Welcome to Part 2 of our probe into the Lancet paper defining ‘clinical o*esity*.’ If you haven’t read Part 1 you can do so here – it’ll make much more sense.
For more than two decades I’ve been wading through the stench-swamp of o*esity research, unmasking the nefarious tricks of the weight loss industry, and honestly I thought nothing could shock me.
But this paper takes the o*esity field from shady to pitch black, forging new frontiers of research depravity. There’s 42 dreary pages of half-hearted reasoning, logic-defying conclusions, and irrelevant side discussions. By the time I finished reading, I felt brow-beaten and exhausted. It’s unlike any ‘science’ paper I’ve read: because it’s not science: it’s PR. Only in a field conditioned to accept substandard practices and rampant corruption could this survive a peer review process, let alone receive such uncritical reception in the media.
I’m not alone – many in the weight inclusive space are incensed at not only the obvious agendas operating in this paper, but the awful quality of the work. Ragen Chastain has some terrific insights on the Lancet ‘opinion piece’ in her Substack– which I highly recommend!
In the interests of preserving my sanity, I’m dividing this critique into three parts. Today I’ll discuss how the Lancet Commission paper was structured to look like science whilst callously murdering the scientific method. After some deep breathing exercises (and a few gin and tonics), in part 2 I’ll dig into the Commission’s claims about BMI and ‘excess adiposity.’ Then, after some time in an isolation tank, in part 3 I’ll dissect the shaky claims of ‘pre-clinical’ and ‘clinical o*esity’.
Let’s get into it: Here’s 10 ways The Lancet paper spin doctors murdered science:
1. Conflicts of Interest
Continuing lead author Francesco Rubino’s tradition of using a ridiculous number of authors to create the impression of widespread agreement, the paper lists no fewer than 56 authors, 47 of whom declare multiple financial conflicts with the pharmaceutical and weight loss industry, notably Eli Lily and Novo Nordisk. Readers are reassured that all authors were green lighted under The Lancet’s conflicts of interest policy, but this only asked them to disclose who paid them: accepting wads of cash from weight loss companies apparently isn’t a red flag for The Lancet, shedding new light on the use of the term ‘Commission’.
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2. Rubino’s Naked Agenda
Like the weight stigma propaganda paper, the Commission on clinical o*esity was dreamed up inside the brain of Rubino, who then used his influence to clear the proposal with The Lancet editors.
Rubino’s disease mongering aspirations are on full view in this sharticle. For years he’s been a vociferous, industry-backed agitator pushing to have o*esity classified as a disease. In 2021 he published an outrageous advertorial paper which ‘surveyed’ European health care professionals and found that 90% considered o*esity a disease, and that physicians everywhere were keen to prescribe drugs and surgery. Unsurprisingly the paper was 100% sponsored by Novo Nordisk.
People with entrenched views and blatant pharmaceutical industry conflicts should never be allowed a leadership role on such a contested topic.
But this is the fetid world of o*esity research, where agendas operate unchallenged. After stating that ‘o*esity as a disease’ is one of ‘the most controversial and polarising debates in modern medicine,‘ Rubino claimed that:
‘Despite evidence that some people with excess adiposity have objectively ill health due to o*esity alone, o*esity is generally considered a harbinger of other diseases, not a disease in itself.’ (emphasis added).
Note how casually Rubino tosses in ‘evidence’ of ‘ill health due to o*esity alone.’ Controversy exists because ill health caused directly, and only, by larger body size – has NOT been demonstrated. A plethora of confounding factors – weight cycling, trauma, medical exclusion, the impact of weight stigma (to name just a few)- are systematically ignored by o*esity researchers, but they’re enormously important.
A genuine exploration of the complex relationship between health and size was not the agenda for Rubino’s PR paper. Those pushing for disease classification are also those who stand to profit most from it. The real controversy we need to discuss is how weight loss industry interests have overtaken any pretence of objective scientific endeavour.
