Weight Loss Industry Big Think - Expanding the Market -Part 2
This is the second part of a series answering a reader’s question about weight loss industry “big think” strategies within healthcare. In part 1 we discussed how the weight loss industry strategically created a market by turning simply existing on the higher end of the weight spectrum into a so-called “disease diagnosis. “In part 2 we’ll talk about how they are relentlessly working to expand that market.
The weight loss industry’s so-called “treatments” are getting progressively more expensive, many far outside of the ability of the average person to afford them. Therefore, getting insurance companies (and governments) to cover them represents an astronomical increase in profit potential. That’s also why they are working so hard to foment the body-size-as-disease and weight-loss-as-treatment idea. To that end they are paying hundreds of millions of dollars to a stable of doctors who teach Medical Education, speak at conferences, and give media interviews regurgitating these talking points (and very often not disclosing their financial ties to the industry that gave them their scripting.)
So, insurance coverage is deeply important but it’s not enough profit for the weight loss industry. That leads us to another important overarching goal - expanding their market.
They do this in a number of ways:
Exaggerated “risks” of being higher-weight
The first way they do this is to try to find ways to exaggerate the so-called “risks” of simply existing in a higher-weight body. This is done predominantly through research that uncritically correlates being higher-weight with health issues – blatantly ignoring confounding variables like weight stigma and weight cycling and implying causation from correlation in a move that would get you flunked out of research methods 101. The reason for this is that treatments are approved based on a risk/benefit analysis. So when they bring dangerous drugs, surgeries, and other interventions to governing bodies like the FDA for approval, they need to make the case that it’s worth risking fat people’s lives and quality of life in an attempt to make them thin. They use this pile of terrible research to make that case.
Supposedly “weight-related conditions”
The exaggerations above set up the nonsensical idea of “weight-related conditions.” The plain truth is that there are people of all sizes all along the health spectrum. There can be two people of the exact same weight with vastly different health statuses, and there can be two people of very different weights with the exact same health status. The truth is that making weight a proxy for health (and weight loss a proxy for increasing health) doesn’t make sense. Also, we know that conditions that get called “weight-related” may be more accurately described as “weight-stigma related” and “weight-cycling related.” But the truth doesn’t sell weight loss interventions. Enter the manufactured concept of “weight-related conditions” They take all of their irresponsible correlations and then any health issue that they can try to claim happens more in higher-weight people gets called “weight-related.” It’s important to note that these exact same conditions happen to people of all sizes, but get called “weight-related” when fat people have them. Then, using the unsupported notion that weight loss will prevent/cure all of these conditions (even though they happen to people who are thinner) they push insurance companies and healthcare systems to cover their drugs, surgeries, and other interventions.
Ever expanding definitions
Next, they attempt to expand the definitions of “overw*ight” and “ob*se.” We saw this with the AMA’s recent announcement about the use of BMI. A lot of people were (purposefully) misled to believe that this was a step in the right direction when the reality was it was part of the weight loss industry’s goal to expand the ways that we “diagnose” these conditions. The AMA’s announcement was followed by a bunch of the weight loss industry’s stable of doctors putting out research and giving interviews bemoaning the fact that we are vastly “underdiagnosing” “ob*sity.”
Pushing for 100% Treatment
I was recently talking to someone who was at a medical conference where a doctor who is on the weight loss industry’s payroll took their “disease like asthma and heart disease” nonsense (that we talked about in part 1) farther by using their time on stage to fear-monger that only 40-whatever percent of higher-weight people are “being treated“ (which, remember, is code for “are weight loss industry customers”). She then went on to say “would we only treat forty-something percent of people with cancer? Forty-something percent of people with heart disease” etc.) The notion that every higher weight person needs (dangerous, expensive, and largely unsuccessful) treatment doesn’t make sense under any concept of ethical, evidence-based medicine (and is exactly what the AMA’s Committee on Science and Public Health feared would happen, and was part of their reasoning for recommending that “ob*sity” NOT be declared a “disease”.)
Next, we have their attempts to expand their market by targeting people for whom treatments are currently considered too dangerous/inappropriate. This includes funding organizations and authors who write “guidelines” targeting children as young as two years old and marketing campaigns (including through the healthcare and elder care sectors) that target senior citizens (ignoring research that weight loss – including intentional weight loss – is a consistent predictor of higher mortality in this population.) It also includes creating specific marketing (in all the usual ways from commercials to conference talks to medical education and more) to target these groups. Finally, it includes the creation of marketing and even research to be used to silence or shout over the protests of people, including and especially higher-weight people, who are pushing back and talking about the harm this does/will do.
Finally, they work to dismantle any other limitations on their medications, surgeries, and other interventions. Often the risks of these dangerous interventions is predicated on size. So, someone with a BMI of 27 would have to have a “weight-related condition” in order to “qualify” for “treatment” whereas simply existing at a BMI of 35 would be seen as “worth the risk” in the drug approval process. Dismantling even these few guardrails protecting people from the harm of these interventions (often using the methods named above) is part of the plan to expand their market.
If you pay attention and you travel in these spaces you’ll soon see these things everywhere which, fair warning, can be super depressing. But it’s also important that we notice these things so that we don’t accidentally fall for/internalize weight loss industry propaganda. It’s also helpful to call them out where we have the power/privilege/leverage to do so – these weight loss industry tactics work primarily because they are being foisted on an audience that has been indoctrinated into the weight-centric paradigm (of which the weight loss industry was a primary architect.) We have all been trained to accept their premise at face value, and treat them as the experts. We can never forget that a paradigm that focuses on eradicating fatness (especially for profit) can never truly support the health of fat people.
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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.