Foodies, Stylists, the Biased, and Denialists

We are on the cusp of great progress for anti-obesity medicines. Writing in Cell Metabolism, Fiona Gribble and Stephen O’Rahilly call it the end of the beginning. They have high hopes for new medications to treat obesity – one of the most common and difficult chronic diseases we face. But these advances fly in the face of some ardent denialists. So anyone with a stake in obesity care should be ready.

Opposition to progress will be stiff. Yoni Freedhoff tells us to expect it in four flavors: foodies, stylists, the biased, and denialists.

Foodies

The foodies are in love with the idea that food is medicine. They ask, “why take any medicine? The real problem is that you’re not on the right diet. If only you ate the right foods (like me), your weight would conform to the ideal (like mine).”

Some dietary concepts are perfectly sound and have great merit. Dietitians are pros at helping people find the healthiest patterns for enjoying food. For some people, a healthier diet can make a big difference. But sadly, this does not usually cure obesity. In fact, many people living with obesity can tell you more about healthy patterns of eating than you might care to know. They live it, but it doesn’t make the chronic disease of obesity disappear.

Stylists

The stylists have a much more expansive view of what’s wrong with people when they have obesity. It’s their whole life. So lifestyle therapy is the answer. A whole discipline within primary care centers upon the practice of lifestyle medicine.

To be sure, healthy patterns for living are important and can be quite helpful. Healthful sleep, active lives, stress reduction, and other lifestyle factors can have a very positive effect for dealing with obesity. But again, cures are not frequent. For most people, obesity remains a lifelong struggle despite best efforts to live a healthy life.

The Biased

Still other people simply see obesity as a marker for sloth and gluttony. Weight bias makes it easy to rationalize ignoring the medical needs of people with obesity. The thinking is that medical resources are wasted on them – if you can call that thinking. It is pervasive in healthcare and often implicit.

Denialists

The denialists come in many flavor. Some are subtle – like the American Heart Association with Life’s Simple Seven. In that paradigm, you can find the presumption that obesity is not a disease, it’s a behavior. But more explicit denialism comes from the fat acceptance movement. There we find great passion for denying that obesity is real. For the more militant people in this movement, any suggestion that obesity is a health problem is unacceptable. People who might want to deal with it or lose weight are demonized.

It’s Coming

This is nothing new. Human history provides ample evidence that progress inspires resistance. Nonetheless, progress is coming with anti-obesity medicines. Semaglutide is just a start, say Gribble and O’Rahilly. Breakthroughs in understanding how the brain and gut regulate adiposity are opening up the possibility for many advances beyond semaglutide.

The future is bright. Foodies, stylists, the biased, and denialists will, in the end, amount to nothing more than annoying nihilists.

Click here for the Freedhoff’s commentary and here for the paper by Gribble and O’Rahilly.

Proud, painting by Sergey Solomko / WikiArt

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April 16, 2021