Lancet: Obesity Drugs Won’t Save Us from Cheeseburgers

Some things never change. Half a century ago, editors of the Lancet proclaimed that “most obesity could, with care, be prevented.” Drugs have “limited usefulness” for treating obesity, they explained, and so, “we need to be more vigilant about preventing obesity throughout childhood.” After 50 years of relying on this advice, obesity prevalence has tripled. It has quadrupled in children. Yet in a January 6 editorial, Lancet editors are still telling us that medicine has a limited role to play in obesity. To make their perspective crystal clear, they offer a picture of a juicy cheeseburger and say “prevention must be the foundation upon which everything follows.”

In other words, obesity drugs will not save us from cheeseburgers.

What Is It with Cheeseburgers?

Can we just let go of the preoccupation with cheeseburgers? Cheeseburgers are not the primary cause of obesity. Many people with obesity don’t like them. Many people who are immune to obesity love them.

The only purpose cheeseburger imagery serves is to suggest that people who have obesity are simply eating the wrong things.

More Than Just Food Is the Problem

But it’s not that simple. The causes of high obesity prevalence are many. Complex, adaptive systems are at work to promote it. We have an altered food supply that is both a contributor to and a result of high obesity rates. Higher levels of stress and distress are triggering obesity. In turn, obesity brings further stress, creating a vicious cycle.

Our tech and physical environment has taken routine physical activity out of daily life. Conscious bouts of exercise might be helpful, but they don’t cancel out the effects sedentary routines.

And then finally, we live with exposures to endocrine disrupting chemicals and drugs that cause weight gain. The full extent of this is poorly understood, but it is not trivial.

The Narrow View from Lancet

Lancet editors suggest a particular emphasis against the “international industry that promotes cheap food and drink.” Advanced obesity medicines should have only a limited role in their view. Perhaps “for a housebound individual with obesity who has exhausted all other approaches.”

This is a fossilized view of obesity that has failed us for five decades. Yes, we need to double down on effective obesity prevention – first and foremost by finding strategies that work. Not by relying on cheeseburger symbolism. Not by insisting that ineffective strategies will work if we stick with them.

At the same time, we should not fear the possibility that people living with obesity might benefit from breakthroughs in treating this disease. We should embrace it.

Click here for the editorial by the Lancet and here for a more enlightened view in the Lancet from outside authors.

Classic American Cheeseburger, photograph by Dallaire8888, licensed under CC BY-SA 4.0

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January 10, 2024