O is for Obesity….
Back in the days, we saw a fat lady sing,
Her song rich and lovely, our hearts would soon ring.
And with her size so big, we silently mocked her,
But we never thought once she should just see a doctor.But that has all changed. It’s obesity not fat,
A medical label wearing a medical hat.
Dieting and exercise, everyone agrees,
Ain’t the modern way to tackle “chronic” disease.She’s caught a new tune, she’s no easy cynic,
And she gets the right needle from the right clinic.
The fat melts away, that drug is quite clever.
As long as she takes it forever and ever.
Welcome to the inaugural edition of The Sick Hustle Dispatch. I’m Alan Cassels, drug policy researcher, author of four books, student, and scholar of the world of medical hype. I have spent 30 years as an independent drug policy researcher, critiquing aggressive pharma marketing and disease-mongering. I believe we are all subject to the sharp end of the pharmaceutical industry’s profitable con of transforming everyday aches, normal aging, social ills, and common fears into lifelong pill-swallowing customers. And in much of my writing this is what I hope to expose.
Back in 2005, with Australian journalist Ray Moynihan our book Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients laid bare the playbook: drug companies, with their legions of PR flacks, paid experts, funded patient groups, and compliant media, systematically widen the boundaries of illness to expand their markets. High cholesterol? Shyness? Mild bone thinning? Restlessness? All rebranded as chronic, widespread conditions, burnished with a patina of respectable medical terminology and paving the way for a lifelong diet of pills. That’s the way the model works.
You see, cures are passée. Cures kill markets. Getting the population properly hooked on a pharmaceutical treatment for a ‘chronic’ condition is where the serious money is.
Our core insight was simple and grim: it’s far easier—and infinitely more profitable—to convince healthy people that they’re sick than to develop genuine cures for the truly ill.
Twenty years later, the hustle is bigger, slicker, and more dangerous than ever.
Watching that hustle unfold with weight loss drugs feels weirdly ominous, like watching a slow-moving train wreck you can’t peel your eyes off of. You know there’ll be carnage and bodies, vast fortunes won and lost, and humanity left just a little bit poorer. We have often documented the pharmaceutical industry’s proven ability to create enormously lucrative markets overnight, by inventing and selling diseases. Now watch as all that ingenuity and energy gets pointed at one of the biggest problems bewitching humanity: human fatness.
Redefining the Disease
The most central issue stems from the very definition of disease.
By way of poignant parable, in the mid-1990s the drug industry and their surrogates had managed to bamboozle the medical world that pain was the “Fifth vital sign,” a card trick that opened the door to the widespread use of opioids (like Oxycontin). This redefinition of pain treatment—through industry-funded textbooks, and lectures—meant our doctors were soon writing routine prescriptions for some of the most addictive substances on earth for everything from simple arthritis or back pain to tooth extractions.
This was similar to how the companies inserted themselves into medical societies and treatment panels, redefining levels at which doctors should treat high blood pressure, blood sugars, or high cholesterol, (lowering them and widely expanding the numbers of citizens treated). Now, makers of one of the most lucrative drug classes in history are using their weapons-grade propaganda to go after the big kahuna, obesity.
Just switch the goal posts, redefine the label, and then supply the treatment. It’s easy when you have more money than God. This sleight-of-hand, which firmly places blame on your “genes” instead of your lifestyle or your socio-economic status will someday be considered as scandalous a catastrophe as a man-made virus escaping from a Chinese lab. Scandalous, and human-caused, because there is no mystical “obesity gene” taking over our lives, but redefining it this way (similar to how Big Pharma redefined “pain”) will allow makers of weight loss treatments to colonize millions of new customers.
As evidence of the shifting goalposts, one only needs to examine a definition-changing study from 2025, vastly increasing our estimates of obese Americans by adding “anthropometric” measures such as waist circumference, waist-to-hip ratio and waist-to-height ratios, leading to estimates that up to 75.2% of US adults have obesity.
Gaining too much weight so that it impairs your health is overwhelmingly linked to diet, exercise, environment, poverty, and ultra-processed food, yet these behavioural, social, and environmental factors get eclipsed by the theory of the “chronic relapsing brain disease” requiring ‘medical, science-based’ cures.
Oprah, in her new book Enough asks that we “step back and look at obesity for what it really is.” Speaking with the certitude of a top-tier celebrity that obesity is not about willpower and burning more calories than you consume, it’s “a chronic medical condition rooted in the body’s own regulatory systems, which are responding to our current environment.”
There’s no irony when she calls this the “crucial shift—from blame and shame to science and treatment.”
As the sellers of sickness are so good at doing, they’ve taken a social/environmental and behavioural condition and turned it into a medical one, feeding an insatiable appetite for an expensive, ineffective, and ultimately deadly drug which stops working the moment you stop taking it.
This is disease-mongering at its peak, redirecting important energy that could make us all healthier, and pouring it into chemical treatments and creating a lifelong, expensive dependency.
The Ongoing Story of GLP-1 Inhibitors
The GLP-1 juggernaut—drugs such as Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound, Trulicity, Victoza, and Saxenda– have undoubtedly become a massive phenomenon.
Admittedly some portion of people consuming these drugs might find that the quality and length of their life has improved. Well-meaning clinicians—who are genuinely trying to help morbidly obese patients and diabetics who feel stuck—might use these drugs as a way to kickstart important lifestyle and behaviour changes. However, we know the drugs are part of an experiment whose ultimate outcome is unknown. Even Oprah can’t tell us how long or how healthy a person will become if they take GLP-1 Inhibitors for the “rest of their lives.” Only time will tell how well humans adapt to a widespread chemical alteration of their appetites.
