The farce of obesity drugs and "lifestyle changes"
Big Pharma acknowledges that lifestyle changes are needed, but its business model depends on people taking the meds *instead of* changing.
Since researching the various tentacles of the vampire octopus whose goal is to hook millions of people on neverending obesity medication, my social feeds have been full of providers pushing those drugs. They have cheerful, upbeat logos, and eerily matching talking points, crafted by the sinister marketers at Big Pharma HQ. Obesity is a “chronic disease” that requires a lifetime of “treatment”, and “it’s not willpower, it’s biology!”
Another thing they have in common: they all claim to offer “support and coaching” and “education about diet and exercise” and “community” and “nutrition advice” as part of their service. But this is just a fig leaf to cover up their real plan, which is to sell medication. (Ask them how many customers they have who don’t buy meds but just find the coaching useful, and I’ll bet you it’s zero.)
When paired with healthy lifestyle changes…
Pharmaceutical “treatments” for many health conditions very often have small print that they should be taken “along with healthy lifestyle changes” — a vague catch-all that does three important things.
First, it acknowledges that taking the meds alone may not be enough, a get-out clause that shifts potential liability for failure away from the manufacturer, which is handy in case of future lawsuits. Second, it moves blame over to the patient — “see, the drugs work, but it’s you who didn’t makes those healthy lifestyle choices. Don’t blame us!” And third, it allows them to nod in the direction of being a comprehensive and “holistic” approach, when it isn’t — in fact it is the opposite.
This last point is key. Obesity is a complex “BEPS” phenomenon (biological, environmental, psychological, social) but that doesn’t fit Big Pharma’s playbook, which rebrands BEPS challenges as simple biological problems with simple pharmacological “treatments”. It’s always a nail, and the solution is always our hammer.
As Scott Alexander put it, in most cases where drugs are indicated alongside lifestyle changes, “Over a generation or so, doctors go from demanding the lifestyle change, to gesturing at the lifestyle change before prescribing the medication, to mostly just prescribing the medication.”
[Gesticulation intensifies]
Big Pharma is clearly planning to sweep aside all lifestyle gesturing in obesity, to clear the pathway for population-wide injections, starting at age 12, but there’s a hitch. It is so obviously untrue that obesity is purely biological: we choose what to eat multiple times each day, and are capable of varying those choices. What we choose is structured by our location, culture, schedule, etc, but we still have agency and accountability.
So given that it’s impossible to deny agency altogether, Big Pharma has a backup plan, where they vigorously pretend to take a holistic approach, even while their only interest is drug sales.
If you look at the major DTC companies selling these drugs direct to the public, you’ll see that the actual product — injectable meds — is always just one of several bullet points, accompanied by other bullets that “alibi” the sale of the drugs.
A few examples of the gestures at lifestyle change:
“Don’t ask questions — just take your meds and keep paying”
This is a terrible but predictable consequence of how the drugs work, and the business model behind them. Once injections stop, the weight returns — most of it is back within a year. That’s why Big Pharma is so determined to label obesity a “chronic” disease. It’s not true, but it hugely helps their pitch of “please buy our lifetime drug subscription.”
They have no interest in coaching you or showing you how your body works, to address the root causes of obesity. Emancipating you would cost them a customer. Nevertheless, they have to pretend to be offering those holistic services, to deflect from the harsh truth that they’re just expensive drug pushers, misdirecting people onto a $15,000 per year highway with no off-ramps.
It makes me angry because it’s unethical. The fake coaching and support actually teaches people nothing about their bodies — it’s just the same warmed-over diet and exercise tips you’ll find on a million useless web pages. And because people end the program no more enlightened than when they started, they continue the same patterns that led to obesity in the first place, and quickly regain the weight. An incredibly expensive yo-yo round trip.
Knowledge is power
At Limbo, the first cohort just passed year one on the system. One member told us she has lost 25% of her body weight since starting the program in January 2022. Every cohort member lost at least 15%, and most much more. And what’s most important: those no longer on the system any longer have kept the weight off. Instead of chemically dulling their body and continuing the same poor food habits, they learned, instead, through intensive blood glucose coaching and real-time body data how to build the right habits, and how to be in control of their weight sustainably, for the long term.
We give people transparency into their own bodies, and put them in the driver’s seat. Just overriding homeostasis temporarily with massive hormone injections, followed by weight regain afterwards, makes people passive passengers on a journey that impoverishes them but makes Big Pharma massive profits. Truly emancipating people from obesity may be a less profitable business model than forever-meds, but it’s a lot more ethical. That’s the food and health revolution that’s needed.