The Mistake of the Loves

Obesity: Learning from Public Health Mistakes

Reuters reported yesterday that the World Health Association is considering, for the first time ever, adding a drug used for diabetes and obesity to the WHO essential medicines list. The specific drug under consideration is liraglutide. This would represent a step toward learning from public health mistakes of the past to make a course correction in dealing with obesity. Reuters explained how important this step might be:

“Including obesity drugs among the WHO’s essential medicines could have great significance for that population. Experts say that adding HIV drugs to the list in 2002 helped to make them much more widely available to AIDS patients in poorer countries.”

The Mistake of Dismissing Treatment

When the AIDS epidemic emerged in the 1980s, public health experts presumed that treatment should have no place in public health strategies. Instead, they focused on trying to control the behavior of gay men. In a 1986 publication about public health policy for AIDS, two professors of public health explained how “sexual freedom” had enabled problematic behaviors to flourish in “homosexual men”:

Approval was never, indeed could never be, explicit; rather, the disapproval once so vigorously explicit, became more tacit. People ‘did their thing’ as law enforcement became more permissive in its approach to ’victimless crimes.’

“The major efforts with these populations must be to prevent the transmission of the infection and disease outside of these very high-risk subgroups.”

They dismissed the possibility of effective treatment. Instead, they said public health must find ways to modify the behaviors that transmit the disease. Otherwise, dire consequences and new epidemics would surely result.

In that same year, a blinded RCT of AZT showed dramatic results after only 16 weeks. It became obvious that this antiviral drug could stop deaths from AIDS. Roll forward to today and antiviral drugs have made HIV infection into a manageable chronic disease. Those drugs are also playing an important role to stop transmission of HIV.

Dismissing the potential for treating AIDS and proposing an exclusive focus on problematic behaviors was clearly a mistake.

A Similar Path in Obesity

Just as in 1986 with AIDS, breakthroughs in treatment for a serious threat to public health are emerging. This time it is obesity. And once again, some voices in public health are repeating the same mistakes. They tell us to focus on the problematic behaviors because treatment will not work. We should come down hard on industries that are promoting unhealthy behaviors. Marketing regulation, taxes, and warning labels will help people stop those bad behaviors.

Promoting healthy behaviors is never a bad idea. But we need both/and thinking to overcome obesity – not either/or. Dismissing and blocking access to treatment for obesity is a foolish mistake. Prevention and treatment of obesity are complementary, not competing strategies.

Click here and here for reports on adding liraglutide to the WHO list and here for the 1986 viewpoint on prevention versus treatment for AIDS. For further perspective on the importance of both treatment and prevention for overcoming obesity, click here and here.

The Mistake of the Loves, illustration by Hablot Knight Browne / Wikisource

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


March 30, 2023