Louise: welcome to the Exposing Obesity Incorporated podcast.
Ragen Chastain (she/her): This is episode six, The Ghoulish Game Changer.
Louise: I'm Louise Adams.
Ragen Chastain (she/her): And I'm Ragen Chastain.
Louise: And we are exposing the sordid underbelly of the weight loss industry, Obesity Incorporated.
Ragen Chastain (she/her): And we want to note that the term quote obesity is stigmatizing and our podcast is based on exposing the people making a fortune using it. So when we use it in the podcast, we'll use quotations or Louise's brilliant invention, oplesity, with our eye rolls always implied.
Louise: So before we get into everything, if you are enjoying our podcast and we are having an exceptionally good time being this angry, please take a moment and subscribe and don't miss episodes when they come out every two weeks and rate and review us. And don't forget that you can even watch us if you like and watch the eye rolls on YouTube, which is youtube.comslash at exposing obesity incorporated. And follow us on Insta, and we are up to like more than 500 people. I can't believe it. It's wonderful. Thank you. So at Exposing Obesity Incorporated on Insta. So let's dive right in. Over the last five episodes, we have been combing through Novo Nordisk's playbook step by step. We've seen how they worked to establish oplesity as a chronic disease, reshaped medical education, influenced. Clinical guidelines, built patient advocacy organizations, and of course created, multitudes of ca-chinged collaborations of shopfront organizations and successfully lobbied regulators and governments to pay for treatments. So we're gonna have a bit of a pause point today and just sort of look at a really obvious question: what are they actually selling? And were these GLP one drugs, the revolutionary breakthrough all of this marketing has heavily suggested? So I can't wait to get into this one with you, Ragen.
Ragen Chastain (she/her): All right, let's go. So you may have noticed that Novo funded doctors and researchers have been shoving the word game changer into every conversation, interview, and media appearance they possibly can. So yeah, we're gonna look at like, is this game changer status warranted? Or is this just another one in the weight loss industry's long line of loser drugs?
Louise: gosh, this game changing thing. If I hear it one more time, I think my eyes will
Ragen Chastain (she/her): I know.
Louise: actually fall out from the rolling.
Ragen Chastain (she/her): Agreed. So when it comes to Ozempic and Mounjaro and their weight loss megadose brethren, Wegovy and Zepbound, I often say that these are type two diabetes drugs with a side effect of weight loss. And that's true. What's also true is that even though Novo Nordisk and Eli Lilly bided their time before marketing these as weight loss drugs, they were well aware of the weight loss side effect. And they were seeding the ground for a new cash crop long before they ever tested or marketed them as weight loss drugs. And so this brings us to Lotte BjerreKnudsen, shout out to pronounce names dot com. She was Novo
Louise: Hello. Well done.
Ragen Chastain (she/her): Nord, yeah, I know. I practiced for y'all. she was Novo Nordisk's chief scientific officer in 1994. And you have to imagine her with her red pigtails and her face all excited and flushed, bursting into Mads Krogsgaard's office. He at the time was Novo's head of research. And Lotte at this point is beside herself, absolutely gushing about a study of GLP1, which was then being tested as a type 2 diabetes drug. But Lotte was not excited about the potential for diabetes use. She was thrilled to report that in a rodent study, Rats who were exposed to high levels of GLP ones stopped eating and drinking and literally starved themselves to death. Yeah. So
Louise: Yay. Yay. So exciting.
Ragen Chastain (she/her): Lotte and Mads over the moon. And As Louise once said about this, never have two people been so ecstatic about dead rats. because to them, those dead rats were the same as dollar signs. And so when she filed the patent for the molecule that would become liraglutide, which was the early GLP one, it included a marketing plan for type 2 diabetes, but also a marketing plan for weight loss. But
Louise: So true. And we don't hear this, do we? We don't hear that this was like from the start. They were all
Ragen Chastain (she/her): No.
Louise: about the weight loss. Yeah.
Ragen Chastain (she/her): Yeah, so Novo released Liraglutide under the brand name Victoza for type 2 diabetes and then acted like they they learned that wow, patients typically lost weight. In this case, about five pounds a year. this is an amount of weight loss that I could lose while recording this podcast today with a haircut
Louise: Uh-huh.
Ragen Chastain (she/her): and a loofah. But the weight loss industry's work over decades to lower the bar of what was considered clinically significant weight loss. Was starting to pay off what would become just absolutely massive dividends here. And so even though it was five pounds a year, Victoza began to be prescribed off label for weight loss. It is very unclear if patients were told that for the side effects, which ranged from unpleasant to very serious, that they could expect to lose five pounds.
Louise: Hm. Well, you know, that's clinically meaningful, Ragen.
Ragen Chastain (she/her): Yeah, absolutely. Good lord. So here's where we see the beginning of a cycle that will soon become very familiar. The pharma companies release a GLP1 for type 2 diabetes. They wait for a small weight loss effect to be shown. And then they run trials on a megadose for weight loss, often with special treatment from the government here in the US. And we'll talk more about that. And so through this process, the 1.2 milligram to 1.8 milligram dose that was Victoza became Saxenda, a three milligram dose of the same drug, but now approved for weight loss alone. And this is despite the fact that a third of the people in the trials failed to lose even 5% of their body weight. This was the game changer drug whose profits Novo Nordisk built that 10-year plan on that we've been talking about for the last Episodes, right? This is the drug they were trying to maximize. But Lotte was still hard at work because Liraglutide required daily injections. And this was a problem people didn't want to inject the drug daily. They felt like it was harming uptake and therefore profit, and they won't stand for that for very long. And so she was working to figure out how she could create a more profitable drug that only required weekly injections. And here we have semaglutide. This was a drug, injected weekly. It showed improved blood sugar and modest weight loss. Now, while Lotte was hard at work on the science, Lars had been hard at work on the shareholders. And Louise is the expert here. Can you tell us a little bit more about the promises that LarsJorgensen was making to the shareholders around Semaglutide?
Louise: Lars was well, the shareholders were pretty unhappy, around when this was coming. Saxenda had been released. It was doing okay, but it wasn't terrific. And Lars just kept dropping these little Easter eggs to the shareholders, promising big things for this new component, And in his shareholder meetings, he was unnervingly accurate. About the kinds of average weight losses people were experiencing on these clinical trials. he told them more than once that on average it was like 15% weight loss But they didn't quite know this right up until the end. And then very bizarrely, when the clinical trials actually occurred, it did show an average fifteen percent. I mean, it's just like
Ragen Chastain (she/her): What do you know?
Louise: he's an uncanny fortune teller, don't you think?
Ragen Chastain (she/her): All right, Creskin, come through.
Louise: Because of course the clinical trials were supposed to be blinded from the executive teams. and this was not supposed to happen. But of course it just was a complete coincidence, and this really got everyone excited because Novo were under pretty big political pressure, especially because they'd been price gouging their insulin for so many years. There was a lot of scrutiny coming. From even like places like Donald Trump and Bernie Sanders were really asking why insulin was costing 10 times more in the United States than it did anywhere across the world. just really a lot of pressure there. At the same time, Novo were settling this massive lawsuit, so 60 million US dollars, for basically marketing Victoza, the Liraglutide. in very, very dodgy ways. essentially trying to downplay the risk of thyroid cancer and training their sales teams as diabetes educators that ended up really being people going into medical practices and just selling Victoza, often pushing it off label as a weight loss drug, like you were talking about, Ragen. and also just pushing for quicker and more intensive diabetes treatments. So they were in really big trouble at this point. They did need a game changer because let's never forget that this is a giant game. This is not about health and wellness. This is about profit and protecting the bottom line of this giant Danish company.
Ragen Chastain (she/her): Yeah. Someday, in the not too distant future, we will do an episode about all of Novo's ethical misdeeds, but I think we're gonna push we're trying to be short form, thirty to forty-five minutes, and I'm I
Louise: Exactly.
Ragen Chastain (she/her): think that this may be a two or three or six parter. It's a lot.
Louise: Yeah. Yeah.
Ragen Chastain (she/her): at any rate, so semaglutide came out for type two diabetes, Ozempic, Novo rushed a study of a megadose for weight loss, and they cashed in on an FDA priority voucher for this. And now these are vouchers that are supposed to be reserved for drugs that meet urgent needs. And, you know, here we have nobody I know
Louise: Sorry. This is like it was designed for AIDS, right? It was like people are dying. Let and
Ragen Chastain (she/her): Yeah. Yes.
Louise: and COVID and things like this is like urgent and they managed to pay for this, you know, when you go to Disneyland and like people pay more and get in the fast lane. That's what they
Ragen Chastain (she/her): Exactly.
Louise: did. And just just to see the difference, but liraglutide, the Saxenda, that took nine months to get through the FDA. And then this one, their game changer one just gonna come along and save them all from going bankrupt. It was very quick.
Ragen Chastain (she/her): Yeah. Yeah, because they are using this voucher. It's so ridiculous. At any rate, so Urgent, right? So
Louise: Urgent.
Ragen Chastain (she/her): wegovy is semaglutide for weight loss Five times the minimum effective dose for type two diabetes. And what do you know? Lars must be prescient because the average weight loss was in fact almost 15% of body weight. And immediately there are press releases, company announcements, paid off researchers and doctors in the media touting the drug as a blockbuster, a game changer, a miracle. A miracle.
Louise: Yeah, it was like Christmas had come, Oplesity Incorporated was visibly gushing and often teary when they talk about this.
Ragen Chastain (she/her): Yes. Yeah. Yeah. Those the tearful interviews that they just it's such a miracle. It's such a game changer. So this all goes back to what I mentioned earlier, which is the weight loss industry's decades-long campaign to chip away what was considered a clinically significant amount of weight loss. we talked about this in an earlier episode, so I won't dig deeply into it today, but I do want to go over it because it's so important. It's important mostly to understand that the term Clinically significant keeps getting attached to this without any clinical research whatsoever to back it up. clinically significant weight loss was an amount of weight loss that was based not on any proof that the weight loss created health changes, but based on the amount of weight loss that it the weight loss industry's interventions could create. So originally with the Metropolitan Height Weight Tables, the claim would be that a 300-pound person. Would have to lose at least 150 pounds to have clinically meaningful weight loss. But they couldn't get people to lose anywhere near that amount of weight. So the weight loss industry lobbied and marketed until the same patient would have to lose a minimum of 57.6 pounds or 20% of their body weight. But they couldn't get people to lose anywhere near that amount of weight, even short term. So they marketed and they lobbied down to 30 pounds. And then just down to fifteen pounds for a three hundred pound person. So now with an average weight loss of forty five pounds, which is less than a third of the original required weight loss, this is now a game changing block blockbuster. You know, sorry.
Louise: It it is game changing because it's actually not five percent, which is what they've all struggled to do for like the entire history of weight loss drugs. So it is a game changer in that it actually kind of works. But it's like you said, it is arbitrary and so common to see, weight loss is equivalent to health gain, but that is not proven at all, right?
