The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.
Writer, speaker, and weight-inclusive health/fitness professional Ragen Chastain joins us to discuss the potential side effects and other downsides of using GLP-1 drugs (like Ozempic and its ilk) for weight loss, the massive influence the manufacturers of these drugs are having on the public discourse about them, why the media don’t often report on these conflicts of interest, how drugmakers have co-opted talking points about weight stigma and weight cycling, how opposition to these drugs in some integrative- and functional-medicine spaces still perpetuates stigmatizing ideas about body size, and more.
Ragen Chastain is a speaker, writer, researcher, Board Certified Patient Advocate, multi-certified health and fitness professional, and thought leader in weight science, weight stigma, health, and healthcare. Utilizing her background in research methods and statistics, Ragen has brought her signature mix of humor and hard facts to healthcare, corporate, conference, and college audiences from Kaiser Permanente and the Diabetes Education Specialists National Conference, to Amazon and Google, to Dartmouth, Cal Tech and canfitpro. Author of the Weight and Healthcare newsletter, the book Fat: The Owner's Manual, co-author of HAES Health Sheets, and editor of the anthology The Politics of Size, Ragen is frequently featured as an expert in print, radio, television, and documentary film. In her free time, Ragen is a national dance champion, triathlete, and marathoner who holds the Guinness World Record for Heaviest Woman to Complete a Marathon. Ragen lives in Oregon with her fiancée Julianne and a rotating cast of foster dogs.
Resources and References
Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being
Subscribe on Substack for extended interviews and more
Ragen’s Weight and Healthcare newsletter
Overview of the evidence on weight cycling
Studies finding that weight cycling can explain excess mortality risk
GLP manufacturers partnering with plus-size influencers
The Observer’s reporting from 2023 on Novo Nordisk’s influence, and its proposal to target people on unemployment
Christy’s online course, Intuitive Eating Fundamentals
Transcript
Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.
Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which was published in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.
Hey there. Welcome to this episode of Rethinking Wellness Today my guest is Ragen Chastain, a friend of the pod and a weight inclusive speaker, writer, and health and fitness professional who joins me to discuss the potential side effects and other downsides of using GLP-1 drugs like Ozempic and its ilk for weight loss. We also talk about the massive influence that the manufacturers of these drugs are having on the public discourse about them, why the media don't often report on these conflicts of interest, how drug makers have co-opted talking points about weight stigma and weight cycling, how opposition to these drugs in some wellness culture spaces like integrative and functional medicine still actually perpetuates stigmatizing ideas about body size, and lots more. It's a great conversation and you can listen to the first half for free and then upgrade to paid to hear the whole thing by going to rethinkingwellness.substack.com.
If you do, you'll not only get to hear full interviews with all of our guests, but you'll also get subscriber only Q and A's, full access to our archives, commenting privileges, and subscriber threads where you can connect with other listeners, and more. Plus, you'll get my undying gratitude for supporting the show. I really am so grateful to everyone who's become a paid subscriber. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes.
I also want to make sure you know about my second book, which is called The Wellness Trap. You've heard me talk about it here before I launched this podcast to continue the conversations I was having in reporting the book. And if you like the interviews here, I think you'll love the book. It explores the connections between wellness and diet culture, how wellness became so intertwined with misinformation and conspiracy theories and scams, why alternative and integrative and functional medicine, or complementary and alternative medicines, it's sometimes called, can lead to disordered eating and other harms, and how we can both protect ourselves as individuals and reimagine well being as a society.
If any of that sounds interesting, you can check out christyharrison.com/thewellnesstrap to learn more and buy the book or just head to your favorite local bookstore and ask for it there. And now, without any further ado, here;s my conversation with Ragen Chastain Ragen. Welcome to Rethinking Wellness. I'm so excited to have you here.
Ragen Chastain: Oh, thank you for having me. I'm super excited to be here.
Christy Harrison: Yeah, so people will have heard you on Food Psych I'm sure. And they can go back and listen to your episodes. We'll put them in the show notes if they havent heard them for like your full story. But I'd love for you to just tell us a little bit about yourself and your history with wellness culture and diet culture.
