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More About Ozempic, Obesity, and the Real Cure
We turn to an expert to help explain why Ozempic, while certainly not evil, is a distraction
Thursday posts are normally for paid subscribers only. However, due to the sheer importance of what we’re talking about here, we’re making this piece free for everyone.
In our post two weeks ago, we (I) didn’t intend to write the last word about obesity and its treatment, but simply to briefly note that Ozempic and its ken are another in a series of “cures” for a problem for which we have a long-term solution that our government, in its obeisance to Big Food and Big Ag and Big Pharma, chooses to ignore. That solution is to provide real, nutritious food to everyone, affordably. (This sounds like a big deal, and it is—but so is treating tens of millions of cases of diabetes. And, of course, providing nutritious food means growing less food industrially, which has profound environmental benefits.)
In any case, the subject is perhaps too loaded for me to have written about in so brief a manner, as some of the comments below demonstrate.*
There’s no particular reason to be “anti”-Ozempic, though I do want to note that a) its short-term side effects can be unpleasant; b) its long-term effects are unknown; c) the moment you stop taking it, it stops working; and d) (this just in!) CNN: FDA updates Ozempic label to acknowledge some users’ reports of blocked intestines. But that’s not really the point of what I was trying to say.
So, as I’m lucky to be both a friend and a colleague of David Katz, who has more authority in this field than I do, I’m going to provide you with links to a couple of stories he’s written that further amplify the notion that we’re both trying to get across: That calling obesity a ‘disease’ is not only incorrect from a medical perspective, it blames the victim and willfully ignores the causes of this ‘disease.’ Here’s David’s fundamental argument; and another, in which he compares obesity to drowning in some detail.
David and I had a number of exchanges on this topic, and I’m going to quote him a bit more here: “While the intense preoccupation with GLP-1s [Ozempic and others] has this topic very much in the limelight at the moment, this is just the latest version in a long-running debate. The House of Medicine wants obesity to be a disease, because it is then a never-ending profit center for them. Saying that it is not a disease does not mean its innumerable victims don’t deserve the best treatments we can manage; of course they do. But that doesn’t mean we should hand the problem over to Big Pharma and surgeons while ignoring its origins. I have been losing arguments for years, and, of course, losing — because the massive profits are all on the other side of the table.
“To understand all of this more clearly, let’s look again at the comparison of GLP-1s to gas masks. What exactly did this comparison imply?
“Imagine that airborne toxins were being blown into the air you breathe as a matter of routine. (Alas, it is true, but that's a topic for another day!). Imagine that we all knew about it; that it was being done at great profit; but that nothing much was done to protect us, and nothing was done to put a stop to the practice. Now imagine that the significant respiratory symptoms we all developed as a result were called a 'disease,' as if somehow our bodies were the problem. And then, imagine that a company introduces, with great fanfare, the definitive gas masks to 'treat' the disease, as in: ‘Wear these, and put an end to your body's dysfunctional response to those highly profitable, air-borne pollutants you are forced to breathe!’ And finally ... imagine that our whole society becomes fixated on the marvelous potential of these fantastic new gas masks to alleviate the problems of cough and breathlessness and expectoration.
“See the problem? It's not that we shouldn't use the best available gas masks when, as a last resort, that is our best defense. It's that we shouldn't allow the last resort available for addressing effects to divert us entirely from addressing causes. It would be both absurd and ruinous.
“Why ruinous? Well, leaving aside the massive costs in money and inconvenience of ‘gas masks for all,’ by failing to address the problem at its origins, we would leave unaddressed the many OTHER harms it imposed. Air-borne pollutants get into soil and water, too. Air-borne pollutants affect not just us, but all other animals and plants. Eventually, there might be massive ecological damage — how would our gas masks help defend against that?
“But when it comes to airborne toxins, the primary culture-wide emphasis is—at least in theory—on preventing them from being spewed into the air. This is not true of obesity, where we have zero regulations to oppose this nightmare, though we’ve known it’s the result of what amounts to an attack on our citizenry, and have known it for some time.
“This attack is exposed; it hides in plain sight — but it is not considered any kind of violation or lapse. Instead, although real food should be the default, willfully addictive junk comprises the majority of calories.” (Since 65 percent of the calories in most American’s diets are now in the form of ultraprocessed foods, this is factually correct – it’s not hyperbole.) “And,” continues David, “for sure, shifting the focus from fixing that situation to ‘medical treatments of obesity as a disease’ provides reliable cover to the food industry to keep on keeping on.