Ragen Chastain (she/her): Exactly. Yeah, and this is what the whole thing spins on is that marketing claim that if people lose weight, they will have health changes. And that ignores research that shows that when they actually test for that, they find that it's not the weight loss, but much more likely the behavior changes that actually create the health changes. And it ignores research that finds that when weight is changed alone, for example, through large volume abdominal liposuction, There are no health changes that come along with that, even though people are losing large amounts of fat, right? So this is all again, and we've gone we've talked about this in previous episodes, but this is that work that they have done to lower the bar for what's considered clinically meaningful weight loss until it's so low that you can trip and fall over it. And now that bet that Lars had told shareholders that they were gonna make on oplesity, this is all paying off now with their game-changing blockbuster miracle drug. So as Semaglutide came on the scene, Novo's marketing was both relentless and ethically extremely questionable at best. even before Wegovy was approved, you could not escape those Ozempic commercials. And those even touted weight loss and implored people to proactively ask their doctors about it. Robert Kushner, who's a Novo funded researcher, appeared on the Dr. Oz show. but Robert Kushner, I guess he forgot to disclose his conflicts of interest with the drugs manufacturer, and Dr. Oz maybe forgot to ask. And this is a lack
Louise: Yeah.
Ragen Chastain (she/her): of ethics. Pretty par for the course for Dr. Oz, who had famously been scolded by the US Congress for calling so-called treatments like green coffee bean extract weight loss. Miracles in a bottle.
Louise: Yeah, God. Dr. Oz.
Ragen Chastain (she/her): When in fact Dr. Oz, So when the attempt for Congress to sanction him failed, the AMA Journal of Ethics actually wrote about it as an indictment of self regulation in medical ethics.
Louise: Ooh.
Ragen Chastain (she/her): So that's not who you wanna be is the guy they wrote that about. But
Louise: gosh.
Ragen Chastain (she/her): so now, he was on TV with Robert Kushner bringing Novo Nordisk's marketing messages to the masses.
Louise: This is yeah,
Ragen Chastain (she/her): And
Louise: we don't we don't have direct advertising here in Australia, but that Oh-Oh-Zempic song jingle thing, I think that that did a lot I mean it was kind of genius, like magic, right? This whole
Ragen Chastain (she/her): Mm-hmm.
Louise: idea that taking a weight loss well, th they they're still not technically allowed to market, but there's, you know, heavy implications like you said. But that Dr Oz thing it looks like medical TV daytime show. It is a infommercial for this game changer, which had not, been approved at that point by the FDA as a weight loss drug. They were just on it, gushing embarrassingly, two, really over excited people about this. And the marketing, it was all the marketing messages. I've watched this. It's just one talking point after another, there's no downside. Everyone's gonna look this is fantastic. Like we can't wait. my goodness.
Ragen Chastain (she/her): Yeah, yeah. It was I mean, it's what you expect from Dr. Oz if you know what to expect from Dr. Oz from somebody who was almost sanctioned by Congress for and you know, when the US Congress says that you're a a charlatan and a con artist, like that's that's
Louise: I think.
Ragen Chastain (she/her): really saying something. Like that rises to a certain level. So it was not just on T V. The New York Times published a piece by Gina Kolata. And people may know Gina Kolata is someone who's been sort of on the outskirts of weight inclusive paradigm work, but like always sort of a paradigm straddler. And now a fence hitter, yeah.
Louise: Yeah, we call it like a fence sitter. Like you've got the fence pole up your butt quite a bit and it starts splintering. It's it's not a good look. But I I think we know which side of the fence she's on now.
Ragen Chastain (she/her): Yeah, so she just like fell or jumped all the way onto one side of the fence and she published a piece in the New York Times that essentially lobbied for insurance coverage of weight loss drugs. And as you'll recall, after the Fen Phen tragedy, in the United States, Medicare put a moratorium on paying for weight loss drugs. And so Medicare coverage has become really the holy grail for weight loss companies. Because not only is it a huge population in the US, but also once Medicare covers something, it creates tremendous pressure for private insurers to cover that drug as well.
Louise: legitimizer for the weight loss industry. It's like putting like a hair cream on Medicare for
Ragen Chastain (she/her): Yeah.
Louise: like bald men to like regrow hair. It's like, ooh, medicine.
Ragen Chastain (she/her): Exactly. Exactly. So New York Times publishes this piece, Lobbying for Insurance Coverage of Weight Loss Drugs. It quotes a number of experts. Every single expert quoted had taken money from Novo Nordisk andor Eli Lilly. And none of those experts, nor Gina herself, had disclosed that.
Louise: See that to too much in the media. it's bad
Ragen Chastain (she/her): Yeah.
Louise: enough that half the time they don't disclose in academic journals, but this issue of the media never, or literally almost never. it's not okay, especially in this echo chamber of magic game changing, weight loss drugs, it's terrible.
Ragen Chastain (she/her): Yeah, and it's not journalism. Famously they say if somebody tells you, it's raining outside and someone else tells you it's not your job isn't to publish both, it's to go outside and see what the weather is like.
Louise: Such a good that's a great way 'cause we do hear the both sides thing, but yeah, it's like, is it actually raining? And who's telling
Ragen Chastain (she/her): That's yeah. Yes.
Louise: you and why?
Ragen Chastain (she/her): I cannot stress enough how much this is not journalism. But This has gotta be my favorite one. And by favorite I mean the most cringe worthy thing perhaps I've ever seen. Novo yeah, I know. Are you ready, Louise? Because it's it's special.
Louise: Wow, okay. I'm I'm bracing.
Ragen Chastain (she/her): Novo put together a PSA video. And they put their talking points into the mouths not of doctors, but of actors who play doctors on television.
Louise: what?
Ragen Chastain (she/her): Literally like people from medical dramas saying very earnestly to the camera, Oplesity is a chronic disease, but it can be managed.
Louise: my what? That's so wild. That's hilarious.
Ragen Chastain (she/her): I was like, am I hallucinating? Is this a fever dream? Surely, but no, it is real. It is real and it is horrific. Like, let's have McDreamy tell us all about science. They're paid actors.
Louise: mean it's kind of apt, isn't it? this is all an act, really.
Ragen Chastain (she/her): Yes, yes. I mean it I can't decide if it's the most sneaky or the most honest thing they've ever done, honestly, but it was just unhinged.
Louise: Yeah. Wow. That's that's got a win. I mean, it's hard. It's hard to pick a winner of most egregious display of naked of disguised advertising in the magic hype But I've just recalled, that Dr. Oz thing, there was a massive bump in Google searches for this drug just after that went to air. Like it's one of the most successful. daytime infomercials it did so much for the interest and hype before the FDA approval happened. So you know, we talked about stealth marketing with the health professionals. moving into TV and celebrities and just publicizing. this stuff is we've never seen anything like this before. And we're only able to cover a tiny, tiny sample today.
Ragen Chastain (she/her): Yeah. And I mean, we have to remember that Dr. Oz was brought to us by Oprah. And so that Oprah effect where when she talks about something, it goes like wildfire, sort of is transferred on to Dr. Oz. And
Louise: Yeah.
Ragen Chastain (she/her): even though he had been touting ridiculous coffee bean extract as a miracle weight loss drug, people still trusted him and Dr. Kushner that this was this was the real miracle now. Right? The real game changer, the real blockbuster. Yeah. Yes.
Louise: Yeah, wow. Kushner from the OMEC, right? The yes. He's a man of many talents.
Ragen Chastain (she/her): He comes up a lot. Novo at this time was also working a separate part of this plan. And Louise talked, in fact, last episode about how they had for a long time these AstroTurf organizations that claim to be patient advocacy groups, but in fact are funded by and acting as a lobbying arm for these weight loss organizations, were tacking on little phrases like And we confront weight stigma and bias, right?
Louise: yeah, PS. Yeah, no bias.
Ragen Chastain (she/her): So just as Novo decided to take weight loss drug marketing to a whole new level, they also wanted to up their game in terms of co-opting decades of actual anti-weight stigma work by fat positive fat people, many of them fat black women of color, to become a tool to transform weight stigma into a tool to sell their weight loss drugs.
Louise: Yeah. This makes me cringe.
Ragen Chastain (she/her): It's so gross. They're trying to manipulate it in the general public. And so what they did was simultaneous to their launch of Wegovy, they launched a campaign called It's Bigger Than Me. Get it?
Louise: Sorry.
Ragen Chastain (she/her): Because fat people are big. Yeah, they're so smart.
Louise: Mm, it's really punny.
Ragen Chastain (she/her): So we've talked about this in previous episodes. I think if your program sounds like it was named by a sixth grade bully, you probably aren't the person to be talking about this. But here we are. And Novo's idea of solving weight stigma was convincing site visitors to sign petitions to demand insurance coverage for Novo's drugs. That was the goal of the It's Bigger Than Me campaign. Yes. Yes.
Louise: All roads lead to Rome. You know. Let's get everyone, even the people we want to sell our drugs to to lobby. So we can get
Ragen Chastain (she/her): Yes.
Louise: yeah, it's such a horrific injustice. okay.
Ragen Chastain (she/her): Yeah, and that's the piece of it, right? These are fat people whose lives are being incredibly affected and even ruined by weight stigma, who have been taught and accepted that their body is wrong and bad and their only path to health or a better life is to change that body through weight loss. And now they're being told there's this miracle game-changing drug, but the government won't let you have it. So you have to go.
Louise: Big nasty government, yes. Yeah.
Ragen Chastain (she/her): Yeah, and you have to petition. and everybody's gotta become a lobbyist for us. So that was their general public manipulation. Novo also was working to manipulate healthcare providers, and we have really dug into this in past episodes as well. their big launch here was the rethink oplesity, which they claimed was an educational hub for
Louise: Mm.
Ragen Chastain (she/her): health professionals. And it was in fact a hub of Novo's key marketing messages. But they got 5,000 healthcare providers to join what they called a training. And what that training did was just to turn Novo's marketing messages into so-called medical education, which is as we talked about, what they've been doing throughout. And so this was their next big play So all of this marketing generated a feeling that these drugs were somehow different than other weight loss drugs and weight loss methods, but that is just not true. Here's the deal. Intentional weight loss is about giving your body less food than it needs to survive in the hopes that it will consume itself and become smaller. There are many problems with this. First of all, that the body has a bunch of ways that it reacts to starvation that turn it into essentially a weight gaining, weight maintaining machine. And one of those is to change the balance of hormones to help people be hungry all the time so that in the famine and whatever else they're dealing with that's causing them to not have enough food, they don't forget to eat if the opportunity should arise. And
Louise: Mm-hmm. It's it's not pathological, right? yeah, if we're not getting enough to eat and our bodies and fat cells are shrinking, there's just defensive mechanisms against that to make us more interested in food and hungrier. And then our bodies are great at defending the range they feel comfortable in. And sometimes, well, a lot of the time that doesn't agree with what we think our bodies should be weighing and what definitely diet culture tells us what we should weigh.
