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All Fired Up


Aug 1, 2019

DO NOT MISS this explosive episode of All Fired Up! The Obesity Collective is a sparkly new organisation gaining attention nationwide for its ostensibly ‘collaborative’ approach to ‘tackling’ obesity, whilst simultaneously erasing weight stigma (oh please how much of a mindboggle is that?!). But who are they really? My guest this week is Mandy-Lee Noble, anti-diet dietitian from Nourished Approach in Brisbane, and she has had a GUTFUL of industry interests penetrating our health narrative. Once we dug a little deeper into The Obesity Collective we found that the tentacles of Big Pharma have a firm hold on the goolies of all our so-called ‘independent’ Obesity organisations. You won’t believe how deep this goes. Next time you read a hysterical news headline highlighting the terrors of Obesity Epidemic, know who funded it!

 

 

ShowNotes

 

 

  • Content warning and Apology !! This episode contains multiple uses of the word ‘obesity’. This is a stigmatising term and not one I nor my guest Mandy Lee Noble are comfortable using. However, as the topic of this episode is all about an organisation called The Obesity Collective, there are a lot of “O” words used.
  • There are also lots of swear words to make up for it!
  • My guest, dietitian Mandy-Lee Noble is all fired up about conflicts of interest and vested interests in health care, and within weight centric research and industries in particular. Mandy & Louise fell down a massive rabbithole when they accidentally stumbled across a particularly troubling example of this, the subject of today’s podcast.
  • During a HAES Australia leadership meeting, we came across the “Obesity Australia” website, and their “fact sheets” were rather hilarious.
  • These fact sheets contained not just outdated, but frankly very bizarre advice regarding weight loss.
  • “Obesity Australia” are ostensibly one of Australia’s leading ‘authorities’ on obesity, and many of the country’s leading researchers, practitioners etc, are involved. And yet the fact sheets look like they were thrown together by either a year 9 school boy or an elderly person with very little connection to the real world.
  • One of the ‘fact’ sheets was about drinks you should be having to lose weight, written by former head of Obesity Australia John Funder, whose diet tips have come directly from 1935. He recommends “egg flips” and “Miss Muffett’s favourite tipple, curds and whey”.
  • Does ANYONE know what an egg flip is? And what about curds and whey??
  • He then goes on to rage against fish and chips, and goes on a bizarre rant telling us to strip the fish and chips of batter, and ‘put it amongst the pickled onion’.
  • What is he even talking about here? Where did the pickled onion even come from? 1970?
  • John also has a huge grudge against potato crisps, which he says are ‘lethal’. Now Mandy, being a bit of a rebel, has on several occasions since reading that thrown caution to the wind and deliberately and vigorously eaten said lethal crisps, and has lived to tell the tale.
  • Another tip was to ‘drink coke zero’, to ‘fool yourself into eating slightly less’. This tip appears to have come from Weight Watchers in circa 1980. Mandy believes this may work through the process of being forced to eat slightly less because you have no teeth! Seriously what’s with the totally SHIT advice here? This is from a highly regarded and very knowledgeable researcher?
  • It’s encouraging behaviours that overall are not hugely health supportive, all in the name of weight loss!
  • John also ‘recommends’ that a ‘rule of thumb’ is to always weigh the same as you did at the age of 25, even if we have less bone and muscle mass as a result. All of the actual research would contest that: there is a plethora of evidence to show that as we age we do get heavier, and preserving muscle mass as we age is very health supportive. It’s quite literally the opposite of what science tells us. People at a higher body mass are actually often healthier than smaller people as they age.
  • Some of the information in the fact sheets started to lead us down a rabbit hole. One of them, written by Professor Joseph Proietto (who does not reveal his association with multiple pharmaceutical companies), states that most people who lose weight will not keep it off, and will regain, so he recommends the use of appetite suppressing medication.
  • As we read, it became apparent that an agenda was peppered throughout these ‘fact’ sheets’.
  • Repeatedly given is the message that most people who lose weight will regain it; that obesity is ‘a disease process’. We experienced a growing sense of unease - just who are Obesity Australia, and who is behind these organisations that claim expertise and leadership in the area of so-called ‘obesity’?
