Disrupting the Obesity Status Quo Is Exquisitely Uncomfortable

“Drug compounding with semaglutide and tirzepatide is a public health emergency,” said a respected obesity medicine physician to us this week. They were right. Most of the compounded drugs people encounter when they are desperate to obtain these life-changing medicines are sketchy at best. This week, FDA announced the arrest of a TikToker for selling adulterated and misbranded “Ozempic” and other products that put people in harm’s way. The agency reported that one of the TikToker’s victims developed Mycobacteroides abscessus lesions because of a contaminated product she sold. This is the nasty part of a radical and uncomfortable departure from the status quo in obesity.

An Unacceptable Status Quo

There’s no two ways about, we are moving away from an unacceptable status quo in obesity. One can argue that the situation is a better now. We have much more effective options for obesity care and many people are starting to recognize past mistakes. Notable among those mistakes was the insistence that prevention had to take precedence over treatment and implicit promotion of weight bias and stigma.

But right now, things are only a little better. Implicit bias is still prevalent – unacceptably high in healthcare. These marvelous treatments are only available to a privileged few and because of an inadequate supply, the price remains outrageously high, especially in the U.S.

This situation makes the proliferation of compounded versions of semaglutide and tirzepetide inevitable. In fact, FDA regulations explicitly provide for legitimate compounding pharmacies to play a vital role in situations where drug shortages are a problem. Unethical characters are exploiting this situation and causing great harm.

FDA has certified the existence of the supply problem with both drugs. Obesity medicine professionals will emphatically tell you that the stress of an uncertain drug supply situation is making life miserable for them and their patients.

This is a hot mess and there’s plenty of blame to go around.

The Buyers Club Mentality

In the 1980s, HIV and AIDS were a death sentence for a marginalized community with very few options. That community organized and put pressure on FDA to change its lethargic approach to the situation. They shut the agency down in 1988, shouting, “Hey, hey, FDA, how many people have you killed today?”

Buyers clubs sprang up, distributing dubious products that were unproven to have any medical value. Some of them were outright dangerous. Those were desperate times that bred desperate actions and spurred more responsive actions from government, researchers, and industry.

Though the situation with a rejection of the status quo in obesity is very different, we see striking parallels. The result of all that angst was the evolution of HIV and and AIDS from a death sentence into a manageable disease.

We sincerely hope that the present angst in obesity care is a signal that we are on our way to a better situation. Disrupting the status quo is exquisitely uncomfortable.

For further perspective on disruptive change in paradigms for dealing with obesity, click here.

Self Portrait, painting by Diego Rivera / WikiArt

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May 5, 2024