By Wendy Scinta, MD, MS
Recently, I was out having dinner with some friends and my phone started blowing up.
“Are you catching this piece on 60 Minutes about obesity?”
“60 Minutes is talking about Wegovy – you have to watch!”
This piece is an excellent commentary on the issues of obesity, and how medications can help treat this disease. That said, I am very disappointed that the focus was just on one medication, and not on the vast complexities of obesity. There are 4 pillars of obesity medicine that play a role in lasting weight loss: nutrition, exercise, behavioral modification, and medical management (which includes disease reversal).
As I’ve stated before it’s important to look at who is paying for the piece and what is the angle. Let’s take a deeper dive into answering these questions, and how we could have made this more beneficial for the millions of folks fighting obesity in America and throughout the world.
Obesity IS a Disease!
Let me start by saying that I know and respect Dr. Carol Apovian and Dr. Fatima Cody-Stanford. In fact, I fought side by side with them ten years ago in my leadership position with the OMA (Obesity Medicine Association) to convince the AMA (American Medical Association) to recognize obesity as a disease and we won! What’s amazing to me is ten years later, we are still trying to convince society that obesity is in fact a disease. Why is this?
It’s never a bad idea to follow the money. As stated in this 60 Minutes piece, the case has been made and won that obesity is a complicated, multifactorial disease that contributes to at least 13 cancers and hundreds of diseases. Many of these conditions are treated with more medications that further weight gain, causing more obesity-related diseases (ORDs). Before you know it, you are on seven medications to “treat” or “control” these ORDs!
There are a few problems with this piece that I’d like to point out here.
Problem #1: Why Don’t We Use the Language Disease Reversal?
In this piece, which was sponsored by Novo Nordisk (makers of Wegovy, and several other medications used to treat diabetes and other conditions), we keep hearing how we must “manage” or “control” ORDs. Isn’t that interesting? Follow the money.
It’s true that obesity is complicated, but we now have plenty of proof that a 5-10% weight loss can reduce and in many cases reverse obesity-related diseases. Unfortunately, these same drug companies that make the AOMs (anti-obesity medications) make the meds to treat obesity-related diseases. What a conundrum.
Problem #2: The “Magic Drug” Phenomenon
Here we go–the war on drugs. There are several classes of anti-obesity medications (AOMs) available including the GLP-1s which have been all over the news lately. Some of these include Wegovy (by Novo Nordisk), Ozempic (which is the same as Wegovy), and Mounjaro (by Eli Lilley).
There is tons of money to be made by whoever can control the obesity market, yet still stay in the game with the meds that treat obesity-related diseases. I’m a minimalist, and my job as an Obesity Medicine Physician is to get folks healthier and reverse as many diseases as possible through weight loss. I like and use all three of the medications listed above. If I can use one drug to get a patient off six, and there is ample supply, I will do it. Up until now, however, Wegovy has not had ample supply. Coincidentally, just before this 60 Minutes piece came out, I received a letter and visit from my Novo Nordisk rep informing me that suddenly the problem was fixed. Well, we will see–this has been an on-and-off problem for all of these medications (GLP-1s) for a long time.
So back to the “magic drug” phenomenon. Let’s assume everyone has an ample supply. That does not mean that you can take Wegovy and go eat whatever you want, not exercise, drink too much alcohol, stay up late, caffeinate too much and lose 50 pounds like your friend did. In fact, I will argue that you will be the one writing nasty comments on my Instagram account about how the drug made you sick and that no one should take it.
The point is, you need to have a sufficient nutrition plan in addition to healthy eating behaviors, adequate sleep, and exercise. If you take this class of drugs (GLP-1s), you must also know how to titrate the medication appropriately (with the help of an experienced doctor) to minimize any side effects. This 60 Minutes piece doesn’t show everything that’s involved in experiencing success from taking this drug. It only shows you one woman who took it and lost weight, and another that didn’t and is still struggling.
Let me let you in on a secret…shh, don’t tell anyone…THERE IS NO MAGIC DRUG. You must manage the other components of your life to benefit from the prolonged weight loss anti-obesity medications have to offer. There is no way around it. Sorry (hands up emoji).
Problem #3: It’s About Shame and Genetics. Period.
Oh did I hear about this one!
Obesity is complicated. VERY complicated.
Genetics plays a role, as does shame for some folks, but there are a number of other factors that contribute to obesity:
- Environmental factors (Epigenetics)
- Produce that is genetically modified
- Meat and poultry that is fed with all sorts of bad stuff
- Our increased use of technology and decrease in overall movement
- The fact that healthy food is more expensive, and that much of the fast food and shelf-ready food offered to us is addictive
- Psychosocial issues like childhood poverty, neglect, and abuse that formulate dysfunctional eating behaviors early in life
- Untrained physicians and other providers who lack empathy even though many of them struggle with their own weight
- Lockdowns during the pandemic where the average American gained 50 + pounds
The list goes on…
Finally, top it with medications for obesity-related diseases that cause further obesity as previously mentioned and there you have it–the hot mess that we have been calling the obesity epidemic for over 30 years.
It’s complicated for sure, but fixable, very fixable! But not with a magic pill or drug alone.
If you’re struggling with your weight, find an obesity medicine physician in your area and get expert help. If your insurance will not cover it, lobby your employer to provide benefits. Don’t give up the fight! You may start hopeless but you will leave victorious. And if you’re in the Central New York area, come see me! The Medical Weight Loss team would love to help you.