Reader Question - What's With Eli Lilly's Oscar Ad

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I got so many questions about Eli Lilly’s Oscar night ad including this one from reader Meeshelle.

“What is the deal with Eli Lilly’s Oscar ad? If they want maximum profit, why would they be telling people not to take their medication?”

As a quick recap, Zepbound is to Eli Lilly what Wegovy is to Novo Nordisk. A Type 2 Diabetes drug with a side effect of weight loss that they repurposed, dosed, and titrated to maximize that side effect.

Their main goal right now, the thing that they and all of their astroturf “advocacy groups” and so-called social justice campaigns are lobbying for, is insurance coverage (and, in the US, Medicare insurance coverage) for their drugs.

In order to get this, they need to enshrine the idea of simply existing in a higher-weight body as a “disease” that is worth risking the significant side effects of the drugs into the healthcare system. This is particularly important because the pushback from insurance companies has been that the drugs don’t have enough benefit to be worth the price.

Enter this Oscar ad claiming that these drugs aren’t for “vanity” they are for “health.”

Except here’s the thing: The FDA approval for the drugs requires that people with a BMI of 27 or greater to have one so-called “weight-related comorbid condition” (these are health conditions that people of all sizes get, that get called “weight-related” when higher-weight people have them, more about that here.) But for people with a BMI of 30 or above, absolutely no health condition is required, you simply have to exist in a body whose weight times 703 divided by height in inches squared (or kilograms divided by height in meters squared for the metric-minded) is greater than 30. So a person with a BMI of 22 with every so-called “weight-related” health condition wouldn’t qualify for these drugs, but someone with a BMI of 50 who had none of them would.

(As always a reminder that health is not an obligation, barometer of worthiness, or entirely within our control, and there is absolutely no shame in having a health issue or disease, it’s simply that existing at a certain weight or BMI doesn’t quality as one.)

What they are neatly sidestepping in this ad is the fact that they are predicating risk on size. It’s absolutely a weight loss drug (we know that because they got specific FDA approval for it based on a primary endpoint of weight loss,) but it’s considered too dangerous for thin people who want to lose weight. They got approval based on shoddy research that correlates being higher-weight with health issues (scrupulously ignoring confounding variables like weight stigma, weight cycling, and healthcare inequalities) to claim that simply existing in a higher-weight body is worth risking someone’s life and quality of life to make them thin(ner).

So the underbelly of ads and claims like this is that higher-weight people’s lives and quality of life are more risk-able than those of thinner people, including thinner people with the exact same health conditions. This allows these companies to dangerously focus significant time, energy, and money on campaigns that champion the eradication of fatness while still clinging to a banner of being against weight stigma and push for their drugs to be used for people at lower BMIs.

Importantly, they can do this without any kind of hit to their sales. First, because it’s predicted that they won’t be able to keep up with demand in 2024 anyway. Second, because people in Hollywood who want these drugs will find ways to get them regardless (the first half of the Oscar night ad sounds like an ad FOR these people - fit into a smaller dress or tux on your big night!”) Finally, because a world where weight stigma is so prevalent and harmful (something that has been, in may ways, created by the weight loss industry) does the heavy lifting for them, allowing them to be a vanity drug in health’s clothing since they don’t have to ask/answer questions like - could weight-neutral, health-supporting behaviors create the same or more benefits with far less risk?

In truth these drugs have serious, some potentially fatal, side effects and we only have a couple of years of research on their weight loss application, during which Lilly’s claim of “maintained” weight loss is based on defining “maintaining” as having gained back less than 20% of the weight lost in 36 weeks in the ensuing 52 weeks.

At a most basic level, Eli Lilly (and Novo Nordisk, while we’re at it) are publicly traded companies in the US, which means that their sole fiduciary duty (their “legal responsibility to act solely in the best interest of another party”) is to their shareholders. So the question to ask when we evaluate their actions is not about their customers, it’s how is this in the best interest of their shareholders?

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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.