Is an obesity drug the answer?

The pharma industry certainly thinks so!

Photo by Kerstin Martin

Tonight we watched an interesting 60 Minutes episode on a new obesity drug called Wegovy. The premise for this particular drug is that obesity is an illness where every time we gain weight, our brain creates a new setpoint that it then tries to protect by sabotaging our weight loss efforts. The message was basically: “Your obesity is not your fault and here is a drug that will help you lose weight and keep it off by changing your brain signals and making you feel full sooner.” This is not that dissimilar from bariatric surgery which reduces people’s stomach size so they feel full more quickly and stop eating.

While our brains absolutely play a role in obesity I find the “It’s not your fault” approach just as problematic as saying “Why can’t you just eat less?” The first absolves us of any responsibility for our own actions while the second shames us by accusing us of being weak and lacking will power. And guess what, both approaches offer solutions where you give a lot of money to the pharma and diet industries.

The mechanics of obesity are simple: most obese people are so because they eat more than their bodies need. The psychology of why we do this, on the other hand, is complex and influenced by many factors:

1. The diet industry that has dictated what we eat and how we feel about ourselves for decades. The less confident we feel, the more we eat, the more we diet, the more money they make.

2. Our families and how we grew up around food, weight and dieting.

3. Peer pressure at school, at work, on the internet - driven by unrealistic ideals of what our bodies should look like.

4. Our environment and infrastructure, which are all about convenience and discourage natural movement and activity.

5. Early life trauma and addictive emotional overeating. Food makes us feel safe. And wanting to feel safe is a very strong motivator, even if we rationally know that what we’re doing is not healthy.

6. Neural pathways in our brain that, over years and decades, have created layers of protective habits that are not so easy to change.

7. Genes? That’s what this drug is saying: obesity is a genetic illness. And because I am not a scientist I am not saying that they are wrong.

What I object to is the singular focus on “this is not your fault and we have a drug to help you,” which basically ignores all the other factors in favor of a wonder drug. Which, by the way, is very expensive and most regular obese folks cannot afford it. So guess who uses it a lot? Hollywood stars. Because they want to keep their teeny tiny tummies flat. Ugh.

I am all for getting professional help and support, even medical intervention if that makes sense and is done safely. I just think that we also need to talk more about all the other factors, especially point 5:

Trauma and emotional overeating.

But mainstream media is not interested in this. And I guess that makes sense, it’s easier to blame genetics and sell a pill than to question the problematic system we live in, or ask people to break generational trauma cycles and do the difficult work of emotional healing.

I am here for those conversations.