Health Care/Joan Retsinas

Obesity: Tapping into a Rich Market

In the spirit of full disclosure, I have never passed up a hot fudge sundae. I put chocolate atop the food “pyramid.” Yet I know the danger of indulgence: increased risk for diabetes, heart disease, stroke, poor birth outcomes. Today Rubens’ nudes look not so much voluptuous as moribund.

Somehow, though, we 21st century Americans have added pounds. ln 1999, 30.5% of us were obese; by 2020, the number had soared to 41.9%. The “severe” obesity incidence rose as well, from 4.7% to 9. 2%. In contrast, only 17% of the French were obese (admittedly, a doubling over the past two decades), 26% of the British.

The solution to our growing girth has been a pincer movement. Physicians, abetted by nutritionists, have urged: eat fewer calories, more grains, more vegetables, less of the sugary salty fatty stuff that we munch as we watch movies. Exercise gurus have urged: move more, sit less at the computer and the television. Aiding both flanks are the support groups, which have re-enforced the eat less/move more message: think weight-watchers. On the fringes has been bariatric surgery, but that has generally been reserved for the most obese, given the drawbacks, the side effects, and the fact that post-surgery, patients still must eat less/move more.

The battle against fat has seemed inexorable. The market for sugary salty fatty foods remains robust. Nutritionists who have tried to ban soda from school lunches have met with resistance. The Girl Scouts stay solvent selling cookies. Restaurants boast mega-sized servings. Supermarket aisles bulge with stuff you shouldn’t reach for. Many people prefer chocolate to kale. Indeed, there is more money to be made from chocolate than kale.

Big Pharma, though, has found a solution.

Amidst this public health epidemic, they have struck gold. Why not a pill to slim us down? With a pill, we can ignore those nanny-like exhortations, stop the “fat shaming,” and rebrand obesity as a disease. Even the term “fat” will sink into the lexicon of déclassé adjectives: nobody is fat, just obese. And now that obesity has entered the pantheon of medical conditions, akin to high blood pressure or high cholesterol, a physician who sees a patient’s weight creep to a dangerous level can take out a prescription pad.

With so many people weighing in as “obese,” the market for these drugs is robust. Already Weight Watchers has bought a digital health subscription service that hooks patients up via telehealth with doctors who can prescribe the drugs. In January the American Academy of Pediatrics released its first practice guidelines for the screening and treatment of children with obesity. The guidelines stress active interventions, pharmaceutical and surgical. Fortuitously, the FDA recently approved the drug Wegovy for children 12 and older.

The obesity revolution is in full swing. Expect television advertisements to show the before/after photos of patients who take an FDA-approved drug, with the message to viewers: call your doctor to ask whether you too can undergo a 40 pound transformational weight loss.

Maybe we should pause before reaching for that pill (as well as pause before reaching for that cookie.)

In a STAT News series, “The Obesity Revolution,” the authors lay out many concerns, including: no general consensus on the BMI as the best measure, no discussion of “overweight” versus “healthy weight,” no long-term studies on these drugs (initially marketed for diabetes) in children with eating disorders, no recognition of the short-term benefits (presumably the drug will stop working when the patient stops taking it, unless the patient has changed lifestyle), no indication that physicians have been trained to treat obesity.

Some people are obese, even after restricting their diets and increasing their physical activity; yet it is hard to accept that 40% of the American population falls into that category. We are not so biologically different from the French. Furthermore, in the last 10 years the biology of our bodies has not changed to explain the decade-long surge.

Admittedly, the old approach was dreary and not particularly effective. Now a pill will reduce our weight. Groups are lobbying for insurers, including Medicare, to cover these pills. The promise: a slimmer (maybe) population, a heftier bottom line for Big Pharma.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, May 1, 2023

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