  • People right now may not be hearing from Obesity Australia as much as “The Obesity Collective”. Now, this might sound like a trendy cafe or a tragic boy band, but it’s actually them who have featured in the media quite a bit in Australia recently.
  • “The Obesity Collective” was launched on 31 July 2018 (happy first anniversary!), at a swanky reception at the Charles Perkins Centre, the University of Sydney’s $500 million hub for the study of ‘lifestyle diseases’ such as obesity. Headed by Professor Stephen Simpson, who also happens to be the head of The Obesity Collective.
  • The Obesity Collective describes itself as “a group of committed individuals and organisations from across the community, working together to take on the obesity challenge together, with empathy and a whole of society perspective”.
  • Doesn’t that sound warm, fuzzy….and a little bit scary!
  • Mandy thinks they’re a bit ‘fast and loose’ with words like empathy!
  • So Stephen Simpson is the academic director of the Charles Perkins Centre, and the executive director of Obesity Australia.
  • Professor Simpson’s research interests are probably not what you’d expect:
  • “Developing an integrative modelling framework for nutrition using insects that has been applied to a wide range of organisms, from slime moulds to humans, and problems, including the dietary causes of human obesity and ageing. He has also revolutionised understanding of swarming in locusts, with research spanning neurochemical events within the brains of individual locusts to continental-scale mass migration.”
  • How much has he studied empathy within locust populations? Potentially more than he’s studied it within humans!
  • Professor Simpson has accomplished a lot in his career, he went to Oxford University, and he’s one of these charismatic figures. He is definitely bringing a hip, urban edge to the Charles Perkins Centre, and also to the Obesity Collective, really trying to make it look engaging, warm and welcoming.
  • He’s trying to portray the Obesity Collective as a great collection of warm and wonderful people who are going to combat not only obesity but obesity stigma, which is...an interesting challenge.
  • Professor Simpson recently appeared on ABC’s The Drum program, on a show about obesity and fat shaming. Professor Jenny Lee was on (academic and fat activist), as was someone with ‘lived experience’ who was actually one of the Nepean Obesity Service’s weight loss ‘success stories’.
  • Sarah Harry from Body Positive Australia was also featured, but did not appear live and wasn’t given enough screen time as someone in a larger body not riddled with internalised weight stigma. Jenny Lee was also somewhat sidelined by Professor Simpson, who remained resolute in his attitude that body size is a disease.
  • The message of the show was definitely skewed towards eradicating the ‘problem’ of obesity, but let’s be nice about it. No amount of empathic-sounding buzz words can disguise the true intention.
  • Professor Simpson asked Jenny Lee to join the Obesity Collective, but she declined.
  • So the Obesity Collective’s launch at the Charles Perkins Centre in 2018 was funded by Novo Nordisk, a pharmaceutical company traditionally known for its production of insulin, but with a flooded market, has recently turned its hand to producing weight loss drugs.
  • The Collective is trying to recruit different organisations and individuals including: NGOs, Academics, Young Entrepreneurs, The Private Sector, Community Leaders, Government, Healthcare Providers and people with lived experience.
  • We couldn’t see any evidence that people with lived experience are actually a part of the Collective, there’s just this statement on their website that they’re there.
  • Novo Nordisk have described themselves to be ‘active members’ of The Obesity Collective. It’s very prominent on their website that Novo is the Collective’s main funder.
  • So what have the Obesity Collective achieved in their first year? They’ve been really good at raising the panic button. They’ve been in the media - not just the Drum, but radio, and print media. So they’re getting attention.
  • They released a report called “Weighing in: Australia’s Growing Obesity Epidemic”. The report outlines statistics around the prevalence of obesity in Australia and bangs on about how much fatter we’ll be at this rate and how many diseases are caused by fatness. The cheekiest part of the report is where they re-cycle the statistics on the apparent economic cost projections of obesity, which they took directly from Obesity Australia’s 2015 report which was prepared by Pricewaterhouse Coopers and sponsored by Novo Nordisk. (more about them later in the conversation). !!
