This page has mentioned Yoni Freedhoff, M.D., a Canadian doctor with some controversial ideas. In a TIME article, he characterized society’s obsession with weight as “hateful,” and deplored the concept that anyone can slim their body if they sincerely want to. Nor does he endorse the idea that the GLP-1 weight loss drugs are a recipe for disaster. In this worldview, what main points seem to need debunking?
First, there is the aspect that many critics regard as a scandalous failure, the necessity of staying on such a med forever, lest the pounds return. The rebuttal begins, “Yes, that’s how treatments for chronic conditions work…”
Second, there are side effects:
But not appreciably more than with other medications used to treat various chronic conditions where the benefits they provide are sufficient to warrant their prescriptions being sustained.
And, people’s bodies seem to gradually acclimate to these drugs, unlike many other substances, so it’s pretty much a matter of just hanging in there. (To which a cynic would say, “Maybe so, but the body also gets used to heroin. That is not necessarily a feature.”)
Also, adult humans presumably have rights. As long as a grownup is willing to pay the bill, she or he can have 67 body-altering plastic surgery procedures and meet no resistance from other people.
So why not a weekly injection? Perhaps Dr. Freedhoff’s most difficult argument to refute addresses the main problem, as seen by many. The new weight-loss meds do not treat the root causes of obesity. Well then,
How many drugs treat root causes? Do asthma drugs treat air quality? Do cholesterol lowering medications regulate trans-fat in our food supply? Do pain relievers prevent injury?
Other publications contain thoughts about other matters. For instance, if a patient presents with high blood pressure, few doctors say, “Go away and try to manage it on your own for six months. Then when you fail, come back and I’ll write you a prescription.” It doesn’t happen that way.
Again, Dr. Freedhoff is less attuned to personal failure and more suspicious of the zeitgeist:
Just as with virtually every other chronic noncommunicable disease with lifestyle levers, intentional behavior change as treatment — which, by definition for chronic diseases, needs to be employed in perpetuity — requires wide-ranging degrees of privilege and is not a reasonable expectation.
…[T]his may be true even if the behavior change required is minimal, the cost is free, and the motivation is large.
What was that about free treatment? Alas, a study showed that among patients who had survived for a year and a half after a myocardial infarction, fewer than half took their pills — even if the cost was zero! And among the folks who were on co-pay plans, fewer than one-third of them took their pills.
How hard is it anyway to swallow a pill? Knowing all this, it would take a real optimist to expect people to reorganize their entire lives and embark on some elaborate exercise program or become vegan chefs. Such dreams indicate what Dr. Freedhoff calls “the folly of believing that knowledge drives behavior change.” Also, it would seem that, in academia, the study of patient non-compliance needs to be pursued more vigorously.
Your responses and feedback are welcome!
Source: “What We Get Wrong About Drugs Like Ozempic,” TIME.com, 06/28/23
Source: “’Patients Fail’ Despite Benefits of Sustained Weight Loss,” Medscape.com, 08/25/23
Image by Jesper Sehested Pluslexia/CC BY 2.0 DEED
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