Ragen Chastain (she/her): Exactly, exactly. And so, you don't give your body food and your body's like, I'm sending the food signal, but you're not giving me food. There must not be food available. Our bodies don't have any sense that we live in a world where this sounds like a good idea to not feed them when they need food and hope they'll consume themselves and become smaller. So all these drugs do is make people able to tolerate that undernourishment for longer, at least in the short term. Because what they do is they manipulate hunger, both mechanically and neurologically. So mechanically, these drugs slow digestion. And the GIP agonists like tirzepatide also reduce stomach acid. And so basically, the food that you have is just in your stomach longer. and this makes you feel less hungry, right? Because you've got food that's very slowly digesting and not moving through the body. It also creates side effects like nausea and vomiting and eventually diarrhea, things that, Don't typically lend themselves to good nourishment or wanting to eat. So that's the mechanical piece. Now, neurologically, these drugs, it turns out, cross the blood-brain barrier, and that was not known at first. Originally, the idea was that these would act on the GLP1 centers in the gut, and those are fairly quick acting. But in the brain, these receptors last much longer. And so it turns out that these drugs. Cross the blood brain barrier and they interrupt the body's natural hunger signals. And it cannot be stated enough. These are survival signals that we're messing with. And the duration is not known, the complete mechanism of action is not known. And the way that this acts on other survival signals is also not known. So anecdotally, I'm hearing often from doctors that they have to tell their patients to set timers to drink because their patients
Louise: Mm.
Ragen Chastain (she/her): lose interest in drinking, don't get thirst signals from their body and then become quite dehydrated and that's secondary to perhaps nausea, diarrhea and vomiting that they're experiencing.
Louise: Yeah, yeah. This is the GLP one effect. I think so far in our podcast we've talked the history of weight loss drugs being mainly impacting the cardiovascular system or serotonin receptors. Here we're talking about an action on our digestive system, which is in a way a game changer, because turning off our appetite signals has been devilishly difficult for the weight loss industry to discover. but it is really a significant impact across lots of systems in the body. And this brain thing is kind of important. I think GLP one receptors turning down our general interest is being increasingly recognized as related to reward. So there's a flattening in reward from eating as well. And I'm a clinical psychologist, I'm seeing a lot of clients who are Noticing a flattening in general reward, and that's definitely impacting on things like mood and the ability to feel pleasure, even sometimes generalizing down to losing interest in sex and and all kinds of things. So this is a really big deal. sometimes I think with all of this medical discourse, this idea that oplesity is a disease, and taking these drugs is going to cure the disease. We kind of forget that the mechanism of action is actually harming or getting in the way of a really normal functioning gut and digestive system. So we're introducing very problematic things and calling that a cure. And I just think we're in a pretty dicey situation in terms of the long-term impacts because no understanding the mechanism of action in the brain is You know it's unsettling.
Ragen Chastain (she/her): Yeah, yeah. And all of this and weight loss industry in general is based on the idea that whatever a fat person is eating, it's too much. And that's certainly not a scientific finding. We know that there are people of all sizes dealing with eating disorders and disordered eating and food insecurity. And so the idea that we can just stop fat people from eating and that's a good and healthy thing is wildly unscientific and in fact dangerous. And so we are both weight inclusive. Neither of us endorse weight, body size manipulation as a path to health. But what I want to talk about now for a bit is actually what the trials showed in sharp contrast to this game changer status. So the drug companies, yeah, good times. Let's geek out. so the clinical
Louise: I can't wait. Okay, let's dig in.
Ragen Chastain (she/her): trials tell, again, a very different story from the marketing messages. The drug companies Were reporting averages, but typically half the people in the study did not reach those averages. So that 15%, for example, and up to 32% of people fail to lose even 5% of body weight. Weight loss generally slows and levels off after about a year. So the idea that, you can just lose as much weight as you want by continuing to take them is misinformation. and in follow-up beyond a year, we see increases in weight. withdrawal studies found that those who go off the drug regain the weight rapidly And the drug manufacturers actually rushed to get this information out to the public, which to the casual observer might seem odd, since typically companies that put out diet drugs would rather chug sewage than admit how much weight is regained when people go off the drugs. But this is where Novo had an ace up their sleeve because they started pushing the definition of oplesity as not just a disease, but a chronic lifelong disease. And so these withdrawal trials showing rapid weight regain, they use those as proof. That people needed to stay on the drugs for life.
Louise: ca-ching. The holy grail.
Ragen Chastain (she/her): Ca-ching.
Louise: An expensive drug that needs to be taken forever. Is that's what it's
Ragen Chastain (she/her): Forever. Yes.
Louise: all about in the wonderful world of pharma. That's fantastic.
Ragen Chastain (she/her): Exactly. And they even told people it's just like asthma or type two diabetes. And the fact that just existing in a higher weight body is actually
Louise: Mm.
Ragen Chastain (she/her): absolutely nothing like asthma or type two diabetes did not matter because the researchers and the doctors on Novo's payroll were spreading this new definition like wildfire. And we'll get more into that into future episodes. and so, you know, they're spreading this new definition pretty soon everyone from doctors to reporters to randos on TikTok are explaining that you just have to stay on these drugs for life to maintain weight loss because oplesity is a chronic lifelong disease. Yeah. So this idea wildly profitable for Novo, but Problematically, existing in a higher weight body does not in any way qualify as a disease. Moreover, there was and is no research to show that people who stay on the drug will actually maintain weight loss even if people could stay on the drugs for life, and there is no reason to believe that they can and lots of reasons within the research to believe that they can't. And I wanna clarify as always, there is no shame in having a disease of any kind. The problem here is that simply existing in a higher weight body doesn't qualify. And the weight loss industry, now led by Novo Nordisk, is manipulating the idea of a disease for money at the risk and harm of fat people. So these drugs come with a long list of physical and psychological side effects. The common side effects nausea, diarrhea, vomiting, constipation, dizziness, abdominal pain, dyspepsia, gastric reflux. Severe side effects include things like acute pancreatitis and gallbladder disease and kidney injury, diabetic retinopathy complications, suicidal ideation and behaviors, and ileus, which is a complete paralysis of the intestinal tract. Now, these are not just serious, but some of these side effects can be fatal.
Louise: Gosh.
Ragen Chastain (she/her): And people have died.
Louise: Yeah. And we're gonna talk about that in more detail in later episodes
Ragen Chastain (she/her): Yeah.
Louise: about the less talked about risks. But they do make sense, you know, given where
Ragen Chastain (she/her): Yeah. Yeah.
Louise: these drugs are having their action.
Ragen Chastain (she/her): Exactly. Exactly. So the drugs also carry the FDA's strongest warning for thyroid cancer risk. And we talked about before with Belviq, where there was a risk of of cancer, but they let the drug on the market anyway and then they had to pull the drug because it turned out that risk was real. And so this may be another repetition of that.
Louise: I have an update on that.
Ragen Chastain (she/her): yes.
Louise: yeah, you remember in the last episode we talked about how there was a thyroid surveillance register that the FDA said Novo needed to do in order to track what happens after they
Ragen Chastain (she/her): Right.
Louise: approved saxenda. so I looked at that surveillance register and this is where different companies added to it as more GLP1 medications make it onto the market. And since it was invented, there has not been a single update provided. so Saxenda was approved in 2014. I think Victoza was years before that. We don't have any of that post-marketing surveillance data that they're supposed to be collecting on thyroid. So I'm going to continue digging into that and perhaps give everyone an update in our episode on side effects and risks, but just wanted to raise a bit of a suspicion that there's not a lot of movement at the station on what's actually going on here. it makes you wonder just how much surveillance is really happening, especially if it's up to the companies who are selling the drugs.
Ragen Chastain (she/her): Right. Absolutely. Thank you. I can't wait to hear the update. I mean, this is terrible, but also I want to know. So thank you for your due diligence there.
Louise: huh.
Ragen Chastain (she/her): All right. So let's talk about these drugs. The longest study we have on these drugs that we claim that if people stay on them for life, they'll maintain weight loss is a four-year trial of semaglutide. Now, if you read this, the abstract, the results, and the conclusion all claim that weight was maintained over four years.
Louise: Mm.
Ragen Chastain (she/her): But they started with 8,803 people, and at four years they ended with 921. Meaning that yeah, yeah. So I did the math for you. In four years they lost
Louise: Huh? What?
Ragen Chastain (she/her): eighty nine point five percent of the sample. That inconvenient truth did not make it into the abstract results or conclusions. And I think about like a sixth grader who's like
Louise: my god.
Ragen Chastain (she/her): For my science fair project, I want to see if fruit flies prefer apples or bananas, but they accidentally let out 89.5% of the fruit flies and then move forward like that never happened and just like do their abstract and their conclusions. That kid's not gonna win the sixth grade science fair. That kid's gonna get a discussion about the basics of good science from a middle school science teacher. Or apparently he's immediately hireable as a researcher for Novo nordisk.
Louise: Yeah. I'm laughing 'cause it's just appalling that so we've lost everyone except eleven percent of the sample and that's where the weight loss has been preserved.
Ragen Chastain (she/her): Exactly. And it gets better slash worse. So
Louise: Mm-hmm.
Ragen Chastain (she/her): beyond the massive trial attrition, weight loss at two years was down to ten percent from the 15 in the original trial. And so here we c
Louise: that sounds like regain.
Ragen Chastain (she/her): right, here we go again, showing that the weight loss industry just moves the goalpost and declares victory, even though here there were very few players even left on the field.
Louise: So how are they defining weight loss maintenance?
Ragen Chastain (she/her): They just said weight was maintained over four years. So this was the SELECT trial, which was the cardiovascular trial, which was separate from the weight loss trials. So they
Louise: Mm-hmm. Mm-hmm.
Ragen Chastain (she/her): reanalyzed the select trial for weight loss and found this 10% weight loss. And instead of saying, huh, this is five percent less than what was shown in the trials, they just said, good news, weight was maintained. Now importantly, you'll note that I said
Louise: Hmm.
Ragen Chastain (she/her): that weight loss was down to 10% at two years. they didn't do full calculations of anything at four years because again they had so few people left in the trial.
Louise: Yeah. science. Science is just science
Ragen Chastain (she/her): Science. Boom. Science.
Louise: is crying in the corner and millions of dollars. Yeah.
Ragen Chastain (she/her): I curled up fetal sucking its thumb.
Louise: Yeah, rocking.
Ragen Chastain (she/her): But the money was absolutely rolling in. And one of the ways Novo spent it was on lavish secret multi-day parties. And this was things like renting out an entire amusement park for 10,000 plus employees, music by huge stars, and
Louise: Did they pay for the fast track for all the rides? I'm sure they did.
Ragen Chastain (she/her): I'm sure they did. Special. Special quality.
Louise: Everyone's on the fast one.
Ragen Chastain (she/her): Yes, it's very important that everybody be on the fast track. They had in these parties one unusual rule. Now Danish culture, where Novo Nordisk is headquartered, looks down on just naked displays of wealth. So
Louise: Oops.
Ragen Chastain (she/her): Novo needed to keep their nudity hidden from the general public.
Louise: Yeah.
Ragen Chastain (she/her): And attendees were not allowed to post about the event on social media, and Novo eschewed the media attention that they normally craved and desperately, desperately sought.
Louise: Cheeky. So we're having this like a massive multi-day party, but just you're not allowed to tell anyone that this is because yeah. All right. Okay.
Ragen Chastain (she/her): Right. Yes, yes. So the money.
Louise: They have a strong grip on their narrative, don't they? That's something I've absolutely like you you
Ragen Chastain (she/her): Yes.
