The Irresistible Attraction of One Size Fits All

We say it over and over again. Obesity is a heterogeneous disease. But it seems never to sink in. Perhaps this is because of the irresistible attraction of the idea that one size fits all – or at least it ought to.

To make matters worse, the one-size thinking coming at us right now for obesity is a wild cacophony of people who all have a singular solution. They each tell us they have the answer and that everyone else is wrong.

One Jab Fits All?

We can blame the current onslaught of people who have the answer for obesity to the remarkable advance of more effective obesity medicines coming available. Having new medicines that genuinely bring a leap forward in effectiveness is indisputably good news. Depicting these meds as a panacea, though, is not so good. One jab fits all is not the answer that will bring “the end of obesity.”

A Dozen Reasons to Reject Obesity Medicines

Hype will reliably bring out detractors and the perception of an “Ozempic Craze” has certainly done that. So the Guardian has taken up the challenge and yesterday published its latest in a seemingly endless series to explain that semaglutide will bring the downfall of civilization. Psychologist Stuart Ritchie says the Guardian has been “attacking it from every spurious angle possible.”

The latest: it’s destroying the body positivity movement. Rachel Pick sums it up by telling Guardian readers to do what she’s done and resist the jab. “Trust me when I say that you can learn to feel this way too, regardless of what size you are.” Yes, she has the answer.

Just Say No to Diet Culture

Another prolific prophet of the righteous way to health is Virginia Sole Smith, who is on tour to sell her new book – Fat Talk. Obesity treatment, she says, is merely diet culture dressed up with science. Just say no is her prescription. “We’ve been pathologizing fat bodies for decades now, and we’re seeing the harm of that for sure.” She describes a diagnosis of obesity as little more than a tool for demonizing fat people.

While we agree with her strong concerns about weight bias and stigma, denying the harm that obesity does to health is not the answer. Much like cancer, obesity is a disease that comes with a lot of stigma. Just as we have learned to do in cancer, we can do a better job of treating obesity and also reject the bias and stigma that people attach to it.

Precision Medicine to Pick the Right Answer

If the irresistible lure of one-size-fits-all solutions is such a hazard, then surely precision medicine is the answer – right? Well, not exactly. Not yet. Though Andres Acosta and others claim to have success with this, reality is a bit more complex. As Arya Sharma wrote recently, “We are far from predicting therapeutic response beyond statistical probabilities.”

One size fits all? Nope. Not even close. And when someone comes to sell you the idea that they have such an answer for obesity, beware. Simple answers in this field are most often simply wrong.

Click here, here, and here for more on the needs and gaps in precision medicine for obesity.

Red Candle, print by Kaoru Kawano / WikiArt

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June 9, 2023