We should be wary of campaigns by pharmaceutical companies to destigmatise obesity, say experts in The BMJ today.
Michael Viggars and colleagues argue that, while destigmatising obesity is the right thing to do, there is a risk that companies profiting from obesity treatment come to influence public conversation and national policy.
They point to Eli Lilly's UK "Obesity Is a Disease" campaign, which explains that obesity is a complex disease rather than a failure of willpower, that the body can resist weight loss, and that people who have struggled for years deserve compassion, not blame.
Adverts invite people to check their body mass index, answer a few questions, and prepare for a conversation with a doctor, nurse, or pharmacist. Although drugs are not mentioned, the campaign is by a pharmaceutical company whose drug tirzepatide is now a principal treatment for obesity.
Almost everything the campaign says about stigma is true, note the authors. The framing is at once scientifically defensible and commercially useful, and that convergence, they say, is exactly what makes it harder to criticise.
"This is what the commercial determinants of health look like in their subtlest form," they argue. "We spot commercial influence far less readily when it arrives wrapped in the language of compassion and destigmatisation that public health has spent years cultivating."
The risk is not mainly that more people will be prescribed weight loss drugs; for eligible patients that is a clear benefit, they write. The risk is that it endorses a clinical first approach to obesity that narrows the field of action.
If obesity is understood primarily as a disease awaiting clinical intervention, responsibility and resources may drift away from its upstream causes including poor urban planning, the food environment, deprivation, and marketing, they explain. "Obesity treatment and prevention may be quietly recast as only a personal, medical matter rather than a collective responsibility."
Addressing this requires us to balance two perspectives: that destigmatising obesity is the right thing to do and that we should be wary of the vested interest pharmaceutical companies have in tackling that stigma, they write.
"Regulators should be willing to test the principles and identify the limits of the code by reference to campaigns like this one by a manufacturer, not only in relation to the pharmacies, clinics or influencers selling or promoting the drugs," they conclude.
