Weight-Neutral Health And Wegovy - Unprinted Interview
I was recently asked for an interview by a reporter who was writing about Novo Nordisk’s new weight loss drug.
I sent a long answer via email and then we did a 30 minute phone call. The short quote that appeared in the article didn’t come from my email interview or the phone interview, but rather from a piece I had written here.
The article itself makes almost every mistake I warned the author against, and quotes researchers and doctors (several of whom take payments for Novo and other companies trying to get into this market) making sweeping claims that are not supported by evidence. (One of the most ridiculous being a researcher who acknowledges that the research credits weight loss with the heath changes without pointing out that they can’t separate whether the health changes were actually due to the behavior changes that preceded both the health changes and the (likely short-term) weight loss. He then claims that “it’s very unlikely” that weight loss is not the “primary contributor” to health changes and, to “prove” his point, he cites a weight loss study of 33 people conducted by a group of people who have all pinned their careers on the weight loss paradigm that…wait for it…doesn’t separate the effects of behavior changes from weight loss. This researcher also fails to mention that Mann, Ahlstrom and Tomiyama actually did study this and found that:
“In correlational analyses, however, we uncovered no clear relationship between weight loss and health outcomes related to hypertension, diabetes or cholesterol, calling into question whether weight change per se had any causal role in the few effects of the diets. Increased exercise, healthier eating, engagement with the health care system, and social support may have played a role instead.”
I have a full breakdown of that here.
Instead of breaking down an article that makes all the same mistakes I talk about all the time, I thought I would share the full email interview that I sent (I asked the reporter for the recording and/or transcription of our call and they declined.) I want to note that this isn’t comprehensive, more of a 101 quick read, andI’ve added items in brackets for some of the things that I clarified or added in our discussion. I’ve also added links in case you want to get more information.
First, the idea of body-size-as-disease is a concept architected by the diet industry that is not grounded in science. For example, diabetes, heart disease, and high cholesterol all have biological markers for diagnosis. The made-up “disease” of “ob*sity” is simply a ratio of weight and height. People with this “disease” do not share symptomology of any kind except height weight ratio. There are people of very different weights with the exact same cardiometabolic health, and there are people of the same weight with very different cardiometabolic health.
The idea of other health issues being “ob*sity-associated” is also scientifically questionable since weight cycling, weight stigma, and healthcare inequalities are all correlated with the same health issues to which being higher weight is correlated. As an example, cis male pattern baldness is very highly correlated with cardiac incidents. If we just stopped there, we would likely have a global war on baldness based on the belief that since bald people had more heart attacks than those with hair, then getting bald folks to grow hair would reduce their risk. Of course that sounds patently ridiculous, but it’s exactly what’s happening with weight and health. [Also, thin people get these exact same diseases.]
I also want to be clear that while the concept is often co-opted, it is impossible to be part of Health at Every Size community and to engage in intentional weight loss. They are mutually exclusive concepts. This goes for all of weight-neutral health community, but it is particularly with HAES because Health at Every Size is the trademarked brand of the Association for Size Diversity and Health, so there are literally rules about it (https://asdah.org/health-at-every-size-haes-approach/)
GLP 1 agonists are solid drugs for some people of all sizes with Type 2 Diabetes. They are sometimes a solution for those who either aren’t achieving their blood sugar goals on other medications, or are contraindicated for other medications. They have significant side effects and so, as with any drug, patient tolerance of the drug and a shared decision making process including a risk/benefit analysis must be undertaken.
When taken for weight loss, [especially at higher dosages] the message becomes that people should risk their lives and quality of life for bit of weight loss that may not even be sustainable.
The manufacturers of GLP 1 agonists can offer no proof that they can actually create long-term significant weight loss. The adult trial that led to drug approval [for Wegovy] lasted 68 weeks. A follow-up study found that a year after patients had gone off the drug (after the initial 68 week intervention) they had regained 2/3 of their weight and lost about 2/3 of their cardiometabolic benefits. [Their “long-term” study, which was only two years, shows weight trending up at the two year mark.]
Novo’s (staggeringly profitable) solution to this is for patients to stay on the drug for life. Except during the 68 week trial weight loss started to level off after week 50 and had actually ticked up slightly at week 68, all while patients were still on the drug. There is every chance that patients will regain the weight even if they remain on the drug long-term. Further, there were significant side effects just within the 68 weeks. We have no idea what the side effects are of taking this drug (which, remember, can be up to a double dose of a type 2 diabetes medication) for someone’s entire life.
If the goal is to generally support the health of higher-weight people [understanding that health is not an obligation, barometer of worthiness, or entirely within our control, and that the main focus should be on decreasing barriers to health, including weight stigma, and increasing access] then I think it’s important to understand that a strong body of research shows that weight-neutral interventions (increased sleep, increased social connection, decreased stress including weight stigma, movement and nourishing foods etc.) can provide similar (or more) cardiometabolic benefits with far fewer risks.
I think it’s also important to remember that Novo Nordisk was not just one of the pharmaceutical companies who put profit over human life by price gouging on insulin but was, arguably the most aggressive about doing it. I think that we are seeing them put profit over human life again with their absolute marketing blitz of this drug following a promise to their shareholders that Wegovy would have their fastest ever post-FDA launch and double their “ob*sity” sales by 2025. Worse, they are co-opting the language of weight-neutral health advocates to do it.
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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.