Ragen Chastain: Sure. So currently I'm a speaker, writer and researcher. My area of expertise is the intersections of weight science, weight stigma and healthcare. And I actually came to this through the research, trying to find the best diet. I had yo-yo dieted for years and so I decided my background is research methods and statistics and I'm a mega nerd. So it seemed reasonable to me to do a literature review to find the best diet. And through that literature review, realized that there wasn't a single study where more than a tiny fraction of people we're actually succeeding at significant long term weight loss, which sent me down a now more than 20-year rabbit hole of learning about the research in the field.
Christy Harrison: It's amazing. I loved what you shared on the first episode about that deep dive you did into the research and just how eye opening that was for you. So definitely encourage people to check out that episode. We're going to talk today about GLP-1 agonist drugs like Ozempic, which I'm sure people have heard all about them. They're a huge trend. They're a relatively new class of diabetes drugs that have also become blockbuster diet drugs in the last few years. And you've done a ton of great reporting about these drugs in your newsletter. So I want to dig into that today. Can we start off, though, by just having you give us an overview of how these drugs are thought to work?
Ragen Chastain: Yeah, so these drugs are actually type two diabetes drugs. They impact the amount of glucose the liver puts out. They impact your body's relationship with insulin. They also slow gut motility. And so they in various ways impact glycemic management or blood sugar and the thing about these drugs that is special is that they only start acting when blood sugar goes up. And so there's less chance with these drugs than some others that you'll have a hypoglycemic episode, which is low blood sugar, which can be fatal. They're solid type two diabetes drugs, and they work well for people who are contraindicated for other drugs or who can't get glycemic management through other drugs, though they're not necessarily a frontline treatment because of the number of side effects that they have. But, yeah, so that's how they came on the scene.
And then what happened was Nova Nordisk and Eli Lilly realized that people who were taking the drugs for type two diabetes had a side effect of some weight loss, and they decided to exploit that by repackaging them and getting FDA approval for them as weight loss specific drugs.
Christy Harrison: Yeah. And that's where the trouble comes in. What are some of the potential side effects and other downsides of using these drugs for weight loss?
Ragen Chastain: Well, so the thing about the weight loss treatments is that they are a mega dose of a type two diabetes drug. And so what we're talking about for diabetes, they're dosed so that you take the minimum amount of the medication you need in order to get the glycemic management that you want and minimize the side effects. But for the weight loss application, the goal is simply to maximize that weight loss side effect, and you can't maximize that without maximizing all of the dose dependent side effects.
And so just to kind of clear up any confusion, Semaglutide is the name of the drug. It's a Novo Nordisk drug. Ozempic is the type two diabetes application, and Wegovy is the weight loss application. So the required dose of Wegovy is 2.4 milligrams. The maximum dose of Ozempic is two milligrams. And up until two years ago, it was just 1 mg. So it's basically the required dose of Wegovy is more than the maximum dose of Ozempic. So it's, again, a mega dose of these drugs to try to get a side effect to happen at the highest rate.
So the drugs themselves have some significant side effects. First of all, they have what's known as a boxed warning, which is the strongest FDA warning possible for a possible side effect of thyroid C cell tumors. They can also, some lesser known side effects include the fact that they can cause fetal harm and they have a long half life. So they warn that folks both what they call, quote, females and males. And I want to be clear, they're not trans or nonbinary inclusive in their labeling at all, of reproductive potential should discontinue the drug at least two months before a planned pregnancy. However, then they also say once pregnancy is recognized, discontinue the drug. But it's unclear to what extent that will help, given that the half life is so long.
So there's that piece of it. Their common side effects are predominantly gastrointestinal things like nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dizziness, stomach pain, eructation, which is burping. But they also have serious side effects, and that can include things like acute pancreatitis, acute gallbladder disease, acute kidney injury, heart rate increases, there's suicidal ideations and behaviors, and also something called Ileus, which part of the drug's effect is. What I mentioned slowed gut motility. So food moves through the digestive system more slowly, but when peristalsis actually ceases, then the body ceases to be able to eliminate solid waste, and that can be fatal and typically requires hospitalization. And that's also a side effect of these drugs. So the side effects are potentially fatal.
Christy Harrison: I had Ileus after my c-section because one potential way of getting it is if you have abdominal surgery and your intestines are manipulated, they can just sort of seize up. And that happened to me, and it was one of the most horrible experiences of my life. The fact that that is a potential side effect is so scary.
