Diab*sity: The Weight Loss Industry's Favourite Couple

The marriage between diabetes and ob*sity is nothing more than a PR stunt dressed up as medicine — and it's been running for 25 years. In this episode, I expose how the pharmaceutical industry invented a fictional condition called prediabetes to create a market of 115 million Americans, and then quietly funded the guidelines that put weight loss at the top of the treatment agenda. This one's personal: I have diabetes and I'm done carrying the shame they built for us.

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Transcript

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Hello, and welcome to the Fat Doctor Podcast. I am your host, Dr Asher Larmie, and it is Wednesday the 29th of April. I know this because I am recording today's episode — episode 16 of Season 6 of the Fat Doctor Podcast — the day before. It's Tuesday the 28th right now. It's very last minute for me. I'm not usually this under-prepared, but it's because I've been very busy. Writing a book. And then editing a book, then proofreading a book, then fixing all the mistakes in the book, then formatting the book, then uploading the book, and getting ready for publishing. But it is ready, it's uploaded, it's done.

It is available to pre-order — the Kindle, the e-book is available to pre-order. The book will be released on the 20th of May. There'll be more details to follow at the end of this podcast. So yeah, I've been a bit busy. I'm super excited. And everything that I've been talking about in Season 6 of the Fat Doctor Podcast has been — or is — in the book.

I appreciate that not everybody reads books. I'm going to be honest with you, I don't read non-fiction books very often. So that's fair enough, and I want you to be able to have all of this information, which is why I'm sharing a lot of it in the podcast. Today is no different. Today I'm going to be talking about something called… I hate to say it, but I'm going to say it anyway. Diabesity.

You ever heard of that one? Diabesity. That is what happens when the medical profession — and I really mean it, the medical profession has done this — ships diabetes and obesity, marries them off, puts them together, turns them into a couple, writes fanfiction about them. That's what they've done.

And this one's personal for me, as many of you know. I am a diabetic. In fact, if you've been with me from the beginning, I remember episode 3 of Season 1 of the Fat Doctor Podcast. I was talking to Dr Gregory Dodell, and I was telling him how terrified I was of developing diabetes. I was like, I'm terrified of the diagnosis, I'm so afraid to go and get my blood checked, because I'm just so sure they're going to tell me I'm diabetic. That was 2020. This is 2026. I can't remember when I was diagnosed — 2021, maybe? Because it was post-COVID. I'd had COVID a couple of times, and then I got diagnosed, so it wasn't that much later that I got diagnosed myself. So this is personal.

I am not the only fat diabetic out there, but there is a lot of shame that we carry with this diagnosis, isn't there? And I'm going to talk to you about why that is today. This is what this episode is all about. Why do we associate diabetes and obesity, and why do we feel so much shame?

Now, I'm going to be using the O-word — obesity — quite a few times in this podcast. I use it quite often now. It's a really horrible word. It makes my skin crawl, it puts the hairs on the back of my neck up every single time I say it. It's gross. But I say it anyway. I say it because that's what they say, and I refuse to be afraid of a word. That's what they say, so that's what I'm going to say. But let it be known that there is really no such thing as obesity. It actually just literally means fat, and the first chapter of my book basically just proves, beyond a shadow of a doubt, that it's a made-up term. It's not a real disease, as they'd like us to believe.

The reason that we think it's a disease is because of the pharmaceutical industry, and that's what I'm going to be focusing my attention on here today, and for the next couple of episodes, actually. It's all about how the pharmaceutical industry has done this, has created this. Now, society has hated fat people for a very long time. It predates the pharmaceutical industry. However, turning fat into a disease? That's on the pharmaceutical industry. They were the main players, they were the ones driving this the whole time. They paid the WHO in 1998 for a report that basically says: this is what obesity is, this is a disease, and this is how we define it — using BMI — and by the way, it's an epidemic, and we're going to call it an epidemic, and that's what the report's title is going to say. The pharmaceutical industry paid for that. Specifically, drug companies who at the time were about to release their weight loss drugs.

