Premature Death Notices for Diet and Exercise

Narratives in health reporting tend to cluster. This is how we get diet fads. It’s also why stories about how bad BMI is have gotten enough traction to drive people to extreme views about it. Lately, we’ve noticed a new cluster forming. Let’s call it the premature death notices for diet and exercise.

In Vox last week, Jolie Myers told us that “weight loss drugs ended the era of ‘lifestyle changes.’” She wrote that:

“Doctors can write a quick prescription instead of making a person self-flagellate for months or years before they’ll consider medical intervention.

“The existence of an effective medication seems to have snapped obesity from a perceived personal failure into the category of treatable disease.”

The Atlantic was even more blunt, with a headline that proclaimed: “Ozempic killed diet and exercise.”

Dead or Transformed?

Early in the rise of GLP-1 medicines for obesity, we witnessed a bit of panic from people who had committed themselves to a career in lifestyle medicine. Celebrity fitness coaches made a point of trying to scare people from using those medicines. The fear that people would just take these meds and keep on eating a lousy diet and living a sedentary life popped up everywhere, it seemed.

Let’s be clear: That was nothing but an expression of weight bias. For people who equate obesity with sloth and gluttony, such fear mongering makes perfect sense.

But that line of thinking turns out to be precisely wrong – as well as very stigmatizing. Myers states it quite well in her piece for Vox:

“People who take GLP-1 drugs often report a distaste for ultra-processed foods and a preference for fresh fruits and vegetables. And losing weight can help people move around more freely. These drugs don’t replace lifestyle changes. They seem to make them possible.”

Complete Care for Obesity

Nutrition professionals seem to be figuring this out. Writing for the Academy of Nutrition and Dietetics, Linda Gigliotti and colleagues describe the evolving role of registered dietitian nutritionists in obesity care. Their comprehensive examination of the subject is impressive. The bottom line is quite simple:

“Long-term management of any chronic disease requires an integrated care approach. The management of obesity is no exception.”

Indeed, obesity is a complex, chronic disease. With GLP-1 agonists, we have important new tools for managing it. But sound chronic care for a chronic disease requires more than writing and dispensing a prescription.

Click here for the article from Vox and here for free access to the piece from The Atlantic. For the publication by Gigliotti et al, click here. Finally, you can find an excellent review of the past, present, and future of behavioral therapy for obesity here.

Dewey Defeats Truman, photograph by Byron H. Rollins / WikiArt

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January 19, 2025