Flipping the Script on Attitudes About Obesity

For those living with overweight or obesity, weight bias and stigma can be very real. The growing use of GLP-1 medications to treat obesity has the potential to change that reality for many. It may also change some market realities for food companies.

Health-care professional and obesity policy advocate Ted Kyle has been thinking about the impact of obesity on individuals and society for decades, and in 2009, he founded a Pittsburgh-based company called ConscienHealth, which focuses on evidenced-based prevention and treatment of obesity.

Too often, Kyle says, obesity is viewed as a character flaw rather than a health problem. That attitude has contributed to bias-based health policies that are expensive and ineffective.

After starting his career as a registered pharmacist and working for a drugstore chain, Kyle transitioned into roles in brand management, marketing, and policy with pharmaceutical company GlaxoSmithKline (GSK). There he worked on GSK’s smoking control business, which included Nicorette gum and NicoDerm CQ nicotine patches.

Based on their work with tobacco dependencies, Kyle and his colleagues wondered if there was an opportunity to develop science-based weight management products. “The first step in trying to figure out a business opportunity in consumer health care is to listen to people and understand their needs,” Kyle says. “And the more I listened to people, the more I heard about the impact that this condition [obesity] has on their lives.”

At GSK, he led the company’s efforts to bring the first nonprescription weight-loss product ever approved by the U.S. Food and Drug Administration to market. Since founding ConscienHealth, Kyle has worked to help clients develop regulatory, policy, and business strategies that align with the perspectives of obesity experts. He devotes half of his time to nonprofit advocacy with organizations including The Obesity Society, the STOP Obesity Alliance, and the Obesity Action Coalition.

In this interview, Kyle shares some of his thoughts on the impact of GLP-1 drugs on public health and the food industry.

How did your work on weight management products at pharmaceutical company GSK lead to your career in public health?

There was more bias and stigma [associated] with obesity than there was any kind of science or effort to genuinely help people. And so the more I saw that and the more I saw the tremendous unmet need, the more I came to think this is something that we can work on for a very long time before we get it right.

How are GLP-1 medications changing the way we think about—and treat—obesity?

For just about 20 years or more, I’ve been working with experts in the field and working toward an understanding of obesity—that it’s a biological thing first and foremost. And we’ve been talking for a long time, really until we were blue in the face. But what the GLP-1s have done is demonstrate that something that is really biologically active makes a huge difference. And when people have their lives transformed by taking a medicine that treats this condition, suddenly all the debate about “Is it behavior or is it biology?” goes away.

And what that means is that people, when they see that, and loved ones [experience] such a big effect from finding medical care for this condition, people get it that, “Oh, this is simply a medical condition.” All the stigma, all the bias, all the assumptions that people are just stupid and eating the wrong things really hasn’t been helping. I’ve known that for a long time. And people who live with obesity kind of know it. It’s just very satisfying to see the world coming around to understanding the medical truth of this condition.

What impact will the advent of GLP-1 medications for treatment of obesity have on public health in the long term?

Well, I think gradually the scale of delivery for care will come to meet the need. And right now we’re not even close to meeting the need for these medicines. The list prices are high, the actual prices that insurance companies and pharmacy benefit managers pay is coming down quite a bit off that list. Prices will be coming down simply because the size of the need is so great. So the scale for delivering care will grow to meet the need, both in terms of the ability of pharmaceutical companies to offer drugs at a scale that can meet the need for so many people who can benefit from it, but also the providers who can actually deliver that care and follow up on that care and do it competently. And people are racing to try and figure this out, but the need is so great that there’s a lot of work to do on that.

So that’s sort of where the future lies. There are folks who have studied this and say, it’s going to be a very bumpy road, but we’re going to get to a place just like we did with hypertension and high cholesterol and prevention of heart attacks through good cardiovascular care where we’re doing much better for the people who are affected by obesity.

How much is known about the long-term impact of GLP-1 medications on health?

The truth is, these GLP-1 agonists, the drugs that work this way, have been used for more than 20 years. So they’re not really new. What’s new is actually taking obesity seriously and using these medicines that are more effective for obesity than earlier generations of these GLP-1 agonists in a thoughtful and wise way.

Photo by Brian Kaldorf

Are there any potential negative ramifications of GLP-1 drug use?

