliminate weight stigma and you’ll avoid creating additional stigma and exposing a group of people to weight loss “treatments” that have limited to no long-term “success” and high risks.

The weight loss industry is trying to claim that you can de-stigmatize higher-weight people while seeking to create a world where they don’t exist and that is beyond just being ridiculous (though it is,) because it is deeply harmful.

The idea that you can treat higher-weight people as a problem to be solved (an epidemic/pandemic/global crisis etc.) who should be treated/eradicated/prevented is incompatible with the idea of ending weight stigma.

A legitimate anti-weight stigma stance must include an unyielding stance against:

Implicit and explicit weight bias

Poor treatment of higher-weight people

Lack of inclusion/accommodation of higher-weight people

Any attempt to eliminate/reduce/prevent fatness/higher-weight bodies

Let me be clear, even if someone thinks that weight loss will make people healthier, there is still no way to say that being higher-weight is a bad thing/disease/epidemic/crisis et al without stigmatizing higher-weight people, because we are talking about a body size and not an actual health issues\. I wrote about this in more detail here and I highly recommend Dr. Rachel Fox’s dissertation on the Anti-Ob*sity Assemblage for a deeper understanding.

Pushing back is important, but at the end of the day I also want to remind us that one of the biggest things we can do to stop the weight centric backslide is to not become part of it ourselves. We have to remain vigilant and critical because the weight loss industry is using its massive resources to try to sweep us back in.

In part 2 we’ll look at more options to stop the backslide.

This month’s online workshop is Exposing the Weight Loss Industry’s Secrets and Tricks with guest Louise Adams. We’ll talk about what they are doing, why they are doing it, and how we can pushback. All registrants get access to a video and there is a pay-what-you-can-afford option so that money isn’t a barrier. Details and Registration here!

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*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.