Ragen Chastain: A really tragic story from Australia. A woman went on these drugs because she wanted to lose weight for her daughter's wedding, and she got what sounds like Ileus and passed away. So she didn't go to the wedding. Or anything else in her daughter's life. I think there's just not any kind of informed consent that I'm hearing from healthcare practitioners that's honest about that. In fact, people are telling me that when they ask about side effects, they get blown off with things like, "Well, all drugs have side effects," or it's no big deal. And that the first statement is true but not helpful. The second statement is not true.
Christy Harrison: So how are these side effects different? Cause I think the thing is, the risk benefit analysis of any drug is sort of seen as, "Well, this drug has benefits, and this is gonna give you something helpful, and you have to weigh it against the potential risks." And in this case, I think both risk and benefit are so blown out of proportion or confused. Because the risks are a lot bigger than I think a lot of doctors are letting on, certainly than a lot of the mainstream reporting is letting on, which we can talk about more. And then the quote, unquote, benefits of weight loss, as you've reported extensively, and as I've talked about, too, are not actually evident that weight loss is not necessarily a path to health and in fact, can lead to far worse outcomes for many people.
Ragen Chastain: Exactly. And I think it's important for people to understand that when the FDA makes these risk benefit analyses for weight loss interventions, they're testing it against a mountain of research that the weight loss industry has spent literally decades crafting funding, conducting, publishing in journals that they own. That makes these simple correlations between being higher weight and health issues, fails to control for confounding variables at all, and then says, "See, it's so dangerous to be fat that it's worth risking people's lives and quality of life in attempts to make them even a little bit thinner." And the FDA agrees and they approve these interventions.
And so we have to understand that FDA approval doesn't mean safe or it doesn't mean the risk is worth it based on what I might believe the risk is worth, but rather based on the idea that they believe it's worth killing us to make us thin. That's an important thing that doesn't get, I think, talked about as much in terms of the way that this works. And, yeah, the medications themselves. So we only have two years of research on the drugs at this dosage, and one, they show that as soon as people go off the drugs, they regain the weight, which is what every single weight loss drug has experienced ever since weight loss drugs started.
But Novo Nordisk and Eli Lilly's unbelievably profitable solution is that, "Oh, people just have to stay on these drugs for their whole life," which is why we're seeing aggressively this phrase that, quote, "Obesity is a chronic, lifelong disease," right? That's in support of them selling these drugs to people for their whole lives. But this is on two years of research. And at the end of the two years, people's weight was going up even if they had managed to stay on the drug. And their own research shows that side effects will mean that many people will not be able to stay on the drug.
So even if people do manage to stay on the drug, there's no guarantee that the weight loss will continue, and there's no guarantee that they'll get health benefits in general. There's just this assumption that, "Oh, if we make people thinner, we'll make them healthier." But that's not, as you've said and reported and wrote entire chapters of entire books about, that's not scientific thinking.
Christy Harrison: And so there are people out there who will say, "Well, these drugs have been researched for diabetes for many years, and so there's long term data about them and showing their safety for that. But how does that compare to the research on weight loss? And why can't we use the evidence that's out there on diabetes to support the supposed safety of these drugs for weight loss?
Ragen Chastain: Yeah. So again, Ozempic has been around for six years, and the first four, the maximum dose was one mg and the last two, it was two. So we have research on these drugs used at much lower rates, much lower dosages. So we don't know what happens when you take 2.4 milligrams of this drug every day or every week, rather, for the rest of your life. We don't have that kind of research at all. And so, again, when you're trying to increase the side effect of the drug, you're going to increase all of the dose dependent side effects of the drug. And we don't have long enough research to find that out.
And the research is being funded by Novo Nordisk and Eli Lilly. It's being conducted by people who are either taking payments from them or are directly employed by them. And so there's no real incentive, to be honest. And if you saw the way that they treated their cardiac study, where they, instead of releasing the study, they held the study, but released a press release that had three lies just in the headline alone, they just can't be trusted.
Novo Nordisk, it should be mentioned, was one of, if not the biggest offenders of price gouging on insulin. They, in fact, engaged in what's called shadow pricing. So they would watch what their competitors did, and as soon as their competitors increased the price, they would increase their price. And so we have to realize, we have to look at this through the lens of, this is a company that has already said we will let people die for money. We have no problem with that.
