This was not needed

Written by Dr. Kate McCann
20th September 2023

Let’s be very clear.  A documentary clearly explaining the health crisis that is obesity in factual terms, without weight shaming, that includes biology and treatment options is critically needed.  A documentary that clearly explains what these drugs are, how they work, who they are for is critically needed. Also, no matter how many times she says it, it’s not called a “skinny jab”.

However, Channel 4’s debacle last night was not that. And based on the reviews, few people have critically thought about how this sort of show does far more harm than any sort of “good.”

The documentary was like a follow-along of an over-privileged person’s “Dr. Google” latest search.

Here are 5 things that she touched on — but could have been deeply explored as a “journalist” and would have been worth her time – and the viewers’ time. Actually, a 5 part mini-series would be warranted to actually treat this topic with the seriousness and detail it deserved rather than the superficial wanderings of a petulant influencer who found out that the latest TikTok trend wasn’t for her.

1. Dodgy prescribing practices among aesthetic/cosmetic clinics who conflate weight with beauty.  Weight is not beauty, and this is a hill I will die on.  Even dodgier prescribing practices among online dial-a-docs.  GLP-1a medications (let’s use their proper name, not Tik-Tokker “skinny jabs”) are only one class of drug that can be misprescribed and misused.  There are plenty more. This deserved a far deeper dive into failure of regulatory statutes and patient protection.  Suggestions here would have been interviews with the GMC ethics committee or doctors who are expert in this field who competently and ethically prescribe.

2. It was a lost opportunity to talk about the problem of health care professionals who are not educated in obesity, and have either unconscious weight stigma or frankly weight shame their patients.  A GP on that programme last night said patients should be on the drug only long enough “to fix their habits.”  An nutritionist opining on potential unknown “longterm” risks (the nutritionist falsely cites these drugs are new despite being used in diabetes very safely for more than a decade)

3. There was a lost opportunity to talk in depth about the complex disease of obesity.  Obesity has been accepted as a disease for years, which is news to the journalist, but hardly to anyone else she interviewed.  Obesity causes include genetic causes as well as socio-economic factors.  The interview with the geneticist was interesting– but why not ask a geneticist about genes – instead of hormones?  Was the genetic part left on the editing room floor? Why not talk to a bariatric surgeon or a endocrinologist?   A disease that has reached epidemic proportions, affecting up to 60% of the population.

4. There was a lost opportunity to talk about the dangerous work blackmarket injection sales (which are never safe) but are not limited to people selling things pretending to be semaglutide.  They also sell dangerous injectable. products including long-acting naloxone or “melotan.”  Did anyone really need her to order these on line to prove that it was a bad idea?

5.  She gives air time to another woefully under-educated GP who laments “how much time these patients will take” to treat their obesity – but fails to challenge the GP to break down the health economics of how if doctors treat obesity — we are then not treating the complications of obesity that is crippling our healthcare system, including diabetes, subfertility, arthritis, asthma, high blood pressure, fatty liver disease, heart disease, stroke, and certain types of cancer.

I could not get past the embedded weight stigma of the programme.  This fixation on “how long a patient should take the drug.”  Has anyone ever asked a patient with diabetes how long they will take insulin?  Asked a person with asthma how long they will use an inhaler?  Asked a patient with high blood pressure or high cholesterol how long they should take their tablets?  Would you patient-blame if they didn’t do “enough” to treat their disease with lifestyle interventions alone?  But this programme made sure the viewer knew that obesity is not treated the same – but is too superficial to challenge this premise.

What she touches on – but fails to truly understand or capture – is the desperation of patients who are living with obesity that leaves them vulnerable to exploitation, not just from blackmarket drugs but from predatory medical tourism, such as gastric bypasses in Turkey, which have claimed multiple lives now. Neither incompetent over-prescribing nor restrictive prescribing practices by healthcare professionals who have weight bias or lack of education in this specialty addresses the problem: Patients deserve competent and compassionate multi-disciplinary care that includes not only medication, where appropriate, but also education, nutrition, psychology, physical activity guidance, and ongoing support for a complex, chronic, recurring, and progressive disease. 

In the end, she shows that she has learned only little more about obesity than when she was part of “shock treatment” to scare lifestyle changes into people with obesity on her “Superskinny vs. Supersize” series 15 years ago.   She fear-mongers the side effects of a potentially life-saving drug, that should only be prescribed competently and correctly, and gives airtime to weight bias.  This was not just a lost opportunity to advocate for patients who are on waiting lists for access to the drug in a global drug shortage while those who can purchase it mis-use it for aesthetics. It was a lost opportunity to inform patients living with obesity that these drugs, when prescribed correctly by physicians who are educated in obesity medicine, can help treat their chronic disease and prevent complications.  And they should not be hesitant or shamed to seek medical treatment for their disease.

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