The National Institute of Health in the US followed suit a year later, and here we go. Twenty-five years — a quarter of a century later — here's where we're at.

So let's talk about the pharmaceutical industry, and how they did this, and what this has to do with diabetes. They have a strategy. It's a very obvious strategy — you don't have to be a genius to understand it. First of all, they create the market. Then they fund the research. The research into all of their drugs is funded completely by the drug companies themselves — not independent researchers. Then they fund the guidelines. Pretty much all of the guidelines processes, all of the approvals — the FDA, NICE, et cetera — it's all paid for by drug companies. Then they train doctors. And they lobby politicians. And they market directly to you, the consumer. They create this incredible PR campaign that is relentless. And then they make money. That's their strategy.

At the beginning of the century, drug companies got together and decided that they needed to improve their PR, essentially. And they chose type 2 diabetes as the ideal vehicle for selling weight loss. It was like the cracker, you know, that you place the cheese on. The cheese being the weight loss product. The cracker — the vehicle — was diabetes.

And there were many reasons for this. Number one, it's a very common condition. It's very easy to screen for — just takes a blood test. It's asymptomatic; you don't know you have it. It's a frightening condition. Nobody wants to get it. But it's also manageable. Most people know somebody who has diabetes. It's scary — you might lose a limb, or drop dead of a heart attack or a stroke — but it's also manageable. It's not so scary that you're going to shut down, but it's scary enough that you're going to take notice. Probably scarier than high blood pressure for most people.

They knew they needed something that was going to really scare people. And so they chose this condition and said: we're going to make the two synonymous with each other. Because diabetes just used to be a medical condition, like any other. But now it's a fat person's condition. Fat people get diabetes; diabetics are all fat. And anyone who doesn't fit into that box — thin and diabetic, or type 1 — is an outlier. To be fair, that is true; we're talking about type 2 diabetes here. But the majority of people are fat and diabetic. They have diabesity. Just give them a label, a name.

So there's a lot of shame around this diagnosis. We carry this shame — us fat diabetics — we carry it because we've been conditioned to experience it. And that makes us very vulnerable to marketing. Even if you are anti-weight loss, if you get a diabetes diagnosis, things change very quickly.

So how did it all happen? Let me paint you a picture. Back in 2001, the American Diabetes Association PR department decided that there was a term — impaired fasting glucose, impaired glucose tolerance — that neither really excited anyone, nor made sense to laypeople, and doctors were a bit non-committal about it. They wanted to get people to take this condition more seriously. So they coined the term prediabetes. It was a public relations exercise, not a scientific one. It was just branding.

And diabetes is a perfect condition for that. You can't have pre-arthritis, you can't have pre-sleep apnea, you can't have pre-asthma. You either have it or you don't. But diabetes is one of these things — like blood pressure — where your blood sugar is allowed to go up to a certain point, and once it tips over, then it's diabetes. Before that, it's not. So they decided that the little bit in between — the buffer zone — let's turn that into a medical condition. Let's call it prediabetes. So that's what they did.

And the problem with this is that the "pre" part of the prediabetes diagnosis implies that eventually you're going to become diabetic. Except you're not. We know this from many, many studies. The best study out there is a 2018 Cochrane review, and it found that most people who are diagnosed with prediabetes never actually progress to diabetes. Most people. In fact, people who have what they call impaired fasting glucose — because they don't use the term prediabetes; it's not a real thing — can return to normal levels up to 11 years later. Probably longer; that's just the longest recorded in the evidence. So it's not a guarantee, it's not even a safe bet — most people won't develop diabetes.

So this idea that, oh, if you have prediabetes you're going to get diabetes unless you do something — that's a lie. And it was always a lie. We kind of always knew, to a degree, that it was a lie, because experts were saying from the beginning: this isn't a real thing, that's PR, that's not science. But the American Diabetes Association was very strongly pro-prediabetes, and the CDC went along with it, because that's what happens — organisations like the CDC and NICE listen to the charities and patient organisations like the American Diabetes Association.