I was speaking at a conference recently, and I was seated next to the current president of the American Medical Association, and we had a great conversation about this. But he said, well, I think the prices will come down because of competition, and I do not share that view because that's not what we've seen Novo Nordisk do. The prices only went up on insulin. And this is a drug whose patent was sold for a dollar to make sure that it always would be affordable.
Christy Harrison: Well, let's talk about Novo Nordisk. These drug manufacturers, Novo Nordisk in particular, but also manufacturers of the other drugs in this class, GLP-1s to some extent as well, have been just pushing these drugs relentlessly as weight loss drugs. And this includes partnering with plus size influencers, influencing the discourse and the media and elsewhere. How have you seen this influence show up? And is it always disclosed?
Ragen Chastain: I would say it's rarely disclosed. There was an article in the New York Times written by Gina Kolata that was essentially lobbying for insurance coverage of these drugs. And that's their holy grail, right? After all of the disasters of Fen-Phen and Redux and people dying, Medicare stopped paying for weight loss drugs. And so their big push here in the States is Medicare coverage, and in other countries, it's getting it on the national formulary. And so this is like a huge goal of theirs. So this article in the New York Times quoted a bunch of experts about the importance of these drugs and why they should be covered by insurance. Every single expert quoted had taken money from Novo Nordisk and or Eli Lilly, and that was not disclosed at all.
Christy Harrison: Yeah, I've seen that a lot in media coverage as well. It's just rampant.
Ragen Chastain: Yeah. And that's sort of some basic journalism, right? If you're quoting a bunch of people who are taking money from the company who you're writing about, that would be something you'd want to talk about. I think it's also important to know that they are starting a bunch of what seem like grassroots campaigns with names like EveryBODY Covered so it sounds a lot like the kind of social impact you would see this campaign from a fat positive or body positive group, but in fact, they're funding them and sort of trying to co-opt the discussion around weight stigma to make it be about weight loss, claiming that the real weight stigma is people not having access to their drugs, claiming that the cure for weight stigma is to lobby your congressman to make Medicare cover these drugs. So it's really, really insidious.
And they're getting well meaning organizations who just simply don't know better, signing onto these. And it's in really sort of despicable ways. They're co-opting decades of actual anti-weight stigma work and trying to center themselves as experts. I was recently on a panel about weight stigma in research, and I didn't know until it was basically too late. It was hosted by someone from the Obesity Action Coalition who only identified them as a patient advocacy organization and forgot to mention that they took over $700,000 last year from Novo Nordisk and Eli Lilly, and that they're almost entirely funded by the weight loss industry.
Christy Harrison: Wow.
Ragen Chastain: One of the researchers on that panel was funded by Weight Watchers and Novo Nordisk and spoke to their talking points and didn't disclose that. And this is what they've done for decades, really, is to infiltrate the healthcare system and then manipulate it from within.
Christy Harrison: They were called out in the UK for sponsoring professional development for medical doctors and also for using sort of shady tactics to get on the national formulary, pushing without disclosing that having medical doctors push for inclusion on the formulary without disclosing that they were taking money from these drug companies. It's great that the UK press has reported on that a little bit. There was some investigative reporting in The Observer and the Guardian. But I don't really see that kind of investigative reporting happening here. Why do you think that is?
Ragen Chastain: Well, the rules in the UK are very different. They're much more restrictive. They don't have commercials for prescription medication on television. And so because I think the rules are not as lax, they're more observant to what is happening. And also Novo has to do even more insidious things to try to get things done. They got actually in trouble with the pharmaceutical trade group there, the APBI, and they had a hearing and they said, "Oh, no, you can't have this medical education that's basically an advertisement for your drug, but call it medical education." And Novo appealed it on the basis that they didn't know that that was wrong. And it backfired so spectacularly that they publicly reprimanded them and suspended them.
In two years, they'll review to see if they get to come back in. I think that there's more scrutiny in the UK because there's more strict rules about how these companies can behave. Here in the states there's also incredible financial ties. I was writing for an outlet that it turned out was being funded by Novo. And so they were promoting what they're calling their, quote unquote, anti-stigma campaign, which is literally named It's Bigger than Me. Like, you get it because fat people are big. If your weight stimulate campaign sounds like it was named by a sixth grade bully, you're probably not an expert in weight stigma.