Louise: rarely see anything that they don't want you to see without quite a lot of determined burrowing. Well done, to find that. That's great.
Ragen Chastain (she/her): Yes. Both of us have noticed that yeah, it's they don't have seem to have a strong grip on science or ethics, but when it comes to marketing and narrative, they are on top of that.
Louise: On point. Mm.
Ragen Chastain (she/her): So the money train though was being derailed. They were immediately plagued with shortages and the ethics in the factories were not much better than the ethics in the research. And I think Lou, you're gonna tell us a little bit about that.
Louise: my gosh. Yeah. So they did this massive splashy launch, first the underhanded stuff and then once it actually got approved, there was a lot of game changing emotional crying and, you know, all of the Mass publicity. So it was next level it was released in the US first because that's their biggest market where they can charge the most. And this is a hideously expensive drug. So the demand for this drug was enormous. And in spite of all of the marketing, which we've realized is a real positive for them, actually being able to cough up the goods seems to be quite difficult. So they said that they didn't expect to have such demand, which is quite weird. Turns out they only had one factory that was producing this drug. And the supply chain completely imploded at the end of 2021 because their factory in Belgium got shut down because of dodgy manufacturing practices. And this fill plant had. Problems going back years and years, they've been pinged again and again and again by regulators for just not, being great in their practices. So they decided that they would use the tons of money that they were making to develop what they called in-house manufacturing. So Novo were very secretive about their production and how they make this drug and just protecting it like it's Gollum's precious jewel. They don't want anyone to know what they're doing. So they decided to use some of the bazillions of dollars that they were making To develop in-house manufacturing factories and in that case, own the entire means of production, pocketing even more money. And they kept telling the public, look, we're gonna be operational by 2023, everything's gonna be fine. They even snapped up an old Purdue pharma factory, which is sort of poetic.
Ragen Chastain (she/her): you love to see it.
Louise: I know. and the American market. So how did they service all of these Wegovy customers? by basically redirecting their diabetes drug supplies into the more lucrative higher dose semaglutides. So during this period, so here in Australia, we had Ozempic approved for type two diabetes. Wegovy was not approved. We had the same kind of issue with massive off-label Gushing about it. So people getting wind of it and getting it off-label. and here in the Australian media, they actually blamed TikTokers for creating off-label demand rather than pinging Novo for just having one factory that was shut down because of being dodgy. It's just wild. But so we in Australia started to notice massive shortages of Ozempic. It was put on the shortage list. And about 125,000 Australians who had type 2 diabetes, who, you know, this is a second line diabetes drug. So if you're on a GLP1, it's usually because the first line of treatment medicines haven't been able to stabilize your blood sugar. So you go on a GLP one as a second line, and it is a really good diabetes drug. So all of these people who were taking Ozempic for their diabetes suddenly were having massive problems getting it. And meanwhile, in the lucrative American market where Wegovy was being sold, they were bragging in the media about being able to continue to quote service their brand new patients. All 125,000 of them. So It's the same chemical, and I was looking at these two figures, just smelling a rat. It's just not okay. And we see this kind of practice like taking from different markets, selling to the American markets, propping it all up at all costs, keeping this game-changing drug going. And meanwhile, people with diabetes are suffering. The weight loss market is being prioritized over. An actual disease of diabetes. Don't get me started. I get so mad about this.
Ragen Chastain (she/her): Just crash out. Well, and it's important to know too that the higher doses for weight loss are also more expensive. And so they're increasing their profits by selling the weight loss dose based on the profit margin. So
Louise: Yeah. That's right. Yeah.
Ragen Chastain (she/her): Yeah. So this led right into the new threat to Novo and Eli Lilly, which was compounding. And compounding is just changing a commercially available medication in some way. And it's legitimate in a lot of cases. So like If a drug is only available as a pill, but a patient can't take pills, it can be compounded into a liquid. Right? A lot of compounding is done for pet medications. And as someone who has fostered and rescued high medical needs senior dogs, ask me how I know. But compounding changes the drug so it's not FDA approved. And the kind of compounding we're talking about here is compounding by what is called a 503B pharmacy. And these are outsourcing facilities that are allowed to manufacture large batches to sell to healthcare facilities without a prescription. And usually they're compounding drugs with a generic option, but there's a loophole. So the law allows outsourcing facilities to compound brand name drugs if the FDA has declared a shortage.
Louise: Yeah, it's the same in Australia. If there's a shortage, compounding is legal.
Ragen Chastain (she/her): Yeah, and so that's where you started to see like med spas and plastic surgery purveyors and all of these people partner with 503B pharmacies and use this shortage loophole to sell these weight loss drugs much cheaper than the brand name and often with few guardrails. A reporter from Hunterbrook wrote that he had qualified for a GLP one knockoff from HIMS after a four-minute survey, which gave him a prescription without speaking to a doctor or submitting any medical records.
Louise: Yeah. I spoke to a New Zealand journalist here who did the same thing and, she weighed as much as my cat and was able to get this really, really quickly, no questions asked. So yeah, who knew you'd get these parasitic organizations and opportunities popping up with the weight loss industry. Never heard of that before.
Ragen Chastain (she/her): Right, yeah, if only Fen phen had happened. wait.
Louise: Yeah.
Ragen Chastain (she/her): So things came to a head when Hims and Hers spent sixteen million dollars on a Super Bowl ad for their compounded drugs. And Novo and Lily obviously were furious because these people selling compounded drugs were cutting into the profits they had promised to their shareholders. And so between them, they filed dozens of legal actions. And there are two ways to stop this kind of compounding. The company that makes the brand name drugs either has to convince the FDA that there is no longer a shortage or that their drug is too complex to be compounded, even if there is a shortage.
Louise: Mm.
Ragen Chastain (she/her): So Novo actually tried both routes, claiming there's no shortage and nominating semaglutide for the FDA's demonstrable difficulties in compounding lists. That's the real name of a list, y'all. I was delighted by that. So meanwhile,
Louise: Geez, that is alliteration on steroids.
Ragen Chastain (she/her): demonstrable difficulties for compounding. Meanwhile, So Lily's drug, Trazepatide, came off the shortage list and they started just rapid filing lawsuits against any company selling their drugs. There was more back and forth with the courts, and the FDA finally set timelines to end compounding for both drugs. And those dates have long passed. So why can you still buy compounded drugs, these GLP ones? Well, the compounders turned to another loophole for personalized use. So this is legitimate if a patient has ill effects, and in this case including the many known side effects of the drugs, and or if they need a dose that's not commercially available, then the drug can be compounded for them. And that's why you're hearing about micro dosing and personalized dosing, neither of which are supported by research, and both of which are making the company selling the compounded GLP ones a metric ton of money. So in April 2025, Novo seemed to decide that, well, if you can't beat em, join em. And they began a partnership with Hims and Hers. That partnership fell apart in just a couple of months. I know, shocking. So
Louise: No.
Ragen Chastain (she/her): Hims and Hers took to Twitter to expose Novo's plan. And they posted, I'm quoting here, in recent weeks, Novo Nordisk's commercial team increasingly pressured us. To control clinical standards and steer patients to Wegovy. We refuse to be strong armed by a pharmaceutical company's anti competitive demands, which is just chef's kiss that Novo is getting exactly what they give.
Louise: They said the quiet part out loud.
Ragen Chastain (she/her): They did on Twitter. So in July
Louise: Yeah. wow.
Ragen Chastain (she/her): 2025, Novo's stock dropped 20%. Lars Jorgensen, the CEO, was booted and he told the media that compounders were to blame. Now, one thing I find interesting was that during the drug compounding wars, so-called quote unquote oplesity medicine doctors and researchers, many of whom were on Novo and Lily's payrolls, were apoplectic. about how compounding weight loss drugs they were yes
Louise: Yes, they hated Yeah. How dangerous they are and how terrible. Yeah.
Ragen Chastain (she/her): yes putting higher weight people who they kept calling a vulnerable population at risk. And I find this to be in sharp contrast to their willingness to risk the lives and quality of life of a
Louise: Yeah.
Ragen Chastain (she/her): population who are only vulnerable because of them and the weight loss industry they're part of. Now, I will say this is not necessarily just a craven act of greed on the part of these providers It can also be a testament to the power of confirmation bias Or a tacit acknowledgement that there is some limit to their willingness to put higher weight people's lives and quality of life at risk, and compounding the meds is just a bridge too far. Still, it is disconcerting to see the Yes, yeah. Extremely disconcerting. Yeah, yeah, all of a sudden.
Louise: Just sorry, yeah. now we're worried. Okay. Now it's too risky. I haven't seen I mean, I don't know if it is more risky because the actual risk has been so well like what we just talked about with cancer, right? Like who's actually looking at it really carefully?
Ragen Chastain (she/her): Yeah, and I mean there were definitely some shenanigans. So semaglutide can be compounded using base or salts, and some of it was being compounded with salts, which is not as good or as safe. And so there were really some issues with compounding. but in general,
Louise: Yeah.
Ragen Chastain (she/her): like again, that the fact that this is a bridge too far and not all of the things we've talked about previously and in this episode that the weight loss industry was doing and has done that these doctors and researchers have co-signed.
Louise: Right. Selective,
Ragen Chastain (she/her): Happily.
Louise: selective worry about this.
Ragen Chastain (she/her): Exactly. So I'm watching the kinds of doctors who frequently recommend that higher weight people risk their lives and quality of life to be thin suddenly get dramatically upset that someone else is providing a cheaper way for higher weight people to risk their lives and quality of life to be thin. And I'm gonna wrap this up by saying this. In order for a drug to be a game changer, we'd have to be playing a game.
Louise: Mm.
Ragen Chastain (she/her): And fat people deserve more than to be pawns in the weight loss industry's game of chance for profit.
Louise: Bravo Ragen, I cannot agree more. This is a game. It's fucking rigged.
Ragen Chastain (she/her): Ha ha.
Louise: Well God, that was a wild ride. Thank you so much. I can't wait to hear more. Cause I think in our next episode we're gonna continue diving into this pile of filthy laundry and we're gonna turn to discussing the very wily ways the lived experience voice has been manipulated by Novo across the world. So thank you everyone for listening to all of this. If you are thinking after hearing everything today, we want to hear from you. Have you got insider information from the weight loss industry? Maybe you work for a pharma company or know someone who has. Maybe you're part of the professional organizations that are getting leaned on here. You might have taken these drugs and had an experience. basically, have you seen something? Say something to us. You can visit our obesileaks portal, which is speakpipe.com forward slash obesileaks and leave us a voice message. Remaining anonymous is fine. It doesn't cost any money and we listen to everything. for show notes from today, because we've got a lot of resources and we've got quick links to obesileaks and much more, you can head to exposing obesityincorporated.com. And if you've got questions you want to ask us or topics you want us to cover, you can email us at obesityincorporated at gmail.com.
Ragen Chastain (she/her): And as always, the views and opinions expressed here are our own. All claims are alleged unless otherwise specified. And this podcast is for informational purposes only, does not constitute medical, psychological, legal, or financial advice. So please do consult with a professional for specific advice tailored to your situation.
Louise: Thank you so much.
