Zepbound/Mounjaro Tirzeptatide for Weight Loss Part 2

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In part one I gave a summary of the drug Tirzepatide. Today we’re going to begin a look into the most recent study of Tirzepatide for weight loss under the brand name Zepbound - the SURMOUNT – 4 trial.

I want to start by analyzing the opening phrase:

“Ob*sity* is a serious chronic, progressive, and relapsing disease.¹ Lifestyle interventions are a cornerstone of obesity management; however, sustaining weight reduction achieved through lifestyle-based caloric restriction is challenging.”

If you are playing Weight-Loss-Industry-Marketing-Language-Masquerading-As-Science BINGO you’ve probably already won.

Their entire paper is based on this premise and to support it they offer a single citation. That citation is to a presentation by Robert Kushner, a doctor who has taken $436,262.39 in direct payments from the pharmaceutical industry and $305,077.33 in associated research funding, predominantly from Novo Nordisk (who are also using this premise as a basis for their GLP-1 agonist drug on whose advertising Eli Lilly is piggy-backing) as well as from Eli Lilly themselves, including as a “consultant” for these companies. The presentation they cite has, as an express objective, convincing people of the above statement.

The first part of the opening sentence is simply nonsense. “Ob*sity” is a height/weight ratio and nothing more. It’s not a disease (serious or otherwise) as those who meet the “diagnostic criteria” (which, again, is simply a shared height/weight ratio) do not share a health status, symptomatology, or cardiometabolic profile. In fact, their health statuses, symptomatologies, and cardiometabolic profiles have a 100% overlap with those who are not “diagnosed” as “ob*se.” The idea that being higher-weight is a disease is purely a construct of the weight loss industry and its use has not helped the health of higher-weight people, but has made billions for the weight loss industry which is probably why they have, and continue to, infiltrate and manipulate the health care system with this idea. I have a deep dive into this here.

So-called “ob*sity” is also not “progressive.” In fact, it is intentional weight loss attempts that strongly predict weight gain. This is a slick attempt to take the harm done by weight loss interventions (the fact that the vast majority of people regain the weight they lost and up to 66% of people regain more weight than they lost,) and blame it on the higher-weight bodies that these doomed-to-fail “interventions” are foisted upon. Then they use the claim (as we see here) to attempt to justify more harmful (but profitable) weight loss attempts.

So-called “ob*sity” is not “relapsing.” That is a wholly unscientific attempt to rebrand weight cycling which actually is dangerous. Weight cycling is the most common outcome of weight loss attempts and is independently linked with most of the health issues that get blamed on the higher-weight bodies who are victims of a healthcare system that has been prescribing weight loss despite a failure rate approaching 100% for a century. As word about the dangers of weight cycling has become more widespread, the weight loss industry went shopping for a way to obfuscate the harm they’ve done and continue to do. Enter the truly ridiculous concept of  “relapsing/remitting ob*sity.” I did a deep dive into this nonsense here.

A look at the study authors and funders shows us why it’s totally unsurprising that the study is promoting terminology from the weight loss industry.

The study is not just funded by Eli Lilly (maker of Tirzepatide) but “Eli Lilly and Company was involved in the study design and conduct; data collection, management, analyses, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The sponsor did not have the right to veto publication or to control the decision regarding to which journal the manuscript was submitted. Final decisions resided with the authors, which included employees of the sponsor.”

So the only things that Eli Lilly supposedly wasn’t involved in were vetoing publication or deciding on which journal, but their employees, who were study authors, did. Talk about your distinction without a difference.

Let’s take a look at their author disclosures (emphasis mine)

