Surface Tension

Slim Pickings or Superficial Analysis?

A superficial analysis of new obesity treatment options in JAMA Internal Medicine has prompted some strong pushback from two of the top organizations devoted to obesity. Leaders of the Obesity Society (TOS) and the Obesity Action Coalition (OAC) this week published rebuttals in the journal to the earlier publication on these new obesity drugs.

In the original publication, Steven Woloshin and Lisa Schwartz characterized the drugs lorcaserin and phentermine-topiramate as “slim pickings.” They dismissed the importance of treating obesity, saying, “Although treatment options are limited, obesity is not an emergency—it is not even a disease, but rather a risk factor for disease.”

Writing for TOS, President Steven Smith pointed out gaps between the analysis and the scientific literature. He concluded by saying:

Opinion that strays from scientific data may keep those affected by obesity from seeking, and accessing, the medications they need.

OAC Chair Ted Kyle and CEO Joe Nadglowski took issue with the trivialization of obesity, saying:

The authors’ assertion that “obesity is not an emergency — it is not even a disease” is incorrect and of concern to millions of people whose health and quality of life are greatly diminished by this chronic disease.

In their reply to these concerns, the authors simply labeled them as “mistaken” and reiterated their original arguments. They said:

Our article was motivated by genuine concern for the health of people living with obesity, regardless of how it is classified.

Then they repeated their view that obesity should not be classified as a disease.

In an interview with MedPage Today, Timothy Garvey, a director of the American Association of Clinical Endocrinologists, said:

Knowledgeable physicians would not call these slim pickings. The FDA has approved both drugs taking efficacy and safety under careful consideration, and cardiovascular outcome trials data will become available. At this point, these additional treatment options can be used when appropriate to reduce the human suffering and social costs exacted by the disease of obesity.

Fatima Cody Stanford, an obesity medicine physician at Massachusetts General Hospital and Fellow at the Harvard Kennedy School of Government, commented:

Anti-obesity medications are an important tool in our armamentarium against obesity. For patients who respond, these medications can promote a long term change in body weight regulation. Their utility should not be overlooked.

Unfortunately, the superficial analysis that Woloshin and Schwartz published reflects the biases of too many healthcare providers who consequently offer people with obesity very little help with their condition. Change is necessary.

“We cannot solve our problems with the same thinking we used when we created them.” — Albert Einstein

Click here to read the letters in JAMA Internal Medicine, here for the original publication, here for more from MedPage Today, and here for more from Medscape.

Surface Tension, photograph © muufi / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.