Ragen Chastain (she/her): See you next time.
Ragen Chastain (she/her): This is episode six, The Ghoulish Game Changer.
Louise: I'm Louise Adams.
Ragen Chastain (she/her): And I'm Ragen Chastain.
Louise: And we are exposing the sordid underbelly of the weight loss industry, Obesity Incorporated.
Ragen Chastain (she/her): And we want to note that the term quote obesity is stigmatizing and our podcast is based on exposing the people making a fortune using it. So when we use it in the podcast, we'll use quotations or Louise's brilliant invention, oplesity, with our eye rolls always implied.
Louise: So before we get into everything, if you are enjoying our podcast and we are having an exceptionally good time being this angry, please take a moment and subscribe and don't miss episodes when they come out every two weeks and rate and review us. And don't forget that you can even watch us if you like and watch the eye rolls on YouTube, which is youtube.comslash at exposing obesity incorporated. And follow us on Insta, and we are up to like more than 500 people. I can't believe it. It's wonderful. Thank you. So at Exposing Obesity Incorporated on Insta. So let's dive right in. Over the last five episodes, we have been combing through Novo Nordisk's playbook step by step. We've seen how they worked to establish oplesity as a chronic disease, reshaped medical education, influenced. Clinical guidelines, built patient advocacy organizations, and of course created, multitudes of ca-chinged collaborations of shopfront organizations and successfully lobbied regulators and governments to pay for treatments. So we're gonna have a bit of a pause point today and just sort of look at a really obvious question: what are they actually selling? And were these GLP one drugs, the revolutionary breakthrough all of this marketing has heavily suggested? So I can't wait to get into this one with you, Ragen.
Ragen Chastain (she/her): All right, let's go. So you may have noticed that Novo funded doctors and researchers have been shoving the word game changer into every conversation, interview, and media appearance they possibly can. So yeah, we're gonna look at like, is this game changer status warranted? Or is this just another one in the weight loss industry's long line of loser drugs?
Louise: gosh, this game changing thing. If I hear it one more time, I think my eyes will
Ragen Chastain (she/her): I know.
Louise: actually fall out from the rolling.
Ragen Chastain (she/her): Agreed. So when it comes to Ozempic and Mounjaro and their weight loss megadose brethren, Wegovy and Zepbound, I often say that these are type two diabetes drugs with a side effect of weight loss. And that's true. What's also true is that even though Novo Nordisk and Eli Lilly bided their time before marketing these as weight loss drugs, they were well aware of the weight loss side effect. And they were seeding the ground for a new cash crop long before they ever tested or marketed them as weight loss drugs. And so this brings us to Lotte BjerreKnudsen, shout out to pronounce names dot com. She was Novo
Louise: Hello. Well done.
Ragen Chastain (she/her): Nord, yeah, I know. I practiced for y'all. she was Novo Nordisk's chief scientific officer in 1994. And you have to imagine her with her red pigtails and her face all excited and flushed, bursting into Mads Krogsgaard's office. He at the time was Novo's head of research. And Lotte at this point is beside herself, absolutely gushing about a study of GLP1, which was then being tested as a type 2 diabetes drug. But Lotte was not excited about the potential for diabetes use. She was thrilled to report that in a rodent study, Rats who were exposed to high levels of GLP ones stopped eating and drinking and literally starved themselves to death. Yeah. So
Louise: Yay. Yay. So exciting.
Ragen Chastain (she/her): Lotte and Mads over the moon. And As Louise once said about this, never have two people been so ecstatic about dead rats. because to them, those dead rats were the same as dollar signs. And so when she filed the patent for the molecule that would become liraglutide, which was the early GLP one, it included a marketing plan for type 2 diabetes, but also a marketing plan for weight loss. But
Louise: So true. And we don't hear this, do we? We don't hear that this was like from the start. They were all
Ragen Chastain (she/her): No.
Louise: about the weight loss. Yeah.
Ragen Chastain (she/her): Yeah, so Novo released Liraglutide under the brand name Victoza for type 2 diabetes and then acted like they they learned that wow, patients typically lost weight. In this case, about five pounds a year. this is an amount of weight loss that I could lose while recording this podcast today with a haircut
Louise: Uh-huh.
Ragen Chastain (she/her): and a loofah. But the weight loss industry's work over decades to lower the bar of what was considered clinically significant weight loss. Was starting to pay off what would become just absolutely massive dividends here. And so even though it was five pounds a year, Victoza began to be prescribed off label for weight loss. It is very unclear if patients were told that for the side effects, which ranged from unpleasant to very serious, that they could expect to lose five pounds.
Louise: Hm. Well, you know, that's clinically meaningful, Ragen.
Ragen Chastain (she/her): Yeah, absolutely. Good lord. So here's where we see the beginning of a cycle that will soon become very familiar. The pharma companies release a GLP1 for type 2 diabetes. They wait for a small weight loss effect to be shown. And then they run trials on a megadose for weight loss, often with special treatment from the government here in the US. And we'll talk more about that. And so through this process, the 1.2 milligram to 1.8 milligram dose that was Victoza became Saxenda, a three milligram dose of the same drug, but now approved for weight loss alone. And this is despite the fact that a third of the people in the trials failed to lose even 5% of their body weight. This was the game changer drug whose profits Novo Nordisk built that 10-year plan on that we've been talking about for the last Episodes, right? This is the drug they were trying to maximize. But Lotte was still hard at work because Liraglutide required daily injections. And this was a problem people didn't want to inject the drug daily. They felt like it was harming uptake and therefore profit, and they won't stand for that for very long. And so she was working to figure out how she could create a more profitable drug that only required weekly injections. And here we have semaglutide. This was a drug, injected weekly. It showed improved blood sugar and modest weight loss. Now, while Lotte was hard at work on the science, Lars had been hard at work on the shareholders. And Louise is the expert here. Can you tell us a little bit more about the promises that LarsJorgensen was making to the shareholders around Semaglutide?
Louise: Lars was well, the shareholders were pretty unhappy, around when this was coming. Saxenda had been released. It was doing okay, but it wasn't terrific. And Lars just kept dropping these little Easter eggs to the shareholders, promising big things for this new component, And in his shareholder meetings, he was unnervingly accurate. About the kinds of average weight losses people were experiencing on these clinical trials. he told them more than once that on average it was like 15% weight loss But they didn't quite know this right up until the end. And then very bizarrely, when the clinical trials actually occurred, it did show an average fifteen percent. I mean, it's just like
Ragen Chastain (she/her): What do you know?
Louise: he's an uncanny fortune teller, don't you think?
Ragen Chastain (she/her): All right, Creskin, come through.
Louise: Because of course the clinical trials were supposed to be blinded from the executive teams. and this was not supposed to happen. But of course it just was a complete coincidence, and this really got everyone excited because Novo were under pretty big political pressure, especially because they'd been price gouging their insulin for so many years. There was a lot of scrutiny coming. From even like places like Donald Trump and Bernie Sanders were really asking why insulin was costing 10 times more in the United States than it did anywhere across the world. just really a lot of pressure there. At the same time, Novo were settling this massive lawsuit, so 60 million US dollars, for basically marketing Victoza, the Liraglutide. in very, very dodgy ways. essentially trying to downplay the risk of thyroid cancer and training their sales teams as diabetes educators that ended up really being people going into medical practices and just selling Victoza, often pushing it off label as a weight loss drug, like you were talking about, Ragen. and also just pushing for quicker and more intensive diabetes treatments. So they were in really big trouble at this point. They did need a game changer because let's never forget that this is a giant game. This is not about health and wellness. This is about profit and protecting the bottom line of this giant Danish company.
Ragen Chastain (she/her): Yeah. Someday, in the not too distant future, we will do an episode about all of Novo's ethical misdeeds, but I think we're gonna push we're trying to be short form, thirty to forty-five minutes, and I'm I
Louise: Exactly.
Ragen Chastain (she/her): think that this may be a two or three or six parter. It's a lot.
Louise: Yeah. Yeah.
Ragen Chastain (she/her): at any rate, so semaglutide came out for type two diabetes, Ozempic, Novo rushed a study of a megadose for weight loss, and they cashed in on an FDA priority voucher for this. And now these are vouchers that are supposed to be reserved for drugs that meet urgent needs. And, you know, here we have nobody I know
Louise: Sorry. This is like it was designed for AIDS, right? It was like people are dying. Let and
Ragen Chastain (she/her): Yeah. Yes.
Louise: and COVID and things like this is like urgent and they managed to pay for this, you know, when you go to Disneyland and like people pay more and get in the fast lane. That's what they
Ragen Chastain (she/her): Exactly.
Louise: did. And just just to see the difference, but liraglutide, the Saxenda, that took nine months to get through the FDA. And then this one, their game changer one just gonna come along and save them all from going bankrupt. It was very quick.
Ragen Chastain (she/her): Yeah. Yeah, because they are using this voucher. It's so ridiculous. At any rate, so Urgent, right? So
Louise: Urgent.
Ragen Chastain (she/her): wegovy is semaglutide for weight loss Five times the minimum effective dose for type two diabetes. And what do you know? Lars must be prescient because the average weight loss was in fact almost 15% of body weight. And immediately there are press releases, company announcements, paid off researchers and doctors in the media touting the drug as a blockbuster, a game changer, a miracle. A miracle.
Louise: Yeah, it was like Christmas had come, Oplesity Incorporated was visibly gushing and often teary when they talk about this.
Ragen Chastain (she/her): Yes. Yeah. Yeah. Those the tearful interviews that they just it's such a miracle. It's such a game changer. So this all goes back to what I mentioned earlier, which is the weight loss industry's decades-long campaign to chip away what was considered a clinically significant amount of weight loss. we talked about this in an earlier episode, so I won't dig deeply into it today, but I do want to go over it because it's so important. It's important mostly to understand that the term Clinically significant keeps getting attached to this without any clinical research whatsoever to back it up. clinically significant weight loss was an amount of weight loss that was based not on any proof that the weight loss created health changes, but based on the amount of weight loss that it the weight loss industry's interventions could create. So originally with the Metropolitan Height Weight Tables, the claim would be that a 300-pound person. Would have to lose at least 150 pounds to have clinically meaningful weight loss. But they couldn't get people to lose anywhere near that amount of weight. So the weight loss industry lobbied and marketed until the same patient would have to lose a minimum of 57.6 pounds or 20% of their body weight. But they couldn't get people to lose anywhere near that amount of weight, even short term. So they marketed and they lobbied down to 30 pounds. And then just down to fifteen pounds for a three hundred pound person. So now with an average weight loss of forty five pounds, which is less than a third of the original required weight loss, this is now a game changing block blockbuster. You know, sorry.
Louise: It it is game changing because it's actually not five percent, which is what they've all struggled to do for like the entire history of weight loss drugs. So it is a game changer in that it actually kind of works. But it's like you said, it is arbitrary and so common to see, weight loss is equivalent to health gain, but that is not proven at all, right?
