Ivy League doctors say that obesity constitutes a new normal for Americans, classifying it as a chronic disease that requires perpetual drug intervention.
In a six-part series on Medscape, “Treating Obesity: Confronting a New Normal,” doctors from the Harvard, Yale, and Rutger medical schools made the case that obesity doesn’t stem from behavioral issues. One of the doctors, Yale School of Medicine professor Ania Jastreboff, said that the traditional understanding of eating less and exercising more had no effect on reversing or preventing obesity.
“Obesity is not a personal choice,” said Jastreboff. “For years, the advice was that our patients needed to ‘eat less and move more.’ That does not work.”
Harvard Medical School professor David Ludwig dismissed the “Western” viewpoint of obesity as a consequence of weak character.
“Western culture has considered obesity a character problem. Obesity is simply a matter of eating less and moving more, and if you can’t do it, it’s a lack of character or discipline. When in reality, obesity is more about biology than behavior,” said Ludwig. “We need to think about nutrition as we think about drugs.”
In the latest episode, the doctors touted drugs as the cure to obesity. They discussed the injectable appetite suppressant semaglutide, the weight loss drug popularized by celebrities under the brands Ozempic and Wegovy, as well as a similar drug, tirzepatide (Mounjaro).
“I think we’re in an incredibly exciting time,” said Jastreboff. “We had tools previously to treat patients with obesity. But now we have new, highly effective and safe medications that target disease pathophysiology.”
In order to keep the weight off once lost, however, the doctors said that individuals have to take the drugs in perpetuity.
“One of the most common questions that I get, whether it’s from my colleagues or my patients, is ‘Well, I took this medication, I have lost the weight, can I stop taking the medicine? Am I all done?’” said Jastreboff. “And the answer is no, you have to keep taking the medicine.”
Chika Anekwe, an obesity medicine doctor with the Massachusetts General Hospital Weight Center, concurred.
“Once you started a medication, we expect that you would stay on it long-term in order to both lose and maintain that weight loss over time,” said Anekwe.
Although the doctors dismissed personal choice as a factor for obesity, the doctors blamed obesity on poor food choices.
The doctors classified America as an obesogenic environment: a prevalence of highly-processed and palatable foods, sedentary and high stress lifestyles, and poor sleep. The doctors indicated that the transition to remote work and education during the COVID-19 pandemic worsened the obesogenic environment.
They linked modern obesity rates to the Nixon administration’s overhaul of agriculture under then-Secretary of Agriculture Earl Butz, who led the mass industrialization of two key ingredients in highly processed foods: soy and corn. The doctors said Butz’s leadership resulted in the massive proliferation of junk foods: processed foods that are easily digestible and consisting of simple sugars.
Rutgers professor Ronald Weiss noted that processed foods hijack “true hunger drives” developed through evolutionary processes: the more junk foods are consumed, the greater an individual’s desire for them.
“I think the most dangerous drug on earth is food. Addictive foods are so pervasive — they’re everywhere,” said Weiss.
The doctors blamed highly-processed foods for creating negative peptide hormonal feedback loops, as well as disrupting the flow of insulin and glucagon. Ludwig said that these foods cause fat cells to hold onto too many calories while starving the brain and other parts of the body, resulting in an individual eating more to feel full; Ludwig said that fasting would be futile in these cases.
The American Medical Association (AMA) recognized obesity as a chronic health condition in 2013. Over 40 percent of American adults and 20 percent of children qualify as obese.