3. A Biased Steering Committee
Rubino hand picked a 7 member steering committee including: Rachel Batterham, David Cummings, I Sadaf Farooqi, Carel le Roux, Geltrude Mingrone, Nathalie Farpour-Lambert and Edward Gregg. Only 2- Gregg and Farpour-Lambert- declared no financial ties with pharmaceutical companies, but even here there’s a pre-existing bias: Farpour-Lambert previously authored a position paper for EASO declaring they were ‘convinced’ that childhood obesity is a disease.
Batterham left the committee halfway through the project to become Senior Vice President (and shareholder) at Eli Lily. You cannot make this up!
Rubino’s disclosures list him as the sole director of the mysterious Metabolic Health International (MHI), a not-for-profit organisation. 3 other members of the steering committee – Cummings, le Roux, and Mingrone, are listed as active directors of MHI*, but they did not disclose this to The Lancet.
The MHI was founded in August 2021, just before Rubino’s monthly ‘commission’ meetings began. Company paperwork states that the MHI aimed to ‘produce, publish and disseminate advice, clinical guidelines and recommendations’ – and to improve access to obesity ‘treatments.’
Although there’s no disclosure of MHI’s source of income, between 2023 and 2024 their bank balance doubled from £31 000 to £62 000. They’re listed as partners in a livestream of the Commission paper’s launch, a 4 hour extravaganza featuring a full 5 minutes devoted to discussing how ‘excess adiposity can directly induce illness,’ and 42 minutes on why the disease/no disease distinction ‘is not the question’ people should be asking.
Of course it is possible that the MHI was fully funded from the pockets of Rubino and his colleagues, but it’s also not unheard of for pharmaceutical companies – particularly Novo Nordisk – to fail to disclose the full extent of their ‘support’ of health care professionals and organisations, particularly in the UK. As an ‘education’ institute, the MHI could conceivably earn money in the future by ‘training’ other health professionals to diagnose ‘pre-clinical’ or ‘clinical’ o*esity, so there’s a definite profit motive operating.
4. Conflicts of Consensus
Rubino and his compromised steering committee picked ‘58 international experts**’ to be on the Commission, claiming to have gathered ‘a balanced representation of relevant medical disciplines and different world regions’.
The fact that 47 of these ‘balanced’ experts disclosed multiple conflicts of interest with the weight loss industry isn’t mentioned***. Critically, as in Rubino’s weight stigma ‘consensus paper’ no-one with expertise in dissenting views of higher body weight was asked to join the group, so we’re again starting what’s been promoted as a dispassionate scientific process with a stacked deck. This is the scientific equivalent of conducting a study asking ‘Do witches exist?’– authored entirely by magic-fearing men.
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The field of o*esity is hopelessly compromised- not only by conflicts of interest, but now by conflicts of consensus. Groupthink is antiscientific and dangerous. Lots of people once thought there were witches in the village, but they turned out to be wrong, and countless innocent women were murdered as a result.
Modern science is not immune to groupthink: In 2020 a group of 27 prominent scientists published a statement in The Lancet condemning other scientists who were questioning whether the origins of the COVID 19 outbreak could have been manmade, calling them ‘conspiracy theorists’. The letter effectively intimidated the scientific community from investigating the source, but it turned out that the lead author and other key figures had significant conflicts of interest.
5. Astroturf ‘Lived Experience’
People who have actually experienced life in a larger body are flavour of the month in o*esity research, but they’re invariably the same small group of ‘patients’ who have been meticulously media trained by weight loss pharmaceutical companies, mostly Novo Nordisk. Rubino and his friends made a big deal out of announcing the inclusion of two ‘commissioners’ (AKA co-authors, but props for making them sound like everyone works at The Pentagon) with ‘lived experience of o*esity.’ But these are not your average fat-people-on-the-street. Both ‘patient advocates’ are more curated than a Kardashian family vacation.