But of course, their solution to weight stigma is insurance coverage for their drug and access to their drug. And so I talked to my editor and was like, what is happening? And they apologized, and they said, "Yeah, this is a separate department from us." And they let me write a piece essentially, like, point by point, explaining why what Novo Nordisk is doing is unethical and wrong and backhanded, which I appreciated, but it's everywhere. They are raking in billions of dollars, and they are spending those billions of dollars influence peddling.
And they got caught in the UK, and they actually got caught in the US with Saxenda, an earlier drug. And Mikey Mercedes wrote an excellent piece about this in her Patreon. But they got fined millions of dollars because they were told that they had to disclose the dangers of this drug. And then they found out that behind the scenes they were telling their salespeople to downplay the dangers and to tell doctors there were no dangers. So they've been fined for this already.
And what they're really doing is taking every page they can from the Purdue Pharma playbook for OxyContin. Everything that Purdue did that Novo Nordis can duplicate, they're duplicating it, and then they're improving upon it. And so it's incredibly scary to watch it happen in real time and to see people kind of get sucked into it.
Christy Harrison: That's terrifying. Why do you think the media and the US have been generally unsceptical about the influence of these drug companies? Because I've spoken with some outlets over the years, over the last several years, that usually don't take my recommendation to look into the financial influence of these companies. And I think if they do disclose that someone has financial ties to a drug company, the attitude is sort of along the lines of, like, "Well, all, quote unquote, obesity experts take funding from drug companies, and that's just how things are done, and it's not a big deal" kind of thing.
Ragen Chastain: Yeah. And I think that's a big piece of it. That they're like, "Oh, well, yeah, doctors take money from drug companies, but, like, everybody does that." That doesn't make it good or okay. And actually, research shows that even small amounts, like less than $20, impact doctors prescribing behaviors. So when you look at doctors who are taking hundreds of thousands of dollars. We have to start really asking questions. Even if someone doesn't believe that can impact them consciously we have to ask about subconscious bias as well.
And so I also think in our media, I think there's an issue with a 24 hours news cycle that has to be fed. I think there's an issue with there being less and less even survival paying jobs for reporters. And so reporters are being asked to report on science, who never wanted to report on science and have no particular interest or skills there. And also the weight loss industry has done an incredible job of constructing a paradigm where fat equals bad weight loss equals good, is considered beyond settled science, like religion.
And so if somebody says, like, fat, bad weight loss, good, then the reporter goes, absolutely. And they write it, and they reach out to the person who wrote the study, and they don't mention that they've taken hundreds of thousands of dollars from the drug the study was about, and everybody sort of takes it as truth. And so I think there's a lot of layers to why we don't have appropriately scientifically literate, critical media around these drugs.
And it really is a huge issue because Novo Nordisk is taking full advantage of that. Their press release around their cardiac event, for example, said that it slashed cardiac events 20% in adults with, quote, overweight and obesity. In truth, it decreased them 1.8% in people 45 and older with cardiovascular disease and without type two diabetes, and who had a BMI of 27 or above. And BMI is a crap measurement. But if you're talking about people who fall into the, quote, overweight and obese groups, that's 25 and up. So all three of their claims were not true. In case you didn't take research methods, making up definitions for terms that have clear definitions is not a best research practice.
But this is exactly what they did. And it traveled like wildfire through the media, slashes by 20%. I'm co-authoring a study that's looking, in fact, at how that 20% number traveled through the media because it was so outlandishly untrue. It takes advantage of the difference between relative and absolute risk. That's something that a science reporter would or should know or ask about. But instead, it just got copy pasted and they didn't release the study. So you couldn't critique it.
Christy Harrison: Right.
Ragen Chastain: That's all you had was a press release.
Christy Harrison: I think that's the part of this. That is so insidious, because it plays on pre-existing issues in journalism, where journalists often are covering science and nutrition and food and weight stuff that are not trained in research methods and how to read a study. And they often report on press releases anyway, or have a press release and then call the scientist for some quotes and maybe look at the abstract of the study but often don't even have access to the full study or know how to read the full study if they do.
