What the Research on GLP-1’s for Weight LosS Actually SHows
Written by: Allyson Inez Ford, LPCC (inspired by an article and podcast by Ragen Chastain et. al.)
“Miracle drug?”
If you've been paying attention to health news over the last few years, you've probably been hit with a wave of headlines calling Ozempic, Wegovy, Tirzepatide and similar medications "miracle drugs." The coverage has been breathless, persistent and exhausting. According to a newly published peer-reviewed paper- the constant coverage of these drugs is shaped by the very companies manufacturing and profiting from these medications.
The paper, "GLP-1 Medications for Weight Loss: A Triumph of Marketing Over Patient Care," was co-authored by researcher and fat activist Ragen Chastain, Dr. Angela Meadows and clinical psychologist Louise Adams. In a recent conversation on the Body Trust Podcast, Chastain broke down the paper's core arguments in a way that's worth sitting with- especially for those of us doing clinical work in weight-inclusive, eating disorder or body image spaces. I hope this also finds medical doctors and anyone prescribing these drugs to folks for weight loss.
The Marketing Machine Behind the "Miracle Drug" Narrative
Chastain is direct about what she sees happening: Novo Nordisk has taken what the weight loss industry has long done to infiltrate and manipulate healthcare, layered in what she describes as Purdue Pharma's playbook for selling OxyContin and elevated it to a new level. If you remember how shady that was, then you know just how shady this has to be to be worse. Yikes.
She points out that as far back as 2015, Novo Nordisk's annual report included a section on essentially building the ‘obesity’ drug market from scratch- and that what we're watching now is that plan playing out exactly as written.
Part of what makes this so effective is the use of undisclosed financial conflicts of interest. Chastain has found author groups in published studies who have collectively taken more than $10 million from the company whose drug they're investigating. She's careful to note that this doesn't automatically mean bad research but that being so deeply invested in a framework makes unbiased analysis extremely difficult. And when you look at the methodology of many of these studies, she argues, it becomes clear that unbiased analysis wasn't really the goal.
One of the more striking tactics she describes is how Novo Nordisk simultaneously launched these drugs and a series of anti-weight stigma campaigns, co-opting decades of genuine weight stigma scholarship, including the foundational work of scholars like Sabrina Strings and Da'Shaun Harrison, to argue that the real problem with anti-fat bias is that fat people don't have enough access to their drug. I’m FUMING at this. The campaign is even called "It's Bigger Than Me." Are we freaking kidding?!?!
For obvious reasons, this is beyond infuriating, oppressive and just icky.
What the Trial Data Actually Shows
Chastain's paper includes supplementary tables for the Phase 3 clinical trials of semaglutide and tirzepatide. These tables let you see at a glance how many participants actually reached various weight loss benchmarks and how many didn't. This matters because trial results are almost always reported in ways that obscure enormous individual variation.
The longest trial we have for semaglutide as a weight loss drug ran four years. The abstract and conclusion claim weight loss was sustained over that period. But when you look at the actual data, average weight loss had dropped to around 10% from the 15% reported at approval and 89.5% of the original sample had left the study by the end of four years. That last number doesn't appear in the places where the study claims sustained results. Chastain says when she presents this data to rooms full of healthcare providers and pulls up that graph, there's an audible gasp. They had no idea.
There's also the question of dosing. Semaglutide was originally developed as a Type 2 diabetes drug, where the therapeutic starting dose is 0.5 milligrams. The weight loss dose is 2.4 milligrams, which is five times higher. When Chastain looks at secondary use studies claiming GLP-1s benefit everything from knee pain to kidney function to cardiovascular health, she's asking: what dose are they testing this at?
In almost all of these studies, it's the weight loss dose. And in almost all of them, buried somewhere in the methodology, there's an acknowledgment that the health benefit appeared before or without significant weight loss. This means it wasn't the body size change driving the outcome!!! My face is literally in my hand at this point.
Of course, that nuance rarely makes it into media coverage. The the level of deception has me wondering how these people sleep at night promoting such big claims with very limited discussion of the risks.
The Fen-Phen Comparison Nobody Wants to Talk About
One of the most sobering parts of this (that Ragen points out) involves the historical parallel to Fen-Phen. Fen-Phen was pulled from the market in large part because of adverse event data: deaths reported to the FDA. What Chastain points out is that both semaglutide and tirzepatide have individually had hundreds more deaths reported to the FDA's adverse event reporting system than Fen-Phen had before it was taken off the market. And yet there's no equivalent public outcry, no equivalent regulatory response. WTF is happening here?!
Regan’s explanation for this is important for clinicians to understand: the weight loss industry has spent decades building research that links higher body weight to health risks while carefully avoiding controlling for confounding variables like weight stigma, weight cycling and healthcare inequality.
The result is that the FDA's risk-benefit calculation for weight loss drugs now operates in a context where fat people's lives are implicitly considered more expendable. The tolerance for harm in the pursuit of thinness has been systematically increased over time.
Chastain names this plainly: the weight loss industry has increased our tolerance for killing fat people in efforts to make them thin.
Informed Consent as the Clinical Obligation
For clinicians, the through line in all of this comes back to what Chastain calls ethical informed consent. She describes speaking with doctors who have told her they don't want to share the full picture with patients because it would be "too discouraging" and patients "wouldn't try it." She responds to this the same way each time: that doesn't change your ethical obligations. In fact, a doctor withholding information because patients wouldn't comply if they had it is coercion. COERCION. Not ethical care.
She also describes patients being prescribed semaglutide after receiving BMI-based denials for other healthcare. Patients are told this is their best chance at getting the surgery or treatment they actually need- in cases where the drug had almost no statistical likelihood of producing the level of weight loss required. This is the context in which these conversations are happening in exam rooms right now and ones that the clients we serve as eating disorder providers are particularly vulnerable to.
The paper doesn't argue that GLP-1 medications have no place in care.
What it argues is that the evidence base has been systematically distorted by the companies that profit from these drugs, that adverse events are underreported and underdisclosed and that patients deserve honest information about what these medications are likely and unlikely to do- including the reality that weight regain after discontinuation is what the manufacturers' own withdrawal studies consistently show (and often the weight regain is higher than the original stating weight, much like the bell curve we see with dieting and weight cycling).
For those of us in therapeutic and dietetic spaces doing body image work, eating disorder recovery or weight-inclusive care in general, this paper is a resource worth having on hand. It doesn’t resolves the complex, individual conversations we're having with clients, but it does cut through the marketing noise with actual data. Clients navigating these decisions deserve that clarity and so do we.
The full article is available through Taylor & Francis, and Ragen Chastain's Weight and Healthcare newsletter on Substack is an ongoing resource for evidence-based analysis as this landscape continues to evolve. Thank you Ragen and all others pushing back against the GLP-1 hype.
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