So we have this situation where there is a made-up condition, and people are being diagnosed with it, and they're being told to lose weight. Why? Why are they being told to lose weight? Why have we put two and two together? Well, that's all because of a study that came out around the same time — 2001 or 2002. It was the Diabetes Prevention Program: a three-year randomised controlled trial, over 3,000 participants recruited between 1996 and 1999. A big study. These were people who had impaired fasting glucose — what would soon become known as prediabetes. They were separated into three groups. One group had an intensive lifestyle intervention — in other words, they went on a diet and lost weight. One group was taking metformin, a medication known to improve insulin resistance. And one group was the control.

Initially, in that first three-year period, they found that people in the lifestyle group had a lower incidence of developing diabetes. So did the people in the metformin group, but the lifestyle group did better, and the control group had the highest incidence. And they said: there you go, proof. Weight loss works. They wrapped it up in a nice bow, presented it to everybody, and said: here's proof, here's a big study.

Turns out they were wrong, because when you look at the long-term data, there is no difference between the weight loss group, the metformin group, and the control group. If anything, weight loss and metformin possibly delayed the development of diabetes in those who were going to develop it anyway — remember, most people don't. It delayed that diagnosis by a couple of years, maybe three years, something like that. So that's all it did. It certainly didn't prevent it.

And as I've explained in previous episodes, diabetes in itself is not actually a condition you need to be particularly concerned about if your blood sugar is relatively low. It's generally asymptomatic. The problem is that it can lead to issues down the line — heart disease, limb amputations, eye problems, kidney problems. So the biggest question we need to be asking is not whether people develop diabetes, but whether losing weight — with a prediabetes diagnosis — prevented them from having a heart attack, a stroke, anything that actually matters. And the answer is no. It didn't prevent anything. Lifestyle interventions made absolutely no difference whatsoever in the long term.

Just in a short enough time period that they could wrap it up in a bow, present it to the world, and go: here's proof. But all of that long-term data came much later — 2015 onwards, 2020, some of it. This was all happening in 2001. The PR campaign was happening in 2001.

In 2009, an international expert committee rejected the term prediabetes. The CDC, instead of going, alright, most of the world thinks we're wrong — maybe we were wrong — literally doubled down. Not only is prediabetes a thing, they said, but we're going to widen the diagnostic criteria, make the blood sugar levels even lower so we can diagnose more people with prediabetes. They assured us that in doing so they were going to reduce the number of heart attacks and strokes. Did they? No. Of course they didn't. That made no difference whatsoever. The only difference it made was to create an incredible marketing opportunity for drug companies, and for everyone selling weight loss. Now they're not just selling weight loss — they're telling you they can help you prevent diabetes. What a wonderful marketing opportunity.

The CDC's budget for diabetes prevention went from $66 million in 2010 to $173 million in 2017. At the same time, the cancer prevention budget plummeted. They took money from cancer prevention — which, by the way, is very evidence-based and very important — and put it into diabetes prevention, even though it has absolutely no impact on the number of heart attacks, strokes, cancer, eye disease, kidney disease. It's completely ineffective. But drug companies are loving it. Where do you think that $173 million is going? A lot of it is going to the weight loss industry.

And it gets worse than that, because millions of people around the US are being diagnosed with a hypothetical, asymptomatic condition. It increases health anxiety. It increases insurance premiums the moment you get that label. It increases the number of weight loss prescriptions. So who's benefiting? The weight loss industry, the insurance industry. And who's suffering? Us. That's the way it works. That's the strategy.

Diabesity is more about branding than it is about facts.

And the thing you have to understand is that the American Diabetes Association — the ones who were pushing for prediabetes to be a thing — it was all about PR and branding. They are sponsored by the pharmaceutical industry. Their founding pathway sponsors are Novo Nordisk, Eli Lilly, and Sanofi. Novo Nordisk and Eli Lilly have the second and third biggest selling drugs on the market in 2025. Eli Lilly went from being an outsider to being the highest grossing drug company in the world in 2025 — solely because of Mounjaro. These are the same companies funding the American Diabetes Association, paying for all of this diabetes branding and marketing and PR.

