Why Weight Watchers Buying Sequence And Getting Involved In The Pharmaceutical Management Of Obesity Is a Necessary And Good Thing
In before the brutal hot takes
Oy, the media is going to be all over this, and not likely in a good way.
Yesterday it was announced that Weight Watchers purchased Sequence, a weight loss program involving virtual care and the prescription of anti-obesity medications (and full disclosure, I’ve been friends with Sequence’s founder Spencer Nadolsky for over a decade).
I’ve so little doubt that the media will be publishing horrifying takes that I wanted to get mine out first.
So here it is - this is a necessary and good thing.
Forever Weight Watchers, inadvertently or deliberately (depending in part on the year and in part on which chapter/leader), has fostered the belief that if you simply want weight loss badly enough all you need to do is try harder. In turn, this underwrites the notion that obesity is a choice and is a disorder of willpower or a simple reflection of lack of knowledge.
And while Weight Watchers absolutely has its share of long term success stories (all weight loss programs do), studies on its long term outcomes tend to uniformly show what all long term diet studies show - it’ll work amazingly well or very poorly for some but mediocre for most, and with time, with exceptions of course, weight lost is re-found.
Why? Not because people aren’t trying hard enough or don’t want it badly enough, but because we have literally thousands of genes and dozens of hormones influencing behaviours that themselves require a tremendous degree of privilege to change in perpetuity.
Happily we are finally at a place where we have the option of the prescription of safe, well-tolerated, medications that lead the majority of those taking them to sustain clinically meaningful weight losses (on the average depending on the drug of 15-20% of a person’s body weight).
No doubt some of the hot takes on this will be about somehow Weight Watchers’ acquisition will lead to the medicalization of obesity and that that’s a bad thing.
It’s not.
Yes, obesity, like high blood pressure, type 2 diabetes, osteoarthritis, and dozens more chronic non-communicable diseases responds to lifestyle change, but unlike all those other diseases, we only moralize about obesity. That’s not to say every person with obesity should be on anti-obesity medication - because like so many diseases, there are varying degrees of severity and impact - both on health and on quality of life. And physicians, unlike society as a whole or Weight Watcher group leaders are trained, capable, and comfortable with assessing whether the prescription of medication is appropriate.
Except of course, when it comes to obesity that is.
Because with obesity, physicians, generally speaking, have little to no training and like the rest of society, are fraught with weight bias.
And this is why Weight Watchers buying Sequence is not just good but necessary. Right now there’s a dearth of physicians trained in obesity medicine. Consequently many people whose only option for care for same would be their weight biased, obesity ignorant doctor will suddenly be able to access expert, thoughtful, well trained medical care.
I look forward to the day - and it will absolutely arrive - when society and medicine, consequent to time, experience, and the continued arrival of safe, useful, effective, and durable anti-obesity medications sees obesity treated just as today we see high blood pressure treated. We’ll know we get there when it’s treated as a matter of routine by family doctors with little fanfare and zero blame or moralizing. Until then I’m glad to see Weight Watchers pivot to the reality that choice alone, for a large percentage of people, is either a physiologic impossibility, or an unattainable luxury.