Ragen Chastain (she/her): Exactly. Yeah, and this is what the whole thing spins on is that marketing claim that if people lose weight, they will have health changes. And that ignores research that shows that when they actually test for that, they find that it's not the weight loss, but much more likely the behavior changes that actually create the health changes. And it ignores research that finds that when weight is changed alone, for example, through large volume abdominal liposuction, There are no health changes that come along with that, even though people are losing large amounts of fat, right? So this is all again, and we've gone we've talked about this in previous episodes, but this is that work that they have done to lower the bar for what's considered clinically meaningful weight loss until it's so low that you can trip and fall over it. And now that bet that Lars had told shareholders that they were gonna make on oplesity, this is all paying off now with their game-changing blockbuster miracle drug. So as Semaglutide came on the scene, Novo's marketing was both relentless and ethically extremely questionable at best. even before Wegovy was approved, you could not escape those Ozempic commercials. And those even touted weight loss and implored people to proactively ask their doctors about it. Robert Kushner, who's a Novo funded researcher, appeared on the Dr. Oz show. but Robert Kushner, I guess he forgot to disclose his conflicts of interest with the drugs manufacturer, and Dr. Oz maybe forgot to ask. And this is a lack
Louise: Yeah.
Ragen Chastain (she/her): of ethics. Pretty par for the course for Dr. Oz, who had famously been scolded by the US Congress for calling so-called treatments like green coffee bean extract weight loss. Miracles in a bottle.
Louise: Yeah, God. Dr. Oz.
Ragen Chastain (she/her): When in fact Dr. Oz, So when the attempt for Congress to sanction him failed, the AMA Journal of Ethics actually wrote about it as an indictment of self regulation in medical ethics.
Louise: Ooh.
Ragen Chastain (she/her): So that's not who you wanna be is the guy they wrote that about. But
Louise: gosh.
Ragen Chastain (she/her): so now, he was on TV with Robert Kushner bringing Novo Nordisk's marketing messages to the masses.
Louise: This is yeah,
Ragen Chastain (she/her): And
Louise: we don't we don't have direct advertising here in Australia, but that Oh-Oh-Zempic song jingle thing, I think that that did a lot I mean it was kind of genius, like magic, right? This whole
Ragen Chastain (she/her): Mm-hmm.
Louise: idea that taking a weight loss well, th they they're still not technically allowed to market, but there's, you know, heavy implications like you said. But that Dr Oz thing it looks like medical TV daytime show. It is a infommercial for this game changer, which had not, been approved at that point by the FDA as a weight loss drug. They were just on it, gushing embarrassingly, two, really over excited people about this. And the marketing, it was all the marketing messages. I've watched this. It's just one talking point after another, there's no downside. Everyone's gonna look this is fantastic. Like we can't wait. my goodness.
Ragen Chastain (she/her): Yeah, yeah. It was I mean, it's what you expect from Dr. Oz if you know what to expect from Dr. Oz from somebody who was almost sanctioned by Congress for and you know, when the US Congress says that you're a a charlatan and a con artist, like that's that's
Louise: I think.
Ragen Chastain (she/her): really saying something. Like that rises to a certain level. So it was not just on T V. The New York Times published a piece by Gina Kolata. And people may know Gina Kolata is someone who's been sort of on the outskirts of weight inclusive paradigm work, but like always sort of a paradigm straddler. And now a fence hitter, yeah.
Louise: Yeah, we call it like a fence sitter. Like you've got the fence pole up your butt quite a bit and it starts splintering. It's it's not a good look. But I I think we know which side of the fence she's on now.
Ragen Chastain (she/her): Yeah, so she just like fell or jumped all the way onto one side of the fence and she published a piece in the New York Times that essentially lobbied for insurance coverage of weight loss drugs. And as you'll recall, after the Fen Phen tragedy, in the United States, Medicare put a moratorium on paying for weight loss drugs. And so Medicare coverage has become really the holy grail for weight loss companies. Because not only is it a huge population in the US, but also once Medicare covers something, it creates tremendous pressure for private insurers to cover that drug as well.
Louise: legitimizer for the weight loss industry. It's like putting like a hair cream on Medicare for
Ragen Chastain (she/her): Yeah.
Louise: like bald men to like regrow hair. It's like, ooh, medicine.
Ragen Chastain (she/her): Exactly. Exactly. So New York Times publishes this piece, Lobbying for Insurance Coverage of Weight Loss Drugs. It quotes a number of experts. Every single expert quoted had taken money from Novo Nordisk andor Eli Lilly. And none of those experts, nor Gina herself, had disclosed that.
Louise: See that to too much in the media. it's bad
Ragen Chastain (she/her): Yeah.
Louise: enough that half the time they don't disclose in academic journals, but this issue of the media never, or literally almost never. it's not okay, especially in this echo chamber of magic game changing, weight loss drugs, it's terrible.
Ragen Chastain (she/her): Yeah, and it's not journalism. Famously they say if somebody tells you, it's raining outside and someone else tells you it's not your job isn't to publish both, it's to go outside and see what the weather is like.
Louise: Such a good that's a great way 'cause we do hear the both sides thing, but yeah, it's like, is it actually raining? And who's telling
Ragen Chastain (she/her): That's yeah. Yes.
Louise: you and why?
Ragen Chastain (she/her): I cannot stress enough how much this is not journalism. But This has gotta be my favorite one. And by favorite I mean the most cringe worthy thing perhaps I've ever seen. Novo yeah, I know. Are you ready, Louise? Because it's it's special.
Louise: Wow, okay. I'm I'm bracing.
Ragen Chastain (she/her): Novo put together a PSA video. And they put their talking points into the mouths not of doctors, but of actors who play doctors on television.
Louise: what?
Ragen Chastain (she/her): Literally like people from medical dramas saying very earnestly to the camera, Oplesity is a chronic disease, but it can be managed.
Louise: my what? That's so wild. That's hilarious.
Ragen Chastain (she/her): I was like, am I hallucinating? Is this a fever dream? Surely, but no, it is real. It is real and it is horrific. Like, let's have McDreamy tell us all about science. They're paid actors.
Louise: mean it's kind of apt, isn't it? this is all an act, really.
Ragen Chastain (she/her): Yes, yes. I mean it I can't decide if it's the most sneaky or the most honest thing they've ever done, honestly, but it was just unhinged.
Louise: Yeah. Wow. That's that's got a win. I mean, it's hard. It's hard to pick a winner of most egregious display of naked of disguised advertising in the magic hype But I've just recalled, that Dr. Oz thing, there was a massive bump in Google searches for this drug just after that went to air. Like it's one of the most successful. daytime infomercials it did so much for the interest and hype before the FDA approval happened. So you know, we talked about stealth marketing with the health professionals. moving into TV and celebrities and just publicizing. this stuff is we've never seen anything like this before. And we're only able to cover a tiny, tiny sample today.
Ragen Chastain (she/her): Yeah. And I mean, we have to remember that Dr. Oz was brought to us by Oprah. And so that Oprah effect where when she talks about something, it goes like wildfire, sort of is transferred on to Dr. Oz. And
Louise: Yeah.
Ragen Chastain (she/her): even though he had been touting ridiculous coffee bean extract as a miracle weight loss drug, people still trusted him and Dr. Kushner that this was this was the real miracle now. Right? The real game changer, the real blockbuster. Yeah. Yes.
Louise: Yeah, wow. Kushner from the OMEC, right? The yes. He's a man of many talents.
Ragen Chastain (she/her): He comes up a lot. Novo at this time was also working a separate part of this plan. And Louise talked, in fact, last episode about how they had for a long time these AstroTurf organizations that claim to be patient advocacy groups, but in fact are funded by and acting as a lobbying arm for these weight loss organizations, were tacking on little phrases like And we confront weight stigma and bias, right?
Louise: yeah, PS. Yeah, no bias.
Ragen Chastain (she/her): So just as Novo decided to take weight loss drug marketing to a whole new level, they also wanted to up their game in terms of co-opting decades of actual anti-weight stigma work by fat positive fat people, many of them fat black women of color, to become a tool to transform weight stigma into a tool to sell their weight loss drugs.
Louise: Yeah. This makes me cringe.
Ragen Chastain (she/her): It's so gross. They're trying to manipulate it in the general public. And so what they did was simultaneous to their launch of Wegovy, they launched a campaign called It's Bigger Than Me. Get it?
Louise: Sorry.
Ragen Chastain (she/her): Because fat people are big. Yeah, they're so smart.
Louise: Mm, it's really punny.
Ragen Chastain (she/her): So we've talked about this in previous episodes. I think if your program sounds like it was named by a sixth grade bully, you probably aren't the person to be talking about this. But here we are. And Novo's idea of solving weight stigma was convincing site visitors to sign petitions to demand insurance coverage for Novo's drugs. That was the goal of the It's Bigger Than Me campaign. Yes. Yes.
Louise: All roads lead to Rome. You know. Let's get everyone, even the people we want to sell our drugs to to lobby. So we can get
Ragen Chastain (she/her): Yes.
Louise: yeah, it's such a horrific injustice. okay.
Ragen Chastain (she/her): Yeah, and that's the piece of it, right? These are fat people whose lives are being incredibly affected and even ruined by weight stigma, who have been taught and accepted that their body is wrong and bad and their only path to health or a better life is to change that body through weight loss. And now they're being told there's this miracle game-changing drug, but the government won't let you have it. So you have to go.
Louise: Big nasty government, yes. Yeah.
Ragen Chastain (she/her): Yeah, and you have to petition. and everybody's gotta become a lobbyist for us. So that was their general public manipulation. Novo also was working to manipulate healthcare providers, and we have really dug into this in past episodes as well. their big launch here was the rethink oplesity, which they claimed was an educational hub for
Louise: Mm.
Ragen Chastain (she/her): health professionals. And it was in fact a hub of Novo's key marketing messages. But they got 5,000 healthcare providers to join what they called a training. And what that training did was just to turn Novo's marketing messages into so-called medical education, which is as we talked about, what they've been doing throughout. And so this was their next big play So all of this marketing generated a feeling that these drugs were somehow different than other weight loss drugs and weight loss methods, but that is just not true. Here's the deal. Intentional weight loss is about giving your body less food than it needs to survive in the hopes that it will consume itself and become smaller. There are many problems with this. First of all, that the body has a bunch of ways that it reacts to starvation that turn it into essentially a weight gaining, weight maintaining machine. And one of those is to change the balance of hormones to help people be hungry all the time so that in the famine and whatever else they're dealing with that's causing them to not have enough food, they don't forget to eat if the opportunity should arise. And
Louise: Mm-hmm. It's it's not pathological, right? yeah, if we're not getting enough to eat and our bodies and fat cells are shrinking, there's just defensive mechanisms against that to make us more interested in food and hungrier. And then our bodies are great at defending the range they feel comfortable in. And sometimes, well, a lot of the time that doesn't agree with what we think our bodies should be weighing and what definitely diet culture tells us what we should weigh.