“Just as gas masks have a place in response to respiratory threats, so, too, do these drugs have a place in a comprehensive response to obesity. (For that matter, so does bariatric surgery.) But although the drugs and surgery should not be posed as an alternative to addressing the (intentional, for profit) root causes of the problem, that’s what they are. And Big Pharma is fine with that; and Big Food is fine with that. We Should Not Be Fine with That.”
Obesity as ‘disease’ means our bodies are the problem, so bring on the drugs and surgery. Obesity as ‘air pollution’ — as an environmental hazard — means society is duty-bound to do all it can to prevent it, while ensuring appropriate treatment for those who succumb despite such efforts.
*Below are some of the notes we got from readers regarding my last Ozempic post. Any personal details, like readers’ locations, have been redacted. — MB
I understand your concern re Ozempic and the choices of what people CHOOSE to eat. However, as a physician I want to reassure you as well that Ozempic was developed for people with a true metabolic syndrome who are unable to maintain a normal weight regardless of what they eat or how much they exercise.
There has been so much Hollywood hype in the popular news that Ozempic is a weight loss drug for otherwise healthy people who either have an eating disorder or have difficulty regulating their input that people have lost sight of its true medical need and necessity for pre diabetic patients and patients who have PCOS, poly cystic ovary syndrome, a true medical condition that affects insulin release and fat storage based on a metabolic disorder.
Under no circumstances should these patients be stigmatized or misunderstood as putting on a gas mask.
I know you have only the best of intentions, you always do.
I've really been feeling like the world has gone mad with all of this. People who are educated and should know better, I see what they eat, listen to their complaints, hear the discussion about the drugs going on around me and just really — what you said. THAT. Thank you for making me feel like I'm not the crazy one and thank you for saying it in a public forum.
You...are...so...wrong. Obesity is a disease and a column like this, without reference to the medical science on this topic is dangerous. Not for a minute am I making an argument that processed foods and the whole nature of our food systems don't contribute to more and more people succumbing to the worse impacts of the disease. But, I take GREAT issue with not following the latest science in this area. It's not just a matter of willpower for those of us who legitimately suffer from the disease of obesity. I say that as someone who for over a decade has done daily calorie intact tracking and average 1500-1800 calories/day, along with exercise, and still can't budge my weight. That's with eliminating processed foods. That's with eating a largely vegan-vegetarian diet. I am not alone. Do more research before you talk. You are not helping this topic.
Understand, I've been FIGHTING to get medically recommended treatment for my condition for over 3 years now. Despite the consensus of my primary care internist, my cardiologist and when I've been lucky enough to have an endocrinologist … my $100K+ … job does not cover ANY medical or other treatments for obesity. I've battled with my HR/Benefits in my company and they've made some minor adjustments and added service "benefits" to our program that don't change the fundamental fact that they don't cover drugs like Ozempic for treating verified obesity disease. IF I were to pay for myself out-of-pocket, it would be @$1,500/month, and I simply can't afford that. I'm actually saving my monies to TRY to afford that. I am not alone.
Please understand, I'm not talking about folks who are looking to lose 50 lbs or less. I'm talking about folks like me who need to lose more like 80-100 lbs or more to mitigate the symptoms and impacts of obesity such as high blood pressure, heart failure and/or diabetes, etc. This isn't about vanity or making eating "easier." It's about basic health.
You're angry? I live it and I'm MUCH more angry.
Spoken like a guy who has no idea at all what it is to really struggle with weight. (From MB: Unfortunately, this is not true.)
While obesity is not a disease, binge eating and eating disorders are very real mental and physical issues. I am a psychotherapist and have seen a number of patients benefit from GLP-1 medications - they report it’s quieting the “food noise.” Many people - even those who don’t meet the diagnostic criteria for an eating disorder - constantly think about food and weight and it causes significant distress in their lives. These medications seem to be interrupting that pattern and patients also report feeling less depressed and less anxious. GLP-1 medications and addiction is also being studied and so far data is encouraging.
Do I think people who need to lose 10 or 20 lbs need to take these medications? No. But they have honestly been a miracle for folks who are significantly overweight - in terms of health outcomes and mental health outcomes.
Food for thought :) appreciate your work!
This is a POS column. Just lose weight! Stop eating junk! No acknowledgement of the biochemistry involved in hunger and satiety.
This is such a clear and true and helpful way of putting it!
Ozempic is not a weight loss drug. It’s a diabetes drug. Too bad the so-called influencers have latched onto it.
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