The problematic advent of anti-obesity drugs

Going through life in a fat body means you’re less likely to do that be hired for a job and will be paid less than non-fat people. In fact, the effects of weight discrimination – including poorer medical treatment, loneliness, psychological distress and increased stress – can cut short the life of fat people.

Deciding whether to take the drugs becomes a “devil’s choice,” says Osborn. “Make sure I have the right to be as I am now – or trade that right for significantly more rights and privileges in the culture.” The fat acceptance movement instead pushes for fat people to be given the same rights as everyone else, regardless of their size.

Novo Nordisk campaign “It’s Bigger Than Me”, which features actor Queen Latifah as the face, has received particular criticism. In doing so, the company seeks to align itself with the themes of fat acceptance—by eliminating weight stigmas and prejudices and breaking the misconception that obesity is simply a lack of deliberate control—while selling a drug that aims to make fat people smaller. “Saying that if you take away the fatness, you give them a chance to thrive, you’re not doing that — you’re just making the person smaller and you’re selling them smallness as a gateway to oppression,” says Marquisele Mercedes, a PhD student in public health from Brown University.

But these concerns are countered by an obvious truth: obesity drugs are effective at tackling a complicated condition. While the underpinnings of obesity remain elusive, there is a conflicting consensus among researchers one irrefutable fact: Obesity is not a physical manifestation of a lack of willpower. Research has proven time and time again that dieting doesn’t work to lose weight and keep it off. Obesity is a complex, tangled mishmash of biological and environmental factors that scientists have yet to fully resolve and cannot be reduced to the simple matter of calories in, calories out. “That concept doesn’t make sense,” said Francesco Rubino, a professor of metabolic surgery at King’s College London. “It’s not true that obesity is the result of too much energy.”

Having working drugs that can intervene where other interventions have failed will provide important health benefits for some. Obesity increases your risk of a number of debilitating and deadly conditions, including heart disease, diabetes, high blood pressure, stroke and certain cancers. These drugs may even help solve the mystery of the root causes of weight gain, says Rubino. In addition to a reduced urge to eat, people taking semaglutide seem to have a reduced impulse to engage in dopamine-fueled behaviors such as drinking or shopping, according to to David Macklin, a physician who has treated many patients with the drug.

But these treatments are not intended for the masses. They are indicated for a specific patient group: people with a body mass index of 30 kg/m², the clinical definition of obesity, or for people with a BMI of 27 kg/m² or higher (thus classified as overweight) if they have another have a weight-related condition that threatens their health, such as high blood pressure. (It is worth noting that BMI, the diagnostic tool most commonly used worldwide to determine obesity, has been shown to be a imperfect and discriminatory health statistics.)

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