Weight Loss Pseudoscience Takes A Page From Addiction Treatment
The weight loss industry, like the addiction treatment industry, is prone to overselling its treatments. But right now the weight loss business is seeing a major shake-up. Ozempic, Wegovy, etc.– we're talking about GLP-1 agonists or semaglutides that were initially developed for Type 2 diabetes but are also now prescribed for weight loss.
I am not a medical provider. Even examining how these medications work, let alone any assessment of who should or should not take them, would be outside my scope. I support anyone in taking any drug they wish, with proper informed consent. This post is to illuminate how GLP-1s' marketing, specifically for weight loss purposes, echoes the marketing of addiction treatment, and what this tells us about how diseases and health care needs are constructed for profit.
Background
I have always been interested in the politics of weight and size, and see a lot of commonalities with substance use in how they play out. Both are sensitive issues in that 1) no one wants any whiff of judgment in either area, and relatedly 2) both topics tend to bring out blanket assumptions and dogma. A large number of people seem totally unmovable by data or clinical evidence that contradicts their beliefs on either topic, leading to conversations that are tense at best and may go nowhere.
More parallels between weight/size and substance use issues:
- Stigma as a proxy for racism, classism, ableism, misogyny: Both higher weight and substance use are associated with, or judged more harshly in, certain demographic groups.
- Contempt for violations of the ideal: Discipline and self-restraint are strong normative values in our culture. People with larger bodies or addictions are judged harshly for not conforming. They may even be seen as freeloading off of others, for example via health care costs.
- Discrimination in health care settings: Clinic protocols and medical equipment often cannot meet the needs of larger-sized people or people with addictions. This has a discriminatory impact regardless of intent, but on top of that, providers and staff often stereotype such patients and may even be openly hostile to them.
- Exceptionally low standards for treatment safety and efficacy: The lives of both larger people and people with addictions are so devalued that they are routinely recommended treatments with abysmal rates of success, or that even risk harm or death.
- Mistrust of providers and avoiding care: People at higher weights and drug users often report bad experiences with health care (see above)– including mental health care. As a result they may avoid care even for acute problems, or mistrust the providers they do see.
The newsletter Weight and Healthcare by Ragen Chastain is a great source for picking apart health claims related to weight. One of Chastain's foundational points is that "obesity" has been constructed as a disease through tautology because it has no symptoms in and of itself other than being "obese" (defined as having a body mass index of 30 or above). A 30+ BMI may be associated with medical concerns like heart disease and diabetes. But many fat people (Chastain prefers the term "fat") have none of these issues, while many thin people do. Chastain documents how time and again, scientific and clinical evidence have failed to demonstrate that "obesity" is a disease in its own right– but the medical-industrial complex nonetheless keeps insisting that it is.
Is addiction a disease? That question is not settled either, and could be a post of its own. But at least "substance use disorder" has a set of identifiable symptoms necessary for diagnosis. And unlike with "obesity," no one gets this clinical label without meeting specific symptom criteria.
Rosalie Genova
"Chronic Relapsing"
This brings us to the marketing of weight loss drugs today. Chastain has shown how these drugs' manufacturers built on the construction of obesity as a "disease" to further claim it is a "chronic relapsing-remitting disease." In other words, this is a condition affecting people for life, and any improvement or recovery is likely temporary. Sounds familiar, I thought! Currently the most popular definition of addiction (or substance use disorder) is as a "chronic relapsing brain disease." Even if we accept that addiction is a disease, the "chronic relapsing" part has never been established because most cases resolve spontaneously– that is, without intervention– and permanently. The only people with addictions who tend toward "chronic relapse" are those found in a treatment population: a small sub-group on which far too many conclusions about this "disease" are based.
But the "chronic relapsing disease" is a marketer's dream. In addiction treatment, it means we have no accountability for long-term outcomes. Patients can fare terribly after, or even during, a treatment course, but providers can never be blamed: it's a chronic relapsing disease, isn't it? What do you expect? "Chronic relapsing" patients also become appropriate for another course of exactly the same intervention that did not work last time– creating the revolving door of returning patients that is expected and even relied upon at addiction treatment facilities.
With weight loss drugs, Chastain shows, the "chronic relapsing" idea functions similarly: it preemptively excuses any intervention (including medications but also prescribed dieting and so on) from having any lasting effect. With GLP-1 drugs specifically, it supports and normalizes patients staying on them for the rest of their lives. This reminded me of opioid maintenance medications, which are also recommended to be taken indefinitely without interruption.
I hesitated to delve into a controversial topic that isn't even within my expertise– weight and size– but I hope this has been helpful in recognizing connections between addiction and other (purported) diseases. When health care is a for-profit industry, marketing will pathologize as many people as possible, for as long as possible, and normalize chronic treatment where what patients really want is cure.