And then now it's sort of like cutting out the rigorous part of the equation where if they could at least have access to the study, someone could fact check it. Now it's like, "Just look at this press release. Don't look over here at the actual data or evidence." And there's research, too, on how misinformation travels so far and so much farther and wider than the truth, and then corrections barely get any sort of traction. So even if this information went out and then was later corrected by some media outlets, which I don't know if they bother to even do that, if some did, based on reading the actual study, it wouldn't really matter because the 20% number is already stuck in people's head.
And that illusory truth effect idea that I probably will have talked about in my newsletter and on this podcast by now is the idea that if things get repeated enough, people start to think of them as fact, even if they're false, just because of the repetition. And this makes me think of that, where it's like they're taking advantage of that, not really caring about the consequences.
Ragen Chastain: And it also slows down the rate of critique. There are several reporters who as soon as Nova Nordisk releases something, they'll contact me either for a quote or on background. So I would have told them, like, "Oh, no, this is absolute versus relative risk. Here's what they actually found in this study, in these results. And here's what's untrue about the press release." But I actually could not do that. There's no way, because they didn't release the study. So it slows down the critique.
And that's something that they're putting progressively, doing. They're learning and evolving. So they'll see people critique them, and they'll slow down the critique, or they see that the word is getting out that weight cycling creates significant health issues independently that may be getting blamed on being higher weight. And so they've rebranded weight cycling into relapsing, remitting obesity. And they claim that it's part of the chronic disease structure. And so we're to expect that on their drugs, weight will go down and up, not because their drugs don't work, which is the truth, but because this is a relapsing, remitting, life long condition. I mean, gross. I want to find a more scientific word, but it's just disgusting.
Christy Harrison: I want to talk about that rebranding more in a minute. But I'm also just curious to dig in a little bit on the idea of relative versus absolute risk, because I think this is something that for science literacy and sort of reading, reporting in general on food and nutrition and weight and health is useful to people to know about. So can you briefly explain the difference between relative and absolute risk and why the concept of relative risk is so popular in the media?
Ragen Chastain: Sure. So relative risk is the percent of decrease of risk in the group who received an intervention in a study versus the group who did not receive the intervention. So this is a good way to tell the difference between groups in the study, but it is not a good way to determine how the intervention will affect individual risk outside of the study. Absolute risk reduction, that's the actual difference in risk between the group that got the intervention and the group that didn't. And so this is a better number to help us understand what's the likelihood that any given individual is going to benefit from the intervention. And so relative risk reduction is often going to be a much larger number than absolute risk reduction.
So I'll give an example. 200 people have condition X. They get enrolled in a study to see if medication Y reduces death from condition X. So 100 of them are given the medication, 100 are not given the medication. They're in the control group. At the end of that observation period, one person who was given the intervention dies, and two people in the control group die. So the relative risk reduction is the percent risk of death in the intervention group divided by the percent risk of death in the control group. So here 0.01 divided by 0.02, which is 0.5 or 50%. So if I were a drug company who did this study and didn't have good ethics, I might report that there was a 50% reduction in risk.
But the absolute risk is actually calculated, you subtract the percentage of risk reduction in the intervention group from the percentage of risk reduction in the control group. So 2% minus 1% which means the absolute risk reduction here is just one percent, which is a much smaller number, and it far more accurately predicts individual experiences. And so when you see these big percentages, we have to be asking, "Wait, is that relative risk reduction or is that absolute risk reduction?" Because it's a huge difference and it can be incredibly misleading. And like the reader shouldn't have to ask that. The reporter should be asking that. But either way, it's a question somebody needs to be asking.
Christy Harrison: And then there's relative risk reduction versus absolute risk reduction, and then relative risk versus absolute risk as well, which I think is another issue people get really confused about, because if 2% of people in a given group have a harmful outcome, and then there's an increase in risk or a decrease in risk, let's say theres a 50% decreased risk, 1% of the people who take the drug or whatever have the problem. I mean, I know, I have thought this too when it's like, you know, food X reduces your lifespan by X number of years or something, or increases your risk of heart disease by 50%, I think the reading in the general public is to think, oh my God, 50% of people who eat this food get heart disease, right? And that's just not the case. The percentage of risk, relative risk, versus the absolute percentage of people who are going to be at risk of something is incredibly different.