Ragen Chastain (she/her): Exactly, exactly. And so, you don't give your body food and your body's like, I'm sending the food signal, but you're not giving me food. There must not be food available. Our bodies don't have any sense that we live in a world where this sounds like a good idea to not feed them when they need food and hope they'll consume themselves and become smaller. So all these drugs do is make people able to tolerate that undernourishment for longer, at least in the short term. Because what they do is they manipulate hunger, both mechanically and neurologically. So mechanically, these drugs slow digestion. And the GIP agonists like tirzepatide also reduce stomach acid. And so basically, the food that you have is just in your stomach longer. and this makes you feel less hungry, right? Because you've got food that's very slowly digesting and not moving through the body. It also creates side effects like nausea and vomiting and eventually diarrhea, things that, Don't typically lend themselves to good nourishment or wanting to eat. So that's the mechanical piece. Now, neurologically, these drugs, it turns out, cross the blood-brain barrier, and that was not known at first. Originally, the idea was that these would act on the GLP1 centers in the gut, and those are fairly quick acting. But in the brain, these receptors last much longer. And so it turns out that these drugs. Cross the blood brain barrier and they interrupt the body's natural hunger signals. And it cannot be stated enough. These are survival signals that we're messing with. And the duration is not known, the complete mechanism of action is not known. And the way that this acts on other survival signals is also not known. So anecdotally, I'm hearing often from doctors that they have to tell their patients to set timers to drink because their patients
Louise: Mm.
Ragen Chastain (she/her): lose interest in drinking, don't get thirst signals from their body and then become quite dehydrated and that's secondary to perhaps nausea, diarrhea and vomiting that they're experiencing.
Louise: Yeah, yeah. This is the GLP one effect. I think so far in our podcast we've talked the history of weight loss drugs being mainly impacting the cardiovascular system or serotonin receptors. Here we're talking about an action on our digestive system, which is in a way a game changer, because turning off our appetite signals has been devilishly difficult for the weight loss industry to discover. but it is really a significant impact across lots of systems in the body. And this brain thing is kind of important. I think GLP one receptors turning down our general interest is being increasingly recognized as related to reward. So there's a flattening in reward from eating as well. And I'm a clinical psychologist, I'm seeing a lot of clients who are Noticing a flattening in general reward, and that's definitely impacting on things like mood and the ability to feel pleasure, even sometimes generalizing down to losing interest in sex and and all kinds of things. So this is a really big deal. sometimes I think with all of this medical discourse, this idea that oplesity is a disease, and taking these drugs is going to cure the disease. We kind of forget that the mechanism of action is actually harming or getting in the way of a really normal functioning gut and digestive system. So we're introducing very problematic things and calling that a cure. And I just think we're in a pretty dicey situation in terms of the long-term impacts because no understanding the mechanism of action in the brain is You know it's unsettling.
Ragen Chastain (she/her): Yeah, yeah. And all of this and weight loss industry in general is based on the idea that whatever a fat person is eating, it's too much. And that's certainly not a scientific finding. We know that there are people of all sizes dealing with eating disorders and disordered eating and food insecurity. And so the idea that we can just stop fat people from eating and that's a good and healthy thing is wildly unscientific and in fact dangerous. And so we are both weight inclusive. Neither of us endorse weight, body size manipulation as a path to health. But what I want to talk about now for a bit is actually what the trials showed in sharp contrast to this game changer status. So the drug companies, yeah, good times. Let's geek out. so the clinical
Louise: I can't wait. Okay, let's dig in.
Ragen Chastain (she/her): trials tell, again, a very different story from the marketing messages. The drug companies Were reporting averages, but typically half the people in the study did not reach those averages. So that 15%, for example, and up to 32% of people fail to lose even 5% of body weight. Weight loss generally slows and levels off after about a year. So the idea that, you can just lose as much weight as you want by continuing to take them is misinformation. and in follow-up beyond a year, we see increases in weight. withdrawal studies found that those who go off the drug regain the weight rapidly And the drug manufacturers actually rushed to get this information out to the public, which to the casual observer might seem odd, since typically companies that put out diet drugs would rather chug sewage than admit how much weight is regained when people go off the drugs. But this is where Novo had an ace up their sleeve because they started pushing the definition of oplesity as not just a disease, but a chronic lifelong disease. And so these withdrawal trials showing rapid weight regain, they use those as proof. That people needed to stay on the drugs for life.
Louise: ca-ching. The holy grail.
Ragen Chastain (she/her): Ca-ching.
Louise: An expensive drug that needs to be taken forever. Is that's what it's
Ragen Chastain (she/her): Forever. Yes.
Louise: all about in the wonderful world of pharma. That's fantastic.
Ragen Chastain (she/her): Exactly. And they even told people it's just like asthma or type two diabetes. And the fact that just existing in a higher weight body is actually
Louise: Mm.
Ragen Chastain (she/her): absolutely nothing like asthma or type two diabetes did not matter because the researchers and the doctors on Novo's payroll were spreading this new definition like wildfire. And we'll get more into that into future episodes. and so, you know, they're spreading this new definition pretty soon everyone from doctors to reporters to randos on TikTok are explaining that you just have to stay on these drugs for life to maintain weight loss because oplesity is a chronic lifelong disease. Yeah. So this idea wildly profitable for Novo, but Problematically, existing in a higher weight body does not in any way qualify as a disease. Moreover, there was and is no research to show that people who stay on the drug will actually maintain weight loss even if people could stay on the drugs for life, and there is no reason to believe that they can and lots of reasons within the research to believe that they can't. And I wanna clarify as always, there is no shame in having a disease of any kind. The problem here is that simply existing in a higher weight body doesn't qualify. And the weight loss industry, now led by Novo Nordisk, is manipulating the idea of a disease for money at the risk and harm of fat people. So these drugs come with a long list of physical and psychological side effects. The common side effects nausea, diarrhea, vomiting, constipation, dizziness, abdominal pain, dyspepsia, gastric reflux. Severe side effects include things like acute pancreatitis and gallbladder disease and kidney injury, diabetic retinopathy complications, suicidal ideation and behaviors, and ileus, which is a complete paralysis of the intestinal tract. Now, these are not just serious, but some of these side effects can be fatal.
Louise: Gosh.
Ragen Chastain (she/her): And people have died.
Louise: Yeah. And we're gonna talk about that in more detail in later episodes
Ragen Chastain (she/her): Yeah.
Louise: about the less talked about risks. But they do make sense, you know, given where
Ragen Chastain (she/her): Yeah. Yeah.
Louise: these drugs are having their action.
Ragen Chastain (she/her): Exactly. Exactly. So the drugs also carry the FDA's strongest warning for thyroid cancer risk. And we talked about before with Belviq, where there was a risk of of cancer, but they let the drug on the market anyway and then they had to pull the drug because it turned out that risk was real. And so this may be another repetition of that.
Louise: I have an update on that.
Ragen Chastain (she/her): yes.
Louise: yeah, you remember in the last episode we talked about how there was a thyroid surveillance register that the FDA said Novo needed to do in order to track what happens after they
Ragen Chastain (she/her): Right.
Louise: approved saxenda. so I looked at that surveillance register and this is where different companies added to it as more GLP1 medications make it onto the market. And since it was invented, there has not been a single update provided. so Saxenda was approved in 2014. I think Victoza was years before that. We don't have any of that post-marketing surveillance data that they're supposed to be collecting on thyroid. So I'm going to continue digging into that and perhaps give everyone an update in our episode on side effects and risks, but just wanted to raise a bit of a suspicion that there's not a lot of movement at the station on what's actually going on here. it makes you wonder just how much surveillance is really happening, especially if it's up to the companies who are selling the drugs.
Ragen Chastain (she/her): Right. Absolutely. Thank you. I can't wait to hear the update. I mean, this is terrible, but also I want to know. So thank you for your due diligence there.
Louise: huh.
Ragen Chastain (she/her): All right. So let's talk about these drugs. The longest study we have on these drugs that we claim that if people stay on them for life, they'll maintain weight loss is a four-year trial of semaglutide. Now, if you read this, the abstract, the results, and the conclusion all claim that weight was maintained over four years.
Louise: Mm.
Ragen Chastain (she/her): But they started with 8,803 people, and at four years they ended with 921. Meaning that yeah, yeah. So I did the math for you. In four years they lost
Louise: Huh? What?
Ragen Chastain (she/her): eighty nine point five percent of the sample. That inconvenient truth did not make it into the abstract results or conclusions. And I think about like a sixth grader who's like
Louise: my god.
Ragen Chastain (she/her): For my science fair project, I want to see if fruit flies prefer apples or bananas, but they accidentally let out 89.5% of the fruit flies and then move forward like that never happened and just like do their abstract and their conclusions. That kid's not gonna win the sixth grade science fair. That kid's gonna get a discussion about the basics of good science from a middle school science teacher. Or apparently he's immediately hireable as a researcher for Novo nordisk.
Louise: Yeah. I'm laughing 'cause it's just appalling that so we've lost everyone except eleven percent of the sample and that's where the weight loss has been preserved.
Ragen Chastain (she/her): Exactly. And it gets better slash worse. So
Louise: Mm-hmm.
Ragen Chastain (she/her): beyond the massive trial attrition, weight loss at two years was down to ten percent from the 15 in the original trial. And so here we c
Louise: that sounds like regain.
Ragen Chastain (she/her): right, here we go again, showing that the weight loss industry just moves the goalpost and declares victory, even though here there were very few players even left on the field.
Louise: So how are they defining weight loss maintenance?
Ragen Chastain (she/her): They just said weight was maintained over four years. So this was the SELECT trial, which was the cardiovascular trial, which was separate from the weight loss trials. So they
Louise: Mm-hmm. Mm-hmm.
Ragen Chastain (she/her): reanalyzed the select trial for weight loss and found this 10% weight loss. And instead of saying, huh, this is five percent less than what was shown in the trials, they just said, good news, weight was maintained. Now importantly, you'll note that I said
Louise: Hmm.
Ragen Chastain (she/her): that weight loss was down to 10% at two years. they didn't do full calculations of anything at four years because again they had so few people left in the trial.
Louise: Yeah. science. Science is just science
Ragen Chastain (she/her): Science. Boom. Science.
Louise: is crying in the corner and millions of dollars. Yeah.
Ragen Chastain (she/her): I curled up fetal sucking its thumb.
Louise: Yeah, rocking.
Ragen Chastain (she/her): But the money was absolutely rolling in. And one of the ways Novo spent it was on lavish secret multi-day parties. And this was things like renting out an entire amusement park for 10,000 plus employees, music by huge stars, and
Louise: Did they pay for the fast track for all the rides? I'm sure they did.
Ragen Chastain (she/her): I'm sure they did. Special. Special quality.
Louise: Everyone's on the fast one.
Ragen Chastain (she/her): Yes, it's very important that everybody be on the fast track. They had in these parties one unusual rule. Now Danish culture, where Novo Nordisk is headquartered, looks down on just naked displays of wealth. So
Louise: Oops.
Ragen Chastain (she/her): Novo needed to keep their nudity hidden from the general public.
Louise: Yeah.
Ragen Chastain (she/her): And attendees were not allowed to post about the event on social media, and Novo eschewed the media attention that they normally craved and desperately, desperately sought.
Louise: Cheeky. So we're having this like a massive multi-day party, but just you're not allowed to tell anyone that this is because yeah. All right. Okay.
Ragen Chastain (she/her): Right. Yes, yes. So the money.
Louise: They have a strong grip on their narrative, don't they? That's something I've absolutely like you you
Ragen Chastain (she/her): Yes.
