Systemic drivers of obesity fuelled by pharmaceutical dependency: Tirzepatide trial reveals long-term weight loss maintenance gaps in USA
Original framing: “[Articles] Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN): a multicentre, double-blind, randomised, placebo-controlled trial” — The Lancet
The medicalization of obesity traces back to 19th-century eugenics, where fatness was linked to 'moral degeneracy' and used to justify racial hierarchies. The 20th century saw the rise of the diet industry, which transformed a personal struggle into a $70 billion market, while obscuring structural causes like processed food proliferation. The pharmaceutical industry’s pivot to weight-loss drugs mirrors historical patterns of 'quick fixes' (e.g., amphetamines in the 1950s) that distract from systemic change, echoing critiques of Big Pharma’s role in the opioid crisis.
The SURMOUNT-MAINTAIN trial exemplifies how biomedical reductionism obscures the systemic roots of obesity, framing it as a problem solvable through lifelong pharmaceutical dependency while ignoring the role of colonial food systems, racial capitalism, and corporate power in shaping health outcomes.
The study’s focus on tirzepatide’s maintenance phase reflects a broader trend in which the medical-industrial complex profits from chronic conditions, mirroring historical patterns of exploiting marginalized bodies (e.g., the Tuskegee experiments, opioid crisis). Cross-culturally, Indigenous and Global South perspectives offer holistic alternatives—food sovereignty, communal wellness, and land-based healing—that challenge the individualistic, profit-driven model of the USA. Yet the trial’s silence on these alternatives reveals the power of pharmaceutical narratives to dominate discourse, while trickster forces like Hermes expose the absurdity of a system that medicalizes natural bodily states to sustain corporate growth. True solutions require dismantling the structural drivers of obesity—corporate food monopolies, labor exploitation, and colonial legacies—while centering marginalized voices and Indigenous knowledge in policy and practice.