Ragen Chastain: And it's not just the general public. I was advocating for a patient who was denied surgery because his surgeon said that there is a 100% risk of complications at his BMI. And I was like, that is not my understanding. And so we talked about it, and it came out it was a 100% increase in complications. So instead of a 3% risk of complications, there was a 6% risk of complications. That's a 100% increase. Three to six. But what the surgeon understood was that 100% increase in risk meant 100% risk.
Christy Harrison: Oh my God. I mean, and this is a science. This is someone who's trained in research methods, right? Ostensibly.
Ragen Chastain: Yeah. This is someone who's denying healthcare to someone on the basis of their understanding of 100% increase in risk, meaning 100% risk. So it's not surprising that lay people are making this mistake and that these drug companies and pharmaceutical industry in general are taking advantage of that lack of understanding and exploiting it.
Christy Harrison: God, that is just so insidious. So let's circle back to weight cycling, because this is a longstanding thing. I feel like these drug companies are trying to weaponize, as you said, critiques of weight stigma and diet culture, and of the traditional weight paradigm, which have focused a lot on weight stigma and weight cycling, and how the traditional weight paradigm increases people's risks of those things, which in turn increases their risk of all kinds of harmful outcomes or of health problems that get blamed on weight itself.
And when it comes to weight cycling, there's a substantial amount of evidence showing that weight cycling is an independent risk factor for things like heart disease, diabetes, mortality, certain forms of cancer. There's at least two studies and very large cohorts of people that showed weight cycling could account for all of the excess mortality risk associated with being in a larger body, or at least cardiovascular mortality risk, I think. Weight cycling is a serious issue, and weight loss attempts make people vulnerable to it. And yet the makers of these new drugs are trying to harness that information and rebrand weight cycling to their advantage to sell their products. Can you talk a little bit about the sort of insidiousness of that and how people can see through language that is ostensibly geared towards reducing weight stigma or calling out the harms of weight cycling, but then trying to use it to sell these drugs?
Ragen Chastain: Yeah, so it is pretty insidious, and they're getting very good at it. And so I think in terms of when you're looking at something and even if you get a sense this doesn't sound right or could this be, if they're using this phrase that, quote, obesity is a chronic progressive relapsing remitting disease like asthma and heart disease. All of that is junk science, but it supports their paradigm. And so we're seeing that phrase more aggressively used and pushed into healthcare. So if they're using that phrase, that's a real good clue.
If they're saying that the real weight stigma is the lack of access to their drugs or that expanding access to weight loss interventions is how we fight weight stigma. If you're seeing phrases that seem like they would be in a weight neutral health or fat activism community, but then they're using terms like, quote unquote, overweight, or, quote unquote, obese, that is a really good clue that this is coming from the weight loss industry. If they're using person first language where they say a person with, quote, obesity or a person with, quote, overweight or a person affected by one of the O words, that is going to be drug company language, weight loss industry language, that's not language that's supported by a weight neutral health community or fat activism community.
And if they're claiming that lack of access to these weight loss drugs is some kind of social justice issue, and one of the ones that I personally think is the most insidious is that the lack of access to these drugs that black and brown people have is like the real racism in weight stigma, but they don't mention that they grossly underrepresented those communities in the drug trials that they put together and funded. So to now come back and say, "Oh, it's an injustice that these communities don't have access to these drugs," when they didn't include them in appropriate levels in their trials, it just repeats a history of performing experimental medicine on these populations. And so to call that social justice, I just can't even wrap my head around. You have to be on your guard all the time because they're getting really, really good at this.
Christy Harrison: Yeah. Kind of switching gears a little bit from the drug companies themselves. I've been seeing some interesting arguments about these drugs and wellness culture, like in integrative and functional medicine spaces, where some providers and influencers have been saying that the drug side effects are concerning and that people shouldnt take them for weight loss, especially kids. And that's good. I appreciate those critiques. But then in the next breath, they say that the real solution is to address the, quote unquote, root cause of the obesity crisis, which is presumed to be the toxic food environment, ultra processed food, sugar. Like, heavy air quotes around all of this stuff, right? And I'm curious to hear your thoughts on this kind of rhetoric.
Ragen Chastain: Yeah. So it's basically people that've been selling weight loss, but now the way that they were selling weight loss is at risk.