History has not been kind to weight loss drugs: even a brief peek back into the last 30 years of drug treatment for weight-loss reveals an unmitigated story of disaster and failure.
As with any massive uptake of a new drug, already lawsuits are beginning to pile up, mostly centred on gastrointestinal effects such as gastroparesis. Drug labels warn of “fatal malnutrition” as well as vision loss and assorted psychiatric impacts. Fresh studies confirm rapid weight regain—and returning health risks—after stopping the drugs. Most people can’t tolerate the side effects of these drugs and stop them.
As of early 2026, the GLP-1 frenzy shows no signs of slowing—despite price negotiations, new oral formulations, and even WHO guidelines endorsing long-term use for obesity as a “disease.” Novo Nordisk and Eli Lilly continue to dominate a market projected to hit $157 billion by 2035, with 2025 sales already topping tens of billions for Ozempic/Wegovy and Mounjaro/Zepbound.
Seven Deadly Sins
The world’s current fixation on GLP-1s is possibly the most egregious disease-mongering exercise humankind has yet seen, representing moral sin on a massive scale. That made me think that the Seven Deadly Sins, also known as the capital vices or cardinal sins, are a useful lens to examine the phenomenon. They are “deadly” because they are believed to be the root causes of other sins and moral corruption. They include:
Pride (Vanity/Hubris): Probably the mother of all sins, pride is an excessive belief in one’s own abilities, qualities, or self-importance, without regard for others. Pharma and the experts in their employ are arrogantly rewriting medical reality—pushing obesity as an inevitable “chronic relapsing disease” driven by faulty hormones and genetics. The self-deception in downplaying the centrality of behavioural solutions to weight loss and positioning the GLP-1s as revolutionary miracles, is hubris at its height. Pride goes before the fall and in this case this “superior” biomedical fix eclipses and denounces humbler societal solutions.
Greed (Avarice/Covetousness): The amount of money in this class of drugs is truly mind-boggling because the size of the patient population is so large. One media commentator in Canada said that 50% of the population should be on a GLP-1. Given the grossly inflated prices of these products, the enormous revenue stream pouring in is being used to buy whatever is needed: the doctors, the media, the scientists, the pundits, the consumer advocates, and the governments and insurers who are being pushed relentlessly to pay for all this madness. The greed feeds an ecosystem for supporting and expanding markets beyond reason and common sense, silencing critics and monopolizing the narrative.
Wrath (Anger): Having followed drug safety controversies for decades and speaking to lawyers involved in GLP-1 lawsuits, I can feel the growing rumble of rage, and desire for revenge by those harmed. The class action lawsuits over the more obvious adverse effects such as stomach paralysis, vision loss, and psychiatric effects are gaining steam, but that is the tip of the iceberg. As more of the unknown unknowns come to light, manufacturers will trot out the usual plausible deniability arguments. Billions are being set aside to fight the inevitable lawsuits coming as mainstream and medical media are suppressing any criticism of the medicalization of obesity with that tired trope of “Science Denier” plastered on anyone questioning the wisdom of these drugs. Indeed: plenty of anger to go around.
Envy: The human proclivity to covet or desire what others have (traits, success, possessions) makes envy a key marketing tool, stoked by the likes of Oprah Winfrey, Elon Musk, and other so-called influencers. Those celebrities who flaunt their dramatic drug-induced transformations make the rest of the world envy their “Ozempic body,” and build resentment towards those who are blocking access to the drugs. All of this, of course, drives off-label use, black markets, and inequity where it seems that only the rich can access the “perfect” thinness. With the drugs soon to be available generically, and prices dropping dramatically, soon price alone will not be a barrier to anyone who’s envious enough.
Lust: An intense or unbridled desire for pleasure can extend to sex, power, or indulgence. Here, the lust is for instant gratification, the dominant quick-fix allure of most drug marketing, where effortless thinness can be found, apparently, without “deprivation.” What most people need is a body size that, for them, is healthy and sustainable. The Ozempic body is the opposite of that, rewarding lust for instant gratification over sustainable health. Still tempted? Google “Ozempic face” and read about a future of gaunt, aged facial appearance—featuring sunken cheeks, hollow eyes, sagging skin, and wrinkles. But don’t worry, the drug industry is good at producing drugs to treat the harms produced by the ones they’re also selling.
Gluttony: If you think gluttony has gotten us into this mess, and reversing it is the only way out, I don’t think that’s fully true. If we have a nation full of overweight people, then why do we persist with accepting a society engineered for inactivity? Most of us drive, sit, or lounge through our waking hours, consume cheap, nutrition-less, calorie-heavy food, and are otherwise unable to eat or exercise our way to a more appealing body shape. There isn’t a drug that’ll fix the underlying disease of living poorly.
Sloth (Acedia): This might be the ultimate lazy shortcut: why address root causes (food systems, activity, poverty, or cities not built for exercise) when a weekly shot bypasses that effort? The marketing preys on what we all seem to want and feeds off our aversion to hard work. Promoting drugs as the easy path while discouraging lifestyle changes as “insufficient,” is a type of societal sloth. We could do a lot better.
These sins aren’t accidental—they’re baked into a system that profits from myth-making and the hustle endures. Time to reject the seduction and demand real solutions. Retake your agency.
Let me leave you with a quote from psychologist Roger McFillin whose Radically Genuine podcast is packed with wisdom and whose understanding of the selling of disease is top notch. He writes mostly about mental health but these words below could apply to any disease.
Tell a man his fate is genetic, and you have accomplished something powerful. You have located the problem somewhere he cannot reach. You have removed his agency. You have made him dependent on a system that will manage his inevitable decline rather than addressing the factors actually killing him. You have created a customer.
Amen to that.
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