In this edition of Med Op-Ed: how far should the FDA go in policing celebrity drug promotion, does a new obesity classification risk cutting people off from treatment, and is it time to stop leaning on BMI alone?

Celebrities, GLP-1 Hype, and Regulatory Blind Spots

The FDA regulates what drugmakers say about their products — but it has far less control over what happens when a celebrity posts about a drug on social media. Writing in The New England Journal of Medicine, Nils Krüger, MD, MPH, and colleagues argue that this gap is real, growing, and shaping how patients ask for GLP-1s.

The Context

• The gaps show up in real cases: An Oprah Winfrey special featuring paid company consultants downplayed GLP-1 risks, resulting in the FDA sending warning letters to manufacturers Novo Nordisk and Eli Lilly and Company. Yet, a Serena Williams campaign for Ro leaned hard on benefits and to date has received no FDA pushback.
• Separate research from the National Opinion Research Center found 7 in 10 prescribers have been asked about a drug a patient saw on social media, and nearly half went on to prescribe it. Some of these drugs carry a real risk for serious side effects, and compounded versions get even less oversight. Kids and teens are especially vulnerable to online marketing.
• One study found more than 740 highly engaged posts about major drug classes racked up 57 million views — 43% posted by celebrities or influencers. Most didn’t disclose sponsorship, and less than half mentioned any risk.

In Their Own Words

“Patient-facing content that now circulates pervasively on social media platforms can blur the distinction between health-related information about prescription drugs and misleading advertising….We believe stronger guardrails are needed to protect the public and to keep pace with the ways in which patients now encounter drug promotion.”

Read it: When Celebrities Prescribe — Regulating Drug Promotion on the Internet

Redefining Obesity: Is ‘Preclinical’ a Backdoor to Rationing Care?

The Lancet Commission proposes splitting obesity into “clinical” and “preclinical” categories, which might lead insurers to use the preclinical label to deny treatment to people who don’t yet have complications. Adam H. Gilden and Barbara McGowan, writing in Obesity, said that fear is understandable — but so far, it hasn’t actually happened in the US.

The Context

• If fully adopted, The Lancet Commission’s clinical vs preclinical split could disqualify 12% of patients with a BMI ≥ 35 from bariatric surgery and 38% from obesity medications (OMs) — skewing treatment toward older, sicker patients and leaving some people with diabetes but no other complications out in the cold. The authors call this a real limitation, not a hypothetical one.
• There is currently no evidence that US payers are using The Lancet criteria to deny coverage. Bariatric surgery coverage has held steady (falling procedure volumes likely reflect people choosing OMs, not restricted access), and in the UK, guidance is still based on trial data, not the new labels.
• US OM coverage is shrinking, mostly because employers are nervous about how many people qualify — even as cash prices creep toward the cost-effective range. The authors’ bottom line: Prioritizing clinical obesity may be a pragmatic stopgap where money is tight, but it shouldn’t become an excuse to delay care for preclinical patients.

In Their Own Words

“We do not support delaying care for individuals with preclinical obesity (as defined by The Lancet Commission). As the costs for highly effective OMs decrease, we believe the goal should be to offer treatment to more people, not fewer. Early intervention in any disease process is critical to avoid costly complications and improve the health of our nations.”

Read it: Using The Lancet Guideline to Ration Obesity Care — Real or Imagined?

Using BMI Alone Misses Half the Patients With Obesity

BMI is quick and cheap but misses roughly half the people who have excess adiposity. Clara E. Tandar; John C. Lin, MD; and Fatima C. Stanford, MD, writing in Nature Reviews Endocrinology, laid out why major societies — the European Association for the Study of Obesity, The Lancet Commission, the American College of Cardiology, and the American Association of Clinical Endocrinologists — are converging on a broader definition: Obesity isn’t just a number on the scale; it’s excess fat plus evidence it’s causing organ dysfunction.

The Context

• BMI’s accuracy shifts by age, sex, and race or ethnicity. Compared with imaging, it produces plenty of false negatives — one meta-analysis put its sensitivity for detecting excess adiposity at only about 50%.
• Waist circumference beats BMI at predicting abnormal lipids, blood pressure, and glucose. Patients with a “normal” BMI but a high waist circumference still carry higher mortality risk — the flagged cutoffs are 102 cm for men and 88 cm for women.
• The authors recommend checking BMI at every adult visit and adding waist circumference and waist-to-height ratio annually. A BMI ≥ 35 is generally enough on its own to diagnose obesity; below that, waist-based measures help sharpen the cardiovascular risk picture.

In Their Own Words

“By systematically pairing refined anthropometric assessment with structured complication staging and EHR [electronic health record]-integrated workflows, clinicians and health systems can more accurately identify individuals at risk, intervene earlier, and allocate intensive therapies to those most likely to benefit. Implemented at scale, this approach can support precise, patient-centered, and equitable obesity care, thereby reducing the burden of obesity-related morbidity and mortality.”

Read it: Diagnosis, Staging and Management of Obesity: A Synthesis of Contemporary Guidelines

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.