Louise: rarely see anything that they don't want you to see without quite a lot of determined burrowing. Well done, to find that. That's great.
Ragen Chastain (she/her): Yes. Both of us have noticed that yeah, it's they don't have seem to have a strong grip on science or ethics, but when it comes to marketing and narrative, they are on top of that.
Louise: On point. Mm.
Ragen Chastain (she/her): So the money train though was being derailed. They were immediately plagued with shortages and the ethics in the factories were not much better than the ethics in the research. And I think Lou, you're gonna tell us a little bit about that.
Louise: my gosh. Yeah. So they did this massive splashy launch, first the underhanded stuff and then once it actually got approved, there was a lot of game changing emotional crying and, you know, all of the Mass publicity. So it was next level it was released in the US first because that's their biggest market where they can charge the most. And this is a hideously expensive drug. So the demand for this drug was enormous. And in spite of all of the marketing, which we've realized is a real positive for them, actually being able to cough up the goods seems to be quite difficult. So they said that they didn't expect to have such demand, which is quite weird. Turns out they only had one factory that was producing this drug. And the supply chain completely imploded at the end of 2021 because their factory in Belgium got shut down because of dodgy manufacturing practices. And this fill plant had. Problems going back years and years, they've been pinged again and again and again by regulators for just not, being great in their practices. So they decided that they would use the tons of money that they were making to develop what they called in-house manufacturing. So Novo were very secretive about their production and how they make this drug and just protecting it like it's Gollum's precious jewel. They don't want anyone to know what they're doing. So they decided to use some of the bazillions of dollars that they were making To develop in-house manufacturing factories and in that case, own the entire means of production, pocketing even more money. And they kept telling the public, look, we're gonna be operational by 2023, everything's gonna be fine. They even snapped up an old Purdue pharma factory, which is sort of poetic.
Ragen Chastain (she/her): you love to see it.
Louise: I know. and the American market. So how did they service all of these Wegovy customers? by basically redirecting their diabetes drug supplies into the more lucrative higher dose semaglutides. So during this period, so here in Australia, we had Ozempic approved for type two diabetes. Wegovy was not approved. We had the same kind of issue with massive off-label Gushing about it. So people getting wind of it and getting it off-label. and here in the Australian media, they actually blamed TikTokers for creating off-label demand rather than pinging Novo for just having one factory that was shut down because of being dodgy. It's just wild. But so we in Australia started to notice massive shortages of Ozempic. It was put on the shortage list. And about 125,000 Australians who had type 2 diabetes, who, you know, this is a second line diabetes drug. So if you're on a GLP1, it's usually because the first line of treatment medicines haven't been able to stabilize your blood sugar. So you go on a GLP one as a second line, and it is a really good diabetes drug. So all of these people who were taking Ozempic for their diabetes suddenly were having massive problems getting it. And meanwhile, in the lucrative American market where Wegovy was being sold, they were bragging in the media about being able to continue to quote service their brand new patients. All 125,000 of them. So It's the same chemical, and I was looking at these two figures, just smelling a rat. It's just not okay. And we see this kind of practice like taking from different markets, selling to the American markets, propping it all up at all costs, keeping this game-changing drug going. And meanwhile, people with diabetes are suffering. The weight loss market is being prioritized over. An actual disease of diabetes. Don't get me started. I get so mad about this.
Ragen Chastain (she/her): Just crash out. Well, and it's important to know too that the higher doses for weight loss are also more expensive. And so they're increasing their profits by selling the weight loss dose based on the profit margin. So
Louise: Yeah. That's right. Yeah.
Ragen Chastain (she/her): Yeah. So this led right into the new threat to Novo and Eli Lilly, which was compounding. And compounding is just changing a commercially available medication in some way. And it's legitimate in a lot of cases. So like If a drug is only available as a pill, but a patient can't take pills, it can be compounded into a liquid. Right? A lot of compounding is done for pet medications. And as someone who has fostered and rescued high medical needs senior dogs, ask me how I know. But compounding changes the drug so it's not FDA approved. And the kind of compounding we're talking about here is compounding by what is called a 503B pharmacy. And these are outsourcing facilities that are allowed to manufacture large batches to sell to healthcare facilities without a prescription. And usually they're compounding drugs with a generic option, but there's a loophole. So the law allows outsourcing facilities to compound brand name drugs if the FDA has declared a shortage.
Louise: Yeah, it's the same in Australia. If there's a shortage, compounding is legal.
Ragen Chastain (she/her): Yeah, and so that's where you started to see like med spas and plastic surgery purveyors and all of these people partner with 503B pharmacies and use this shortage loophole to sell these weight loss drugs much cheaper than the brand name and often with few guardrails. A reporter from Hunterbrook wrote that he had qualified for a GLP one knockoff from HIMS after a four-minute survey, which gave him a prescription without speaking to a doctor or submitting any medical records.
Louise: Yeah. I spoke to a New Zealand journalist here who did the same thing and, she weighed as much as my cat and was able to get this really, really quickly, no questions asked. So yeah, who knew you'd get these parasitic organizations and opportunities popping up with the weight loss industry. Never heard of that before.
Ragen Chastain (she/her): Right, yeah, if only Fen phen had happened. wait.
Louise: Yeah.
Ragen Chastain (she/her): So things came to a head when Hims and Hers spent sixteen million dollars on a Super Bowl ad for their compounded drugs. And Novo and Lily obviously were furious because these people selling compounded drugs were cutting into the profits they had promised to their shareholders. And so between them, they filed dozens of legal actions. And there are two ways to stop this kind of compounding. The company that makes the brand name drugs either has to convince the FDA that there is no longer a shortage or that their drug is too complex to be compounded, even if there is a shortage.
Louise: Mm.
Ragen Chastain (she/her): So Novo actually tried both routes, claiming there's no shortage and nominating semaglutide for the FDA's demonstrable difficulties in compounding lists. That's the real name of a list, y'all. I was delighted by that. So meanwhile,
Louise: Geez, that is alliteration on steroids.
Ragen Chastain (she/her): demonstrable difficulties for compounding. Meanwhile, So Lily's drug, Trazepatide, came off the shortage list and they started just rapid filing lawsuits against any company selling their drugs. There was more back and forth with the courts, and the FDA finally set timelines to end compounding for both drugs. And those dates have long passed. So why can you still buy compounded drugs, these GLP ones? Well, the compounders turned to another loophole for personalized use. So this is legitimate if a patient has ill effects, and in this case including the many known side effects of the drugs, and or if they need a dose that's not commercially available, then the drug can be compounded for them. And that's why you're hearing about micro dosing and personalized dosing, neither of which are supported by research, and both of which are making the company selling the compounded GLP ones a metric ton of money. So in April 2025, Novo seemed to decide that, well, if you can't beat em, join em. And they began a partnership with Hims and Hers. That partnership fell apart in just a couple of months. I know, shocking. So
Louise: No.
Ragen Chastain (she/her): Hims and Hers took to Twitter to expose Novo's plan. And they posted, I'm quoting here, in recent weeks, Novo Nordisk's commercial team increasingly pressured us. To control clinical standards and steer patients to Wegovy. We refuse to be strong armed by a pharmaceutical company's anti competitive demands, which is just chef's kiss that Novo is getting exactly what they give.
Louise: They said the quiet part out loud.
Ragen Chastain (she/her): They did on Twitter. So in July
Louise: Yeah. wow.
Ragen Chastain (she/her): 2025, Novo's stock dropped 20%. Lars Jorgensen, the CEO, was booted and he told the media that compounders were to blame. Now, one thing I find interesting was that during the drug compounding wars, so-called quote unquote oplesity medicine doctors and researchers, many of whom were on Novo and Lily's payrolls, were apoplectic. about how compounding weight loss drugs they were yes
Louise: Yes, they hated Yeah. How dangerous they are and how terrible. Yeah.
Ragen Chastain (she/her): yes putting higher weight people who they kept calling a vulnerable population at risk. And I find this to be in sharp contrast to their willingness to risk the lives and quality of life of a
Louise: Yeah.
Ragen Chastain (she/her): population who are only vulnerable because of them and the weight loss industry they're part of. Now, I will say this is not necessarily just a craven act of greed on the part of these providers It can also be a testament to the power of confirmation bias Or a tacit acknowledgement that there is some limit to their willingness to put higher weight people's lives and quality of life at risk, and compounding the meds is just a bridge too far. Still, it is disconcerting to see the Yes, yeah. Extremely disconcerting. Yeah, yeah, all of a sudden.
Louise: Just sorry, yeah. now we're worried. Okay. Now it's too risky. I haven't seen I mean, I don't know if it is more risky because the actual risk has been so well like what we just talked about with cancer, right? Like who's actually looking at it really carefully?
Ragen Chastain (she/her): Yeah, and I mean there were definitely some shenanigans. So semaglutide can be compounded using base or salts, and some of it was being compounded with salts, which is not as good or as safe. And so there were really some issues with compounding. but in general,
Louise: Yeah.
Ragen Chastain (she/her): like again, that the fact that this is a bridge too far and not all of the things we've talked about previously and in this episode that the weight loss industry was doing and has done that these doctors and researchers have co-signed.
Louise: Right. Selective,
Ragen Chastain (she/her): Happily.
Louise: selective worry about this.
Ragen Chastain (she/her): Exactly. So I'm watching the kinds of doctors who frequently recommend that higher weight people risk their lives and quality of life to be thin suddenly get dramatically upset that someone else is providing a cheaper way for higher weight people to risk their lives and quality of life to be thin. And I'm gonna wrap this up by saying this. In order for a drug to be a game changer, we'd have to be playing a game.
Louise: Mm.
Ragen Chastain (she/her): And fat people deserve more than to be pawns in the weight loss industry's game of chance for profit.
Louise: Bravo Ragen, I cannot agree more. This is a game. It's fucking rigged.
Ragen Chastain (she/her): Ha ha.
Louise: Well God, that was a wild ride. Thank you so much. I can't wait to hear more. Cause I think in our next episode we're gonna continue diving into this pile of filthy laundry and we're gonna turn to discussing the very wily ways the lived experience voice has been manipulated by Novo across the world. So thank you everyone for listening to all of this. If you are thinking after hearing everything today, we want to hear from you. Have you got insider information from the weight loss industry? Maybe you work for a pharma company or know someone who has. Maybe you're part of the professional organizations that are getting leaned on here. You might have taken these drugs and had an experience. basically, have you seen something? Say something to us. You can visit our obesileaks portal, which is speakpipe.com forward slash obesileaks and leave us a voice message. Remaining anonymous is fine. It doesn't cost any money and we listen to everything. for show notes from today, because we've got a lot of resources and we've got quick links to obesileaks and much more, you can head to exposing obesityincorporated.com. And if you've got questions you want to ask us or topics you want us to cover, you can email us at obesityincorporated at gmail.com.
Ragen Chastain (she/her): And as always, the views and opinions expressed here are our own. All claims are alleged unless otherwise specified. And this podcast is for informational purposes only, does not constitute medical, psychological, legal, or financial advice. So please do consult with a professional for specific advice tailored to your situation.
Louise: Thank you so much.
Ragen Chastain (she/her): See you next time.
