In the News: Follow Up 60 Minutes on Obesity

Yesterday I shared some thoughts on the 60 Minutes January 1, 2023 report on obesity and diet drug Wegovy. Today, I’d like to add to it with insights from Dr. Tom Rifai, whose YouTube videoing on the topic is quite critical. First, here’s my blog post which links the original 60 Minutes story:

https://lindawbrowning.com/2023/01/05/60-minutes-on-obesity/

And here is Dr. Rifai’s rather lengthy rebuttal:

This video is really packed with information. Besides explaining how Wegovy works, Dr. Rifai critiques many points from the 60 Minutes report. Instead of blaming our genetics for suddenly changing our weight status, he looks at the food industry as the most important contributing factor to the obesity epidemic.

His explanations seem reasonable. It would likely take centuries (or perhaps millennia) for long lived animals like us to change to such a degree. Consider this National Institutes of Health graph illustrating obesity in youth: (1).

Trends in obesity among children and adolescents ages 2–19 years, by age: United States, 1963–1965 through 2017–2018

What has changed in the last 50 years that could have caused childhood obesity to rise from about 5% to close to 20%? Dr. Rifai has a clever acronym for the cause: CRRAHP, pronounced crap, Calorie Rich Refined And Highly Processed foods. Yes, he says we are eating crap, and for the most part he is right! We are consuming more calories which generally translates to higher weight.

Dr. Rifai agrees with some of the points made in the report, such as set-point weight increasing due to the pandemic. He also finds fat shaming appalling. He does see some value in this class of drug. But, he places more importance on the foods we are eating. For example, most processed foods are calorie dense which translates into small volume portions. Consider that a small handful of chocolates may have more calories than an entire bowl of strawberries. We don’t feel that fullness or satiety when we eat calorie dense processed foods, causing us to crave more.

As he suggests in his video, lifestyle changes are important in weight management. This is a part of Dr. Rifai’s commercial business, and he charges $349 for his master class on the topic – which I am not promoting (but have linked to attribute the information (2)). He feels we should consider nutrition, activity, environment, accountability, and psychology, his Flex5. We have to take responsibility and exercise our agency in weight maintenance.

As with all medications, there are downsides to taking Wegovy. Each of us must decide, with the aid of our medical team, if the risks are justified. But, it seems worrisome that no one has mentioned the black box warning on this class of drugs. Although it’s extremely unlikely, these drugs are associated with the risk of medullary thyroid cancer. For 60 Minutes to basically promote a drug with the FDA’s most serious warning, yet not mention the risk, is a significant omission (3) (4).

We don’t know the long term effects of these costly drugs. We don’t know what may happen if large segments of the population take these drugs and how they will get off of them, if they ever can. Will they regain weight? Will they experience long term side effects? Can they be used for weight management for those who have met weight loss goals but have difficulty with maintenance?

If you read my first post on this report you may have seen that I was originally prescribed this class of medication. (Due to shortages, Saxenda was prescribed rather than Wegovy.) Let me be honest with you – I really wanted it and hoped it would be the fix I needed. But at this point, I’m glad that it didn’t work out and that I found another way to reach my goal.

Weight maintenance truly is a journey with twists and turns. But with perseverance we will find continued success!

(1). https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

(2). https://dpm.drtomrifai.com/

(3). https://www.goodrx.com/healthcare-access/medication-education/fda-black-box-warning

(4). https://online.epocrates.com/drugs/1022111/Wegovy/Black-Box-Warnings