Rethinking the label anti-obesity medication
Authors: Stuart W Flint
Journal: The Lancet Diabetes & Endocrinology (2024)

Pharmacotherapy approved to support people living with obesity has received much attention from the scientific and clinical communities, and general public. Clinical trials have reported substantial effects of these medications, including weight reduction and a reduced risk of cardiac events in people living with obesity.1Jastreboff AM Aronne LJ Ahmad NN et al.Tirzepatide once weekly for the treatment of obesity.N Engl J Med. 2022; 387: 205-216Crossref PubMed Scopus (743) Google Scholar, 2Rubino D Abrahamsson N Davies M et al.Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial.JAMA. 2021; 325: 1414-1425Crossref PubMed Scopus (409) Google Scholar, 3Wilding JPH Batterham RL Calanna S et al.Once-weekly semaglutide in adults with overweight or obesity.N Engl J Med. 2021; 384: 989-1002Crossref PubMed Scopus (1314) Google Scholar, 4Lincoff AM Brown-Frandsen K Colhoun HM et al.Semaglutide and cardiovascular outcomes in obesity without diabetes.N Engl J Med. 2023; 389: 2221-2232Crossref PubMed Scopus (134) Google Scholar I believe the terminology used to describe these medications is important, both in scientific and clinical literature, and in popular media. In scientific and clinical literature, these medications are referred to as anti-obesity medications. The word anti is oppositional by definition. Instead, the language used around these medications should be supportive. Empirical evidence has shown pervasive weight bias surrounding current language used to talk about obesity, and that the use and impact of stigmatising and harmful language relating to obesity could lead to internalised weight bias, negative emotional responses (eg, disgust), and reduced health-care engagement.5Brown A Flint SW Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity.Clin Obes. 2021; 11e12470Crossref Scopus (7) Google Scholar, 6Brown A Flint SW Batterham RL Pervasiveness, impact and implications of weight stigma.EClinicalMedicine. 2022; 47101408Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar When considering pharmacotherapy treatments for long-term health conditions, terms such as anti-cancer or anti-kidney disease are avoided. These treatments are instead referred to by their clinical function, such as chemotherapy or immunosuppressant medication. In instances where the word anti is used, it often relates to the function the medication serves—ie, anticoagulant instead of anti-stroke. The term chemotherapy, coined by Paul Ehrlich, originates in the idea of using chemicals to treat a disease. Similarly, terminology surrounding pharmacotherapy in people with obesity should reflect function. An alternative terminology could be medications for obesity medications for obesity, which removes the word anti but highlights that these medications are specifically for obesity and not for widespread use by the general population. A phrase that reflects the function of these medications could also be used, such as metabotherapy, which is aligned with the word combination used by Ehrlich when coining the term chemotherapy. The term metatherapy combines metabolic and therapy as these medications affect a range of metabolic pathways that are associated with glucose metabolism, energy homoeostasis, and inflammation.4Lincoff AM Brown-Frandsen K Colhoun HM et al.Semaglutide and cardiovascular outcomes in obesity without diabetes.N Engl J Med. 2023; 389: 2221-2232Crossref PubMed Scopus (134) Google Scholar It is imperative that the terminology around treatments for people with obesity avoids generating stigma towards the people who could benefit from them, while also reflecting their clinical nature. Consistent terminology can also highlight, as in the case of GLP-1 receptor agonists, that these are not for use by people without obesity. In popular media, these treatments are often referred to as weight-loss injections or drugs, which only serves to infer to people who are not clinically eligible that they can be used as a weight loss measure, regardless of the fact that it might be unsafe to use them in this way. Alongside the portrayal of these drugs in popular media, are concerning reports of their use among celebrities or influencers for aesthetic purposes, rather than as a clinical treatment. These reports also contribute to misconceptions about the required multidisciplinary support that should be offered as part of any clinical treatment programme. I call on the scientific and clinical community to cease the use of the term anti-obesity medication, and to use terminology aligned to pharmacotherapy and long-term health conditions. I propose terms such as medications for obesity or metabotherapy, and call on policy makers, governments, media, and other public facing sources for their support in the use of consistent, scientific and clinical terminology. I also call for these sources to build on public awareness by emphasising that these medications are not for popular use but should only be available for patient groups in whom they have been clinically tested and approved. It is it is critical that governments and health systems that approve clinical treatments take adequate steps to both educate and counteract misconceptions that might lead to improper use. Finally, I call on social media platforms to restrict content that infers and, in some instances, promotes the use of these treatments among people who do not meet the clinical eligibility criteria for which they have been clinically approved. The continued dissemination of inaccurate information relating to pharmacotherapy for obesity represents both a patient and public safety concern. Content that promotes the similar use of treatments for other health outcomes would not be accepted, and nor should it be in the case of obesity. A combination of improved public awareness and restriction of the promotion of the improper use of medications for obesity might also support greater access for people living with obesity or with diabetes. These are the clinical populations for whom the medications have been approved, and who continue to face limited access and supply. I declare researcher led grants from the National Institute for Health Research, the Office of Health Improvement and Disparities, Doncaster Council, the West Yorkshire Combined Authority, and Novo Nordisk; and support for attending academic conferences from Johnson & Johnson, Novo Nordisk, Devon NHS Integrated Care Service, the UK Parliament, and Safefood. I am President of Scaled Insights. Scaled Insights is an Artificial Intelligence company.