There’s Vicki Mooney, an Irish national with multiple financial relationships with Novo Nordisk and Boehringer Ingelheim. A former plus size model and author of the body-positive book ‘Curve-a-licious,’ she then had weight loss surgery and is now the Director of the European Coalition for People Living With O*esity (ECPO), an astroturf patient organisation funded by Novo Nordisk, Eli Lily, the EASO (an organisation also funded by pharma), and bariatric surgery company Medtronic.
The other voice of ‘lived experience’ is Joseph Nadglowski****, President and CEO of The O*esity Action Coalition (OAC), a weight loss pharma-funded lobbying ‘charity.’ Oozing more charisma than a Kennedy, Joseph is a tireless lobbyist for government subsidised weight loss drugs and surgery. Joe popped up as the single voice of ‘lived experience’ in Rubino’s previous ‘consensus’ propaganda paper on weight stigma.
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The fact that the Commission authors are proud rather than embarrassed about their flagrant tokenism and use of industry funded patient puppets speaks volumes about the level of entitlement in this field.
6. Who Needs Ethics?
Real scientific research, especially when it potentially impacts millions of people, requires official ethical approval prior to starting. Ethical clearance ensures that researchers will behave safely and ethically, and that the proposed methodology is scientifically valid. Because they believed that the questions being asked of commissioners weren’t unusual, ethical approval was ‘not deemed necessary’ by Rubino and co. This is a major red flag: there’s been zero checks and balances on this group.
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While it may be true that the co-authors wouldn’t be affected by the process (other than increasing their bank balances), the millions of people potentially impacted by these recommendations most certainly will be.
7. Corrupted Delphi ‘Method’
Adopting the same terrible methodology of the weight stigma paper, the Lancet paper used a corrupted ‘Delphi-like’ process: omitting the critical first stage of open questions, replacing them with forced choice ‘agree’ or ‘disagree’.
In what they called the ‘pre-Delphi’ phase (which is not a thing), they gave commissioners ‘preparatory’ questionnaires with forced choice responses on the question ‘is obesity a disease,’ alongside other questions designed to ‘define a suitable model for the definition of illness in obesity, principles to guide the definition of clinical obesity, and identification of its diagnostic criteria’.
These ‘preparation’ questions already assume that an illness caused by size exists, rendering the entire process of Delphi moot. A rigorous exploration of weight science is desperately needed, and this could have been an opportunity to do so. This is especially important when exploring highly contentious subjects, particularly ‘controversies’ which have largely been whipped up by those with vested interest seeking to milk their o*esity drug cash cow.
8. Missing Information
In spite of being excruciatingly long-winded, important information describing how the Commission operated was missing. 9 ‘subcommittees’ were formed on the basis of ‘volunteering’ and ‘specialised expertise,’ but there’s no list revealing who was on each subcommittee. This is a problem: we’ve got no way of understanding the level of involvement of each author in each subcommittee, and no way to trace the level of conflicts operating within each subcommittee (though admittedly, we can assume this is high given that 84% of the authors are conflicted).
On this topic, no mention is made of how the group managed their enormous conflicts during the process- clearly, many of the authors stand to gain hugely from the potential outcome of their recommendations, including, crucially, Rubino and the directors of the MHI who were on the steering committee. But the management of only one author’s conflicts was described, and this was an egregious example: Batterham, who left to become a shareholder and VP at Eli Lily. In this case, the only measure taken was that she had ‘no active involvement’ for a measly 2 weeks prior to taking up her new job. The revolving door between the o*esity research community and weight loss industry money is a massive problem, totally ignored by the interdependent o*esity ecosystem.
9. Feelpinions And Industry-Funded ‘Special Guest Stars’
Here’s a quote from the paper which I actually agree with:
‘Whether o*esity is a disease or not is quintessentially a medical question. As such, it should be addressed with the rigour of scientific inquiry, using arguments grounded in clinical and biological evidence.’
