No ‘easy’ weight loss: don’t overlook the social cost of anti-obesity drugs

[Eddy Edson]

No ‘easy’ weight loss: don’t overlook the social cost of anti-obesity drugs

Ideas of diet and exercise as the ‘best’ way to lose weight could stigmatize people taking Ozempic, WeGovy and other blockbuster drugs that affect appetite. Lessons from weight-loss surgery reveal ways to help.

www.nature.com

Ideas of diet and exercise as the ‘best’ way to lose weight could stigmatize people taking Ozempic, WeGovy and other blockbuster drugs that affect appetite. Lessons from weight-loss surgery reveal ways to help.
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We’ve seen it before, in the context of weight-loss surgery. Between 2013 and 2016, through in-depth interviews, we traced the journeys of 35 people undergoing bariatric surgery in the United States. We tracked the experiences of another 300 individuals through surveys1
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There is also a widespread sociocultural myth that becoming and staying thin should be achieved through arduous and morally valued dietary control and exercise. Being fat is seen as a sign of laziness and of a lack of self-discipline — but so is the use of medical interventions to help lose weight7. Social-media posts provide myriad examples of how weight loss and staying slim through diet and exercise is viewed as a virtuous achievement. This general idea that success should be the outcome of personal effort is embedded in many aspects of contemporary life, including education and wealth8.
Such cultural beliefs profoundly influenced the weight-loss experiences of the people with whom we spoke1.

More than half of our US study participants didn’t tell people other than close family that they were undergoing bariatric surgery, because they feared judgement. This fear was borne out in the remainder of the cohort — among those who did speak openly about their surgery, 90% were told by at least one person in their social networks that they were cheating at weight loss. Because they underwent a surgical intervention, they were viewed as not working hard enough, not showing enough discipline or not displaying enough moral fortitude to ‘deserve’ their weight loss. They had lost their physical weight, but they still carried the stigma of being labelled as lazy and undisciplined.
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In real life, managing extreme weight loss is a life-long effort. Thirty-six per cent of our survey respondents reported chronic struggles with vitamin deficiencies, and 47% reported new food intolerances after surgery. Nausea was common — as it is for those who take anti-obesity drugs. Other side effects of rapid, extreme weight loss — by any means — include a drawn face and loose, sagging skin that can be painful and becomes infected easily1. As well as being physically challenging, such bodily features are viewed societally as unattractive.

In our view, the widespread enthusiasm for weight-loss drugs is not just a solution to a medical problem — it’s also a response to deeply held, widespread fear and anxiety around body weight. The stigma of being labelled by others as fat can shape decisions to use weight-loss medications, and with weight loss comes the expectation of a ‘better’ life with more social acceptance. But, as our research with people undergoing bariatric surgery shows, weight-loss trajectories are not that simple. It’s crucial that pharmaceutical companies, clinicians and researchers consider the emotional aspect of decision-making around anti-obesity drugs.