In 2020, Novo Nordisk was essentially a diabetes company. It started off as an insulin laboratory, and most of their business has been diabetes for 100 years. Eight out of every $10 they earned before 2020 was for diabetes — mainly from insulin. Then in 2021, they released Wegovy — semaglutide for weight loss. Ozempic, actually, is not supposed to be prescribed for weight loss. Prior to 2021, Ozempic was being prescribed for diabetes. It was earning Novo Nordisk a fair amount of money because it was a novel diabetes drug and everyone was prescribing it, partly because it caused weight loss — but that was for diabetes. 2021, Wegovy — not Ozempic, Wegovy — was licensed by the FDA, and then shortly after by most countries, for the treatment of obesity — just for the treatment of fatness. And then Ozempic sales skyrocketed, Wegovy sales skyrocketed, and by 2025, semaglutide and Ozempic accounted for two-thirds of Novo Nordisk's entire global revenue. Eight out of every $10 was for diabetes treatment — that's 80% of their income. And now, two-thirds of their income is from weight loss.

It's very obvious what's going on here. The market for treating sick people is limited. But the market for treating healthy people is unlimited — sky's the limit. If you can convince healthy people that they are sick, and that they need to take a treatment to lose weight so that they will prevent an illness — sky's the limit. According to the CDC, over 115 million Americans — that's 1 in 3 — have prediabetes. Talk about creating a marketplace. It's kind of genius, if you ask me. They're not stupid; they knew what they were doing.

So just to remind you: in 2001, they created a disease. Solely a PR campaign. Absolutely no evidence. In spite of all the warnings from international experts around the world, from 2001 until today. Everyone saying: there's no such thing as prediabetes, stop spending money on it, there's no point in treating it, if we treat prediabetes nothing happens, we don't benefit people in any way, the only people benefiting are drug companies and the weight loss industry, stop taking money away from cancer prevention, stop wasting money on drug companies. In spite of all the experts saying this repeatedly, over and over again — we're living in a world where diabesity is so very much conditioned, it's ingrained in our society. We are conditioned to believe that the two go hand in hand: if you're fat, you're going to be diabetic, and so you need to lose weight to prevent diabetes. And that's just one of the many conditions associated with being fat, of course. There are so many.

But I picked diabetes because it's personal, and because it's the biggest one. And even with the NHS — the doctors who are clinical directors responsible for a particular area of medicine — the one responsible for diabetes is also responsible for obesity. They go hand in hand. It's a joint job. They're responsible for diabetes and obesity together, because the two things are so closely related now that the NHS can't even be bothered to have a separate director for both. They just join them together. Like I said, they've married them off — they've shipped them.

And it just impacts you and me. Because, like I said, it's the shame. It's the way that people can say: you're going to get it. And if you go, actually, technically that's not true — they say you're just making excuses, you're cherry-picking data. They refuse to believe you, because it's a narrative. A narrative driven by 25 years of PR. You can't convince people they're wrong. They know they're right. Even if you shove a ton of evidence in their faces. The damage has been done. They were very clever about it.

And so if you don't have diabetes, your doctor looks at you — stares at the size of you, waves their hand at you — and they're horrified. Your blood sugar is normal? They keep checking it over and over again, just in case the first test was wrong. Because it's not possible that you can be fat and have a normal blood sugar. Same with blood pressure — you can't have a normal blood pressure, you're fat.

And also, if you're like me — fat and diabetic — oh, they sit back in their chair, cross their arms, and very smugly tell you: well, you know, that was bound to happen, wasn't it? And what are you supposed to say to that? How are you supposed to feel? It's my fault. I did it to myself. Because I ate the wrong things, didn't exercise enough, didn't take care of myself. It's because I'm fat. I'm so ashamed, I can't admit it to people. You carry that stigma with you everywhere you go. And it affects the way you eat. It affects the way you move. It affects the way you live your life.

