Reader Question – Weight Loss Industry Big Think Part 1

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I got the following question from reader Dr. Marcey:

I always appreciate your exceptionally thorough breakdowns of research, but I also feel like I want to know what to look for and expect on a macro level. Could you widen the lens a bit to talk about the overarching  “Big Think” strategies that the weight loss industry are using in healthcare? I’m learning that I’ve been fooled by them for a long time and I don’t want it to keep happening and I’m not certain I know how to stop it.

Absolutely, let’s talk about this.  In Part one, we’ll talk about how they have established their market. In part two we’ll talk about how they are relentlessly trying to expand it.

First and foremost, we can never forget that the weight loss industry is a for-profit industry. There are many places where representatives of the industry have very intentionally enmeshed themselves into healthcare to boost industry profits and priorities (like as the majority of the members of the group that recommended that the NIH change what was considered “normal weight” and “overw*ight” so that they could increase their market by about 29 million Americans literally overnight,) and some of the healthcare system actually IS simply part of the weight loss industry – medical “weight management” programs, bariatric surgery centers etc.

Some of these people/corporations are fully aware that they are harming fat people for money. Others are true believers who have been indoctrinated with weight loss culture (often throughout their medical education) and believe that they are doing the right thing.

Regardless, the most important concept for their profitability is the idea that existing in a higher-weight body (which they have taken to calling “overw*ight” and “ob*sity” which are terms that were literally made up for this express purpose) is a “lifelong, chronic disease.” As always, there is no shame in having any disease, the issue here is that simply existing in a higher-weight body does not qualify, and claiming that it does creates massive profits for the diet industry while doing great harm to higher-weight people.

This has been a very long game for the weight loss industry, including and especially the pharmaceutical and surgical branches.

It started with the claim that existing in a higher-weight body (whatever one’s actual health status) constituted a disease. In one notable example with wide-ranging implications, the weight loss industry successfully poured millions of dollars into lobbying efforts that ultimately convinced the American Medical Association to ignore the opinion of their own Committee on Science and Public Health (which had studied the question for a year and determined that it should not be considered a disease, in part because of a deep concern about unnecessary/over “treatment). When the AMA declared “ob*sity” to be a disease, they overrode their own experts to do the bidding of the diet industry.

Now we’re seeing the attachment of “lifelong, chronic” to the idea of “disease” often fluffed up with the addition of “like asthma or diabetes.” So we now have “ob*sity is a lifelong, chronic disease like asthma or diabetes.” I covered this in some detail here, but the bottom line is that Novo Nordisk and other companies were continuing to pump out weight loss “interventions” that created short-term weight loss, almost all of which was regained. Novo’s (staggeringly profitable) “solution” to this is to suggest that people take these drugs for their entire lives. In order to make this work, they are trying desperately to make a comparison to medications that are legitimately needed over the course of someone’s life – such as those for asthma or diabetes - to their diet drugs.

Another more insidious aspect of this is that an industry that has, for decades, profited through a repeat business model built on viciously blaming fat people for failing at (doomed-to-fail) weight loss interventions is suddenly falling all over themselves to say that being fat and weight cycling aren’t people’s fault… because simply existing in a large body is a “disease” requiring “treatment.” The benefits of this messaging are two-fold. First, it’s an attempt to co-opt decades of work from fat activists and weight-neutral health advocates which was reaching some critical mass around the history of the failure of weight loss interventions. Second, it allows them to say “diets don’t work” and instead of saying “so let’s look at the evidence-based concept of weight-neutral health” they say “so let’s sell more dangerous (and more profitable!) interventions!”

Novo Nordisk brings this all together with their simultaneous launch of weight loss drug Wegovy and their ridiculous “It’s Bigger Than Me” campaign. Their own research says that people rapidly regain weight after stopping the drug, so they are recommending that it be taken for life (even though they don’t have research showing that will actually work and their own two-year research shows people regaining weight at the two-year mark). They are not just taking advantage of the “higher-weight is a disease” messaging but actively fomenting it with the “Ob*sity Action Coalition” which claims to be a non-profit advocacy group for higher-weight people but it almost entirely funded by Novo Nordisk. Their “It’s Bigger Than Me” campaign is supposedly an anti-weight stigma campaign. Their solution for weight stigma? Expanded access and insurance coverage for their drugs. But representatives of this campaign (who are either employed by Novo Nordisk or taking payments from them) are being booked and interviewed all over as “weight stigma experts” often to the exclusion of actual weight stigma experts, including and especially those who are fat.

Finally, the higher-weight-as-disease model allows the weight loss industry to talk about higher-weight people in truly horrific ways – like calling us an “intractable worldwide epidemic” and then claiming that isn’t weight stigma because they're not talking about higher-weight people, they are talking about our “disease.” (For me, as someone who is both queer and fat, this is giving major “hate the sin, love the sinner” vibes.) Then, using their newly minted status as “weight stigma experts” they spread the ludicrous notion that one can be actively trying to eradicate fat people from the earth and prevent any more from existing (for profit!) and somehow not be creating stigma around being fat. All while pressuring the medical establishment to have a policy of wanting fat people to either become thin people (ignoring the reality that thin doesn’t mean healthy or happy) or suffer (and even die) trying. Either way, they make their hundreds of billions of dollars. That’s why weight loss messaging, no matter where it comes from, is always buyer beware.

Now that we’ve seen how the industry created this market, in part 2 we’ll explore the (often insidious) methods they are using to try to endlessly expand that market.

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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.