Charing Cross Bridge, Fog on the Thames

Persistent Confusion About Weight Loss and Obesity Care

We have mixed feelings about a new report in JAMA this week about GLP-1 agonists and the associated risk of gastrointestinal adverse events. On one hand, this is helpful data. It is a reminder that despite all of the sensational reporting about “weight loss miracles,” these drugs are serious medicines that require careful prescribing and monitoring by skilled healthcare professionals. But on the other hand, it’s sad to see the implicit bias written into this reporting. This is bias that arises from persistent confusion about weight loss and obesity care.

Presumptions About Weight Loss

Stated simply, the authors betray a bias that the sole purpose of using GLP-1 agonists in people with obesity is weight loss. Not health gain, and not to manage the chronic disease of obesity. They do it with the very first words they wrote:

“Glucagon-like peptide 1 (GLP-1) agonists are medications approved for treatment of diabetes that recently have also been used off label for weight loss.”

The tone of the whole report flows from there. The presumption is that using these medicines for diabetes is legitimate. For obesity, it is not, because it’s all about simply losing weight. These authors convey no understanding of medical care for obesity.

In fact, the authors barely mention obesity. The word crops up only four times in their article and then not to acknowledge the disease these drugs can treat. Rather, it’s just a way to sniff out people who might be using these drugs “for weight loss.”

A Different “Risk-Benefit Calculus”

The real story this article is pushing emerges in the conclusions. The risk benefit for using these drugs to treat diabetes is just fine. But not so for obesity care, which the authors describe only in terms of weight loss:

“Given the wide use of these drugs, these adverse events, although rare, must be considered by patients who are contemplating using the drugs for weight loss because the risk-benefit calculus for this group might differ from that of those who use them for diabetes.”

There is only the faintest flicker of awareness from these authors about their limited understanding of obesity care. “Whether GLP-1 agonists were all used for weight loss is uncertain,” they write.

Perhaps one day they’ll dig a little deeper on that point.

Click here for the article in JAMA and here for further reporting on it. For perspective on the importance of language that frames obesity, click here.

Charing Cross Bridge, Fog on the Thames; painting by Claude Monet / WikiArt

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October 7, 2023