Double Standards Continue in Antiobesity Meds Discourse

The arrival of semaglutide for obesity management in the UK has attracted much attention. My BS radar ("bias sensitivity," surely) was pinging all month, thanks to the media's stigmatizing and uninformed views of obesity and obesity care.

Recent coverage of semaglutide has been — unsurprisingly for those of us working in obesity treatment and advocacy — largely dismissive of the compelling evidence we now have that tells us obesity is a complex chronic disease. Part of the reason obesity coverage is far more negative is, clearly, weight bias.

For decades, studies have documented the extent of weight bias in the media. The persistent way in which the media portrays individuals with obesity as lazy and lacking willpower and self-control contributes to obesity stigma in healthcare, research, education, and policy, and explains why new obesity therapies and the people who make them happen are judged far more critically than in other chronic diseases.

We see this in recent reporting in the UK, in which much semaglutide coverage has amounted to little more than moralistic handwringing and pearl-clutching in pieces that discuss anything but the nature of the disease and the evidence supporting various treatments. In these pieces, the drug "does nothing to address the root causes of obesity"; we also learn that losing one's appetite and love for food because of the effects of a medication makes life less enjoyable; semaglutide apparently "makes food repulsive"; and that taking a medication for obesity is self-harm.

Compounding this dubious coverage was a flurry of stories about how a commissioned opinion piece on semaglutide didn't disclose that the author had received research funding from the drug's manufacturer, nor that the nonprofit for which he serves as president also receives various forms of funding from the company (and others), as revealed by The Guardian newspaper group and reported by Medscape UK.

Now, no one should argue against the need for transparency and disclosure, especially when it comes to industry funding healthcare education, NGOs, etc. But we ought not to ignore that nearly every single treatment available today for chronic illnesses has been developed and introduced to the clinic through a multistakeholder process that at some point involves industry — drugs being expensive things to develop.

Disclosure is one of the tools we all rely on to ensure that these relationships remain above board. You'd never know it from most of The Guardian's coverage of other disease states and emerging treatments, which set a rather low bar for transparency.

(Also, I want to stress here that I am in no way suggesting that these stories, or the research they cite, or the researchers behind it, or the funders behind them, are anything but above board.)

Take this 2021 story about a clinical trial of adavosertib, a new agent being developed that shows promise for slowing the growth of inoperable bowel cancer. It notes that the trial was funded by arms of the UK government, a cancer charity, and some universities. Not one mention, however, that a major global pharma company was developing the drug (which they did until 2022) and provided "drug supply and distribution" as well as an "educational grant" for the study. Or that the study's authors (The Guardian doesn't link to the actual paper) cite having received various forms of support from more than a dozen companies in the pharma/biotech space. Oh, and eight of the 22 authors, including the lead author and an additional author — both of whom are quoted in The Guardian story — cite having received some form of support from the pharma company developing the drug.

Or this one from 2021 (another "gamechanger"), about the NHS approval of the cardiovascular drug inclisiran, after the manufacturer agreed to a price cut. It quotes the director of a university-based cardiovascular disease center. What's not noted in the story is that the director has been lead or co-author on inclisiran research, published prior to the 2021 Guardian story, supported by the company developing the drug. That company was acquired in 2020 by the manufacturer who agreed to the NHS price cut. Oh, and that cardiovascular disease center? Among its funders are five pharma companies (note that the maker of inclisiran is not listed among them).

And here's one from 2022 on lecanemab, a new drug showing promise in treating Alzheimer's disease. It quotes an expert who is also credited as director of a university-based research institute. While the piece names the two drug companies developing the drug, it includes no disclosures. A simple internet search reveals that he has consulted for several pharma companies, including one of the drug's developers. An opinion piece on lecanemab was published on the same day as the above-mentioned lecanemab story, and also in The Guardian. It mentions results of a "long-awaited" trial (published in The New England Journal of Medicine on the same day as The Guardian stories — a skeptical reader might conclude that this was all part of an "orchestrated PR campaign" as The Guardian/Observer hinted at regarding the semaglutide launch). You have to travel to the lecanemab paper on NEJM (The Guardian doesn't provide a link) to learn that the trial was supported by the company who makes the drug with "partial funding" by a co-developing company. You'd also learn that seven of the 19 authors are listed as employees of the first company.

You get the idea.

There are several points to be made here:

• Innovation in healthcare has nearly always been led by investments by universities, NGOs, industry, and healthcare systems, all of whom may have conflicting priorities.

• Media are, at best, uneven about when they include disclosures of authors and interviewees. This is not solely a Guardian problem, obviously. Researchers and clinicians are also, at best, uneven (and, likely, often unasked) about offering disclosures.

• Media and the public generally don't understand how these relationships work and how risk and conflict can be mitigated, and therefore it can be hard to tell if there is indeed fire where there is smoke.

Transparency to mitigate conflicts of interest is something we all should embrace, but it's time to call the media on their obesity BS (that doesn't stand for "bias sensitivity" here) and to stick to the science while adhering to a cohesive disclosure standard.

People living with obesity have been waiting lifetimes for respect and evidence-based treatments. They deserve better. Achieving equity for them would truly be a newsworthy gamechanger.

Follow Yoni Freedhoff on Twitter @YoniFreedhoff

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Cite this: Double Standards Continue in Antiobesity Meds Discourse - Medscape - Apr 12, 2023.