We’re still blaming people for obesity.

We’re still blaming people for obesity. We’re telling them, “You should be able to fix this WITHOUT medication”.

We blame them for having it. We question their discipline, their choices and their willpower. And when they seek medical treatment, we often judge them for that, too.

This post began as a frustrated, spur-of-the-moment reel about the media attention around GLP-1 medications and potential blindness. A very rare but serious medical condition known as NAION.

Vision loss is serious. Medication risks deserve investigation, clear communication and appropriate medical care. But people also deserve context.

What is the risk? How common is it? What are the potential benefits of treatment? And what are the risks of leaving the underlying disease untreated?

A frightening headline cannot answer all of those questions.

Where is the context?

Dr. Salas @drsalaswhalen made a point that stayed with me: Viagra and Cialis also carry warnings about potential vision loss.

My mother takes methotrexate for lupus. Vision problems, including sudden vision loss, are among its reported serious adverse effects. She has to see her eye doctor every 3 months.

We never hear about these in the media, as big CNN headlines.

These medications have different risk profiles and serve different purposes. We generally understand that prescribing a medication involves weighing its possible risks against its expected benefits.

People receiving treatment for obesity deserve that same consideration.

The eye condition behind the GLP-1 headlines, non-arteritic anterior ischaemic optic neuropathy, or NAION, is rare but serious and can cause permanent vision loss. Patients deserve to understand that risk and to discuss what it means for their care.

Dr. Nadolsky @drnadolsky (an obesity doctor) made an important point: “While there are lawsuits, the lawsuits are not evidence that there is an actual risk. We have to do studies. The best way to study this would be to do randomized controlled trials with a placebo vs the drug. The issue is, the incidence of NAION is so low that you would need tens of thousands of in these trials to even find a signal.” In other words, ONE possible case.

We all deserve to understand the risks of the conditions being treated.

You know what else causes blindness? Diabetes.

Diabetes can damage the eyes and cause permanent vision loss.

So how many people might avoid diabetes-related vision loss because treatment helps them manage their blood sugar? Like a GLP-1. Potentially many. This is a reminder that managing diabetes has benefits that belong in this conversation.

The risk of a medication vs the benefit of treating the condition both belong in the conversation on the decision to take it or not.

A useful discussion considers the person’s health, the benefits they may gain, the possible harms, the alternatives and the monitoring they need.

That information helps people make decisions. Fearmongering without context leaves them fearful and uncertain.

Judged for the condition. Judged for the treatment.

My frustration goes beyond how a medication risk is reported.

I think much of the reaction to GLP-1s reflects the same blame and shame that people with obesity have faced for generations.

Obesity is still widely treated as evidence of a character flaw. A lack of willpower. A failure to exercise enough or eat correctly.

And when someone seeks treatment, another accusation appears: they are taking the easy way out.

What exactly are they allowed to do?

If they struggle without treatment, they are blamed for struggling. If treatment helps, their progress is judged because they had help.

People should not have to earn access to care by demonstrating how much suffering they can tolerate.

“Gluttony” does not exist.

I have worked with metabolic health for more than 22 years, supporting people through changes in eating, fasting, bariatric surgery and GLP-1 treatment. I also bring lived experience to this work.

Telling someone to try harder does not help persistent hunger or cravings. It does not explain why one person feels satisfied after a meal while another continues to think about food.

Hunger, cravings and fullness are regulated by complex biological signals, including hormones. Genetics, sleep, stress, medications, our environment and access to food and care all play a role.

Individual choices matter, but they happen within those biological and hormonal circumstances.

What we call “Gluttony” is a moral label we’ve given to a condition where we need medical understanding.

A chronic disease deserves ongoing care.

Obesity is a multifactorial, complex, chronic disease. Its treatment should reflect that complexity.

Someone may benefit from changes in food and eating structure, physical activity, sleep support, medication, surgery or a combination of approaches. Their needs may also change over time.

We accept that hypertension, diabetes and heart disease may require ongoing care. We do not generally expect a person to prove their moral worth before receiving treatment for those conditions.

People with obesity deserve the same dignity.

Medication risks should be discussed openly. Benefits should be discussed honestly. Treatment decisions should be based on the individual person and the evidence.

Shame contributes NOTHING useful to that process.

Science has evolved. Has society caught up?

Will we start looking at our neighbours, friends and family members with obesity differently?

Will we stop assuming that someone’s body tells us how they eat, how much they move, what they have tried or how hard they are working?

Nobody wants to feel out of control around food. Nobody deserves to be reduced to their weight. And nobody should have their character put on trial because they sought medical help.

We can take medication safety seriously while treating people with compassion.

We’re still blaming people for obesity.

It’s time we stopped.