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I was a member of the FDA advisory committee that voted against approving lorcaserin (Belviq) in the first round. These meetings are public and there were quite a few people there who were investors of some kind in the drug (not from the company, just individuals who somehow had some kind of investment, like buying stock) and were angered by the vote against approval.. Just after the meeting ended, one of them came up and threatened a committee member! I think the FDA had to get security for the next meeting.

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Holy crap! That is intense. Thanks for sharing that experience - though I'm sorry you had it!

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Oh my gosh, that’s incredible. Thank you for sharing this. (And for voting against the drug’s approval!)

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Oh, the evil that some companies do!

In 1997 I was working with a guy who started on Fen-Phen, just before the drug was pulled. I recall

that his regular doc refused to prescribe it & he found another who would. Unfortunately, after a

few months, maybe 3 or so, he developed some serious problems -- after all these years, the poor guy

still has the heart problems caused by Fen-Phen, and he weighs just about what he did to begin with.

So - a real screw up: he's nowhere near as healthy as he was at the start, and he never lost any of

the weight that he wanted to be rid of. If only there had been more material like your research,

Ragen, facts that could enable people to make really informed decisions. Will we ever know how many

people were permanently damaged by ALL the diet drugs?

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And as a bonus to the drug company and fat bigots everywhere, his health issues are likely blamed solely on his "obesity", requiring more dangerous diet industry interventions to " cure" them. Quite a racket.

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Oy!!! This brings back memories! My mom started me on Fen-Phen when I was in middle school. We were in the lucky 2/3 that didn’t have any serious side effects, but I think a lot now about how risky that was!

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Like Barbara, love this series and was recently pushed by my cardiologist after a serious heart diagnosis, to lose weight, and the push was toward bariatric surgery, or, if not that, Ozempic. I’m really interested in reading more.

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I'm sorry you're dealing with this and glad to help a little. I have a series on bariatric surgery if that is helpful (You can find links to all three parts here) https://weightandhealthcare.substack.com/p/weight-loss-bariatric-surgery-the

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Hi! I am enjoying your newsletter and have to say that I too have been on many of the PILLS that was mentioned. I am eager to see what has been revealed about WEGOVY/OZEMPIC because a Dr, and 3 Physician Assistants wants me to get on it along with METFORMIN. Because of my morbid obesity

@ 310lbs and 5'3". Reading your email has given me more doubts and has assured my SUSPICIONS about ALL OF THESE MEDICATIONS but am at a lost as to WHAT TO DO ABOUT my DISORDERED EATING!

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Thank you for this overview/series!

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It's important to realize that these weight-loss drugs are used mostly by women and often by women with BMI levels below 25, who can also be harmed. In fact, it could be argued that younger women who are not particularly fat are an important target for such drugs.

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Thanks for this Kathy. I absolutely agree that the ways in which this can disproportionately impact women (in particular women of color) are definitely important (as well as the ways in which they are disproportionately impacting other marginalized people including those at the highest weights and people, including and especially trans and nonbinary people, to whom these drugs are recommended when their gender-affirming procedures are held hostage by BMI limits.)

And I also absolutely agree that thinner women are often collateral damage in the "war on ob*sity" and all the risky "treatments" it has wrought. That said, I think it's also important to remember that these drugs are being approved, marketed, and prescribed based on fear-mongering claims about fatness. For example, the very first sentence in the lorcaserin study that got published in 2013 is "In the U.S., ob*sity is prevalent in epidemic proportions, and rates continue to rise" which does almost nothing to set it apart from the opening sentences in most other studies around weight loss drugs (or weight science research as a whole.)

Then there are medications (like Wegovy, which I'll talk about in part 3) whose FDA approval predicates risk on size, allowing prescriptions to people with a BMI 27 kg/m2 or greater who have at least one "weight-related comorbidity" or in patients with a BMI of 30. So approval is based on fatness alone for some patients, and for others based on the idea that health conditions that people of all sizes get are "weight-related."

All this is to say (and I'm not saying that you are doing this, it's just something I want to make sure gets pointed out) for me, I never want to lose sight of the fact that the harm that comes to thin people through weight stigma is solved by ending weight stigma and the related harms to fat people, focusing on the highest weight people. However history has shown us that if we focus on the thin people, then things get better for them while fat people continue to be harmed.

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Once a drug is approved, it can be prescribed for other uses, including off-label uses. The companies can't recommend or advertise its use for off-label purposes, but it can still be used. So there is no restriction that stops a weight loss drug from being prescribed for people with lower BMIs or with no "weight related comorbidity." Getting FDA approval for weight loss drugs, using health conditions as the justification, facilitates the use of such drugs by anyone. Who really are the major users of these drugs?

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