Dr Aronne reported receiving grants or personal fees from Altimmune, AstraZeneca, Boehringer Ingelheim, Eli Lilly, ERX, Gelesis, Intellihealth, Jamieson Wellness, Janssen, Novo Nordisk, Optum, Pfizer, Senda Biosciences and Versanis and being a shareholder of Allurion, ERX Pharmaceuticals, Gelesis, Intellihealth, and Jamieson Wellness. Dr Sattar reported receiving personal fees or grants from Abbott Laboratories, Amgen, AstraZeneca, Boehringer, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche, and Sanofi outside the submitted work. Dr Horn reported research funding from Lilly and Novo Nordisk during the conduct of the study and personal fees from Eli Lilly, Novo Nordisk, and Gelesis outside the submitted work. Dr Bays reported receiving grants from Eli Lilly during the conduct of the study and grants from 89 Bio, Alon Medtech/Epitomee, Altimmune, Amgen, Boehringer Ingelheim, Kallyope, Novo Nordisk, Pfizer, Shionogi, Viking, and Vivus and personal fees from Altimmune, Amgen, Boehringer Ingelheim, and Eli Lilly outside the submitted work. Dr Wharton reported receiving nonfinancial support from Eli Lilly during the conduct of the study and personal fees from Novo Nordisk, Boehringer Ingelheim, Biohaven, Bausch Health Canada, and Eli Lilly outside the submitted work. Dr Ahmad reported being an employee and shareholder of Eli Lilly and Company during the conduct of the study. Dr Zhang reported being an employee and shareholder of Eli Lilly and Company during the conduct of the study. Dr Liao reported being an employee and shareholder of Eli Lilly and Company during the conduct of the study. Dr Bunck reported being an employee and shareholder of Eli Lilly and Company during the conduct of the study. Dr Murphy reported being an employee and shareholder of Eli Lilly and Company during the conduct of the study. No other disclosures were reported.

When they say “no other disclosures were reported” it may be helpful context to know that there were only two listed authors who did not make disclosures: Wen-Yuan Lin, MD and Irina Jouravskaya, MD.

Wen-Yuan Lin, MD, is listed under “author affiliations” as Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

Curiously, Dr. Jouravskaya is listed under author affiliations as “Eli Lilly and Company, Moscow, Russia” but does not disclose being an Eli Lilly employee in the disclosures.

It’s important to note that, overall, these authors have pinned their careers – both ideologically and financially - to the body-size-as-disease model which means that they may not be ill-intentioned or creating ethically and scientifically questionable research for money. They may simply be unable to see outside of their paradigm. I think, as someone who is both fat and queer, that if we went back to a time when the predominant view was that “homosexuality” was a disease to be treated, if you got together a group of doctors as invested in that paradigm as this group is invested in the idea of body-size-as-disease/weight-loss as treatment, you would get research a lot like this.

That said, I’d like to dig a bit more into Louis J. Aronne, MD, the lead author of this study.

According to his bio, he is “a leading authority on “ob*sity” and its treatment.”

He’s been shilling weight loss books for decades.

In 1996 he wrote “Weigh Less, Live Longer: Dr. Lou Aronne's "Getting Healthy" Plan for Permanent Weight Control”

Though maybe not that permanent since in 2009 he wrote “The Skinny: On Losing Weight Without Being Hungry-The Ultimate Guide to Weight Loss Success”

Though maybe not so ultimate or successful since in 2016 he wrote “The Change Your Biology Diet: The Proven Program for Lifelong Weight Loss”

Though maybe not so lifelong since now he’s shilling for weight loss drug companies who are using the fact that methods like the ones he wrote about don’t work as a reason that their (dangerous, unproven) interventions should be undertaken.

According to openpayments.gov he has taken $139,448.44 in general payments
and $1,422,266.49 in associated research funding from the pharmaceutical industry predominantly from Novo Nordisk, and also from Eli Lilly and other companies.

While neither he, nor his books, offer any actual research to back up the claims, the book descriptions continuously leverage his title of Dr. to sell copies “Let Dr. Lou Aronne help you achieve your goal,” and “Tried diet after diet and still can’t lose weight? It’s time to call the expert. In The Skinny, Dr. Louis Aronne, America’s top weight-loss specialist, shares the plan that has worked so well for his many patients,” and “Louis J. Aronne, M.D., an internationally recognized weight-management expert and the director of the Comprehensive Weight Control Center at Weill-Cornell Medical College, has created the Change Your Biology Diet, a proven program that helps people break through weight loss “resistance” to drop excess pounds and keep them off.”

I, personally, am concerned that someone who was comfortable writing book after book, each promising proven permanent weight loss through behavior change (without any research to back it up) is now lead authoring research around diet drugs that make similar claims.

In part 3 we’ll dig into the research that this group of industry-loyal, industry-funded, and in some cases industry-employed authors created.

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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.