But by now, ‘rigorous scientific enquiry’ was on life support, and things were taking a turn for the worse. Faced with straightforward questions like ‘how does o*esity directly cause illness,?’ rather than turning to established science- such as systematic reviews and meta-analyses- they ‘relied on narrative reviews and experts’ assessment:’ in other words – the opinion of the conflicted Commissioners. They even admitted this was a design ‘weakness,’ but doubled down, claiming that the nature of the questions asked by the Commission ‘required expert interpretation of existing evidence and insights rather than a focus on quantitative data analysis’ (p35).
This is utter bullish*t. It’s not beyond the realm of science to examine the objective evidence for or against a discrete disease process in fat human bodies. The fact is, they avoided rigorous science because it wouldn’t have given them the conclusions they so desperately sought.
My next point is the death blow to science. I’ve never read a scientific methodology in which experts watched ‘invited presentations’ from ‘special guest stars’ selected by the Steering Committee, but this is exactly what happened. Among this group were Professor Donna Ryan and Dr Arya $harma, two of Novo Nordisk’s star ‘key influencers’. Over the last ten years, Ryan has earned over $1 million from Novo, and we met Dr Sharma in Part 1 of this series: the comedic o*esity physician and peddler of the ill-fated EOSS. Canada doesn’t require physicians to disclose how much they’ve pocketed from Big Pharma, but Sharma’s academic publications reveal that he’s consistently received money from Novo Nordisk.
Readers are not told of the content of these ‘presentations,’ just that the speakers gave ‘further input by presenting reviews of evidence on specific topics’ (p5). What could 2 of Novo’s biggest spin doctors- both of whom have traveled the world convincing people that o*esity is a disease- have added to the Commission’s rigorous groupthink process?
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10. Conflict of Consensus (Again)
In a massive flex, prior to publication (before the peer review process was completed- cheeky!), Rubino and his cabal sent out the ‘methods and conclusions’ of their PR masterpiece for ‘formal endorsement’ from 78 organisations. They weren’t even asking for feedback, just ‘endorsement’- another example this group’s arrogant use of forced agreement.
The index lists 76 groups: most (41) are o*esity organisations, o*esity surgery societies, or weight loss companies linked to the authors. There’s 1 ‘patient’ group – the Novo-funded ECPO.
Worryingly, over 30 medical associations, including the Royal College of Physicians in the UK- read this scientific bloodbath and ‘endorsed’ its conclusions. Sneaky, unpublished ‘research’ seeking organisational ‘endorsement’ bypasses all the normal methods by which medical groups assess medical diagnostic criteria.
We need to be very, very wary of precedents like this. If Pfizer convinced a bunch of paid-off erection researchers to invent a ‘floppy dick disease process’ and sent the advertorial ‘paper’ to multiple medical organisations for ‘endorsement,’ all before publishing, they’d likely be marched off the premises quicker than you could say ‘Viagra’. But this is o*esity research, which relies so heavily on pre-existing biases against larger bodies that outrageous conduct like this is a walk in the park.
Right, I’m off for a well deserved gin and tonic! I’ll see you soon for the next instalment, where I’ll (finally) dive into Rubino’s ‘recommendations.’ We’re going to explore the idea of ‘excess adiposity,’ and unmask some intriguing facts about human body size which somehow got left out of the Lancet sharticle!
Stay strong diet culture dropouts,
Louise x
*I’ve decided to revert to using a * in the word ‘o*esity’ because I’m in dire need of resistance! I know I’ve gone back and forth on this issue a few times, but I’m at my wits’ end and fed up to the back teeth with ‘O’ word BS!
** Only 56 authors are listed in the final paper- no explanation is given as to what happened to the other 2.
*** In her deep dive on the Lancet’s Clinical O*esity paper, Ragen Chastain has done an impeccably thorough job investigating each of the authors, and discovered multiple undeclared conflicts – well worth a read.
**** Joe is also absolutely not larger bodied. It’s weird.
If you are struggling with issues relating to food, your body, exercise, or with an eating disorder, I can help. I have offices at Flourish Kirribilli, in Sydney, and am also available for online appointments. If you’re a health professional looking for hep with providing weight-inclusive care I also provide clinical supervision, and my books are currently open.