It's not the condition itself — because diabetes is relatively easy to treat. We have lots of drugs, there's a protocol, almost every healthcare professional knows how to manage it. It's not an obscure disease with no treatment. Of all the diseases you might get, it's fairly middle of the road. Just take a pill. It's asymptomatic. There are far worse conditions out there. But the shame — for me, the shame of it — I don't know what's more stigmatising: having a mental health diagnosis, or having a diabetes diagnosis and an obesity diagnosis. I think they're all stigmatising. Why don't we treat diabetes the way we treat asthma — just a medical condition, we'll treat it like one? Although I've heard that people get blamed for being fat and having asthma now as well. Joint pain — it's because you're fat. Sleep apnea — it's because you're fat. Liver problems — fat. Blood pressure — fat. Heart disease — fat. Yeah, there are a lot of conditions.

Anyway, that's my little spiel on diabetes.

In 2023 — and this is really important — the American Diabetes Association updated their guidelines on the treatment of type 2 diabetes. In 2023, weight loss and blood sugar control are now officially of equal importance. They are just as concerned about your weight as they are about your blood sugar. That was not the case before. Weight loss was always mentioned in the guidelines, but now it's at the very top. Right at the very top: the two mainstays of treatment — manage the blood glucose, manage the weight. That was in 2023.

The American Diabetes Association. In 2023, they received just over $10 million from Novo Nordisk and Eli Lilly. That represents 40% of all the pharmaceutical donations they received. Of all the pharmaceutical donations, 40% came from just two drug companies. $10 million is a lot for one year.

This is a charity. You can go and look at what the American Diabetes Association does — a lot of it is lobbying and persuading healthcare professionals to promote drugs. They're sponsored by drug companies, so there's a definite conflict of interest. But specifically, in 2023, $10 million spent by just two drug companies — who happen to be the only two manufacturing weight loss injections right now. Very convenient. And all of a sudden, weight loss goes to the top of the list. Right there, black and white, page one. Lose weight. They stop short of recommending GLP-1s to lose weight, but it doesn't matter, because doctors put two and two together.

So now, if you're one of the 1 in 3 Americans — one of the 115 million Americans — who happens to have a prediabetes diagnosis, what's going to happen? The American Diabetes Association says weight loss is very important, and whilst they stop short of saying you should prescribe Wegovy or Mounjaro, your doctor is going to prescribe Wegovy and Mounjaro. All thanks to a made-up condition that was a PR stunt. Funded by the pharmaceutical industry. That's what's going on. Just so you know. It's up to you what you choose to do about it. But you need to know what's going on.

And it's just one of the many things I'm going to be exposing in my book — No Weigh: Everything You've Been Told About Weight Loss Is a Lie. It is available to pre-order on Amazon right now. Publication date is the 20th of May — just three weeks away. If anything you've heard today resonated with you, then this book is for you. Everything we've covered in this season is laid out in full, with all the evidence, in one place. There are more than 200 clinical references in this book. So it's all backed up. Not that I'm expecting you to look at the references — I'm just telling you that I'm not making this up. There is evidence. If you want to know the evidence, if you want to see sources, it's right there. Back of the book. Last 35 pages or so.

The link to my book is in the show notes. Pre-order it now and it will land on your device on the 20th of May. I'd love you to order the e-book. You can also order the print book if you prefer, but I'm very happy for you to order the e-book.

If you know someone who needs to hear this — whether it's a friend, a family member, a healthcare professional, anyone you think might listen — please share this episode with them. Especially if you've got someone who has been diagnosed with diabetes or prediabetes, or is worried about diabetes, or is wondering why everyone won't stop talking about diabetes. Please share this episode with them. Tell them about the book. Tell them it's all going to be in there, from start to finish.

No Weigh. That's the name of the book. N-O W-E-I-G-H. No Weigh: Everything You've Been Told About Weight Loss Is a Lie.

Thank you very much for listening. Next week, I'm going to be doing a podcast episode on GLP-1s. I know there are many podcast episodes out there on GLP-1s — I'm putting my own spin on it, and I encourage you to join me. We'll talk then. In the meantime, have a great week, and take care of yourselves!