I would say the principle negative ramification is that health disparities are widening because of this. And that’s not to say that the medicines are bad, but our approach to using them is bad in that the people who tend to get access to these medicines right now are either wealthy or privileged. And [obesity] is a condition that disproportionately affects people who are on the other end of the spectrum. And so those people with the most need have the least access to this care that they so greatly need. And that’s just wrong.

Because these drugs diminish appetite and often change food preferences, the food industry has been abuzz with discussion about how GLP-1 medications will impact sales. What do you foresee in terms of bottom-line impact on the food industry, both short term and long term?

I think it’s kind of unknown. … I’m hopeful that it will bring people to realize that the model for food marketing needs to change right now. A food company prospers by figuring out how to sell more units of their products, how to innovate and bring products to market that people will buy more frequently in higher quantities and repurchase because they really like it.

There’s this concept, for instance, of healthy snacking. And when that is used as a tool for stimulating people to buy more units of food, the end result is probably not better health. And so my hope is that the business model for food will evolve toward quality over volume so that we are trading people up to food that they can enjoy in a more healthful way, food that will promote healthier patterns of eating, albeit not necessarily larger quantities of food consumed. That is the sustainable model for food marketing and for the food business in the future, in my view.

What about now? Do you see opportunities for food companies to develop different kinds of products in response to the GLP-1 drugs?

I think that food companies have an opportunity to take a really hard look at the quality and value of what they sell and the food culture that they influence through their marketing efforts. And it is not easy. It will not be easy to do, but they will need to think about ways to evolve toward a business model where they prosper based upon selling people a higher quality of food that people enjoy in patterns that are more healthful than the patterns of consumption that are more dominant now that promote obesity.

What role, if any, do you think the food industry has played in the current public health crisis?

I would say that the food environment has been one of four major factors that have driven the rise in obesity. Now people don’t really know how the food environment has driven the rise in obesity. People speculate about that. And at one time, they were speculating that the problem [was] high-fat foods. So through the ’80s and ’90s, it was like, we need healthier foods in the food supply, and so we’ll come out with low-fat cookies and low-fat everything. And how did that work out? Well, it didn’t work out all that well.

And then the next phase was to say that the problem with the food supply was too much added sugar and refined carbohydrates. So we have low-carb everything. We have high-protein this and high-protein that, and we have defined sugar as toxic and if you look at USDA (U.S. Department of Agriculture) stats on per capita consumption of sugar and sweeteners, that has gone down since the year 2000. But at the same time, obesity has continued to rise. So gee, that didn’t seem to be the final answer. So now the final answer is thought to be ultra-processed foods.

Well, the common thing about all those threads of thought is that it is the substance of the food that is the problem and that these awful food companies are going around formulating foods that will cause obesity. And I’m here to say that the food environment that is driving obesity is about more than the substance of food. … The marketing of food is a factor because the idea is, “let’s put food at our fingertips that is fun to eat on every occasion.”

You mentioned three other factors contributing to the public health crisis. What are they?

Another factor is the physical and tech environment that puts us into lives where we are less routinely active. Stress and distress are metabolic triggers of obesity. And the increased stress and distress that we experience in our current environment, especially around social determinants of health, have a lot to do with triggering obesity. And then, finally, drugs and chemicals can disrupt immune function. There are studies out there that about 10% to 20% of adults are taking drugs that will actually cause them to gain weight. And then on top of that, we are exposed to an increasing level of endocrine-disrupting chemicals from plastics and other sources of pollution that cause us to gain weight. And those effects might be small, but over time and across generations, they can add up. I think the food industry has lots to answer for, but you can’t hang it all on the food industry.

What are your thoughts about the Nova food classification system where the concept of ultra-processed foods originated?

I think the Nova classification system raises more questions than it really answers. There’s research that suggests, well, there’s something going on here. Precisely what is not really clear. And I think that particular tool is kind of a blunt instrument. And the questions that it raises are part of the reason why the Dietary Guidelines Advisory Committee came to the conclusion that it might be premature to issue broad guidance about ultra-processed foods.

Adding to that is the thought that food is more complicated than the characteristics of individual foods. So it is the overall pattern of eating. And a person can have a fairly healthful diet, eating some carefully chosen ultra-processed foods, and a person can have a fairly unhealthy diet eating poorly chosen whole and unprocessed foods. So foods are just so, so complicated. And then when you layer onto that, the patterns of eating, it makes it even more complicated. And, ultimately, it’s the patterns of how you consume food that say a lot about what the outcomes will be. It [Nova] raises more questions than it answers.ft