  • The 2019 report did not disclose any funding from Novo Nordisk, it said it was authored by The Obesity Collective without naming who actually wrote it. But substantial sections have been taken directly from a previous report which had unlimited funding from Novo Nordisk.
  • The Obesity Collective have also released a ‘fact sheet’ in which they say that obesity is ‘not just about personal responsibility’.
  • Obesity Australia & The Obesity Collective just don’t get that the very framing of obesity is stigmatising. They really don’t get stigma. They actually think weight stigma is their tool to try to get people to lose weight (like take weight loss drugs!).
  • And weight loss drugs like Novo Nordisk’s Saxenda, if you can tolerate the side effects, will maybe give you very modest weight loss results - if you can believe their own industry funded research!
  • In 2015 in Australia, Novo Nordisk got TGA approval for their new weight loss drug, Saxenda.
  • Since then, they have been quite aggressive in their tactics in raising awareness of how ‘awful’ obesity is and how urgent it is that we ‘act’. Through avenues such as these organisations, Obesity Australia & The Obesity Collective.
  • The Obesity Collective also provided a submission to the Senate Select Committee on the ‘obesity epidemic’ - as did HAES Australia.
  • In their submission to the committee, they said ‘we are working to transform the way society thinks, speaks and acts on obesity to reduce the impact obesity has on all of us”.
  • What a mind fuck of a statement! In one part, they claim to be working to de stigmatise obesity, in the next breath, they stigmatise it all over again.
  • What they are aiming to do - eradicate larger people - is implicitly stigmatising.
  • They think stigma is a barrier to weight loss.
  • They want people not to feel stigmatised coming in and asking for weight loss drugs.
  • Mandy & Louise have been blown away by how pervasive the industry funding is in this area. We don’t have enough time or woman hours to delve completely, but this rabbit hole is massive.
  • In their submission, The Obesity Collective stipulate the causes of obesity to be genetic, epigenetic, and biological drivers. But on the next breath they say this does not excuse people from committing to try to lose weight. So again, in one breath stating how body weight is not within our control, in the next demanding that we as individuals keep trying to control it.
  • This thread runs throughout: on the one hand, all of the recognition of the science is there, and an almost HAES-y style of writing, and on the other, we’re back to keep trying to lose weight!
  • Same science: different conclusions.
  • They also referred to the Novo-funded report from 2015 in their submission, saying that the overall direct costs of obesity to Australia in 2011-12 Australia were determined to be $3.8 billion, while indirect costs were calculated to be $4.8 billion (PWC 2015). But if you compare even this figure (which Mandy really doesn’t think is totally convincing), considering that our total health expenditure for 2011-12 was $150 billion, then it’s just a drop in the ocean of our health care spending, hardly the health sector crushing scenario we’re often given.
  • The same report also argued that the costs incurred from the stigma of obesity, including discrimination across education, work, and social spheres, is ‘incalculable’. It’s so much more than the actual cost! They are using stigma for their own agenda.
  • These ‘reports’ put out by bodies such as the Obesity Collective or Obesity Australia are always the same format: 1. Obesity is bad, and getting worse, 2. obesity causes all sorts of diseases, 3. obesity is going to cripple our health system, and 4. we MUST urgently act and do something.
  • And - it’s not your fault and it’s hard to fix - so - here’s some thing (ie drugs, put them on the PBS).
  • But who are The Obesity Collective? They are actually a subsidiary of Obesity Australia. Essentially, Obesity Australia are the parent company of the Obesity Collective.
  • Obesity Australia are a registered charity, and they have been in operation since 2011.
  • They describe themselves as “an independent, not-for-profit, legal entity’.
  • The ‘independent’ angle is interesting, because Obesity Australia receives most of its funding from industry ‘partners’, including Weight Watchers, Allergan (a pharma company who make the lap bands), and other pharma companies including inova and Novo Nordisk, who gave around $200 000 to Obesity Australia between 2011 and 2015.
  • In 2011, Allergan kicked in quite a bit of money to get Obesity Australia started - around $150 000. Over 3 years they kicked in around $300 000.
  • Allergan had actually gained a lot of cred for helping to fund these organisations, it helped them to be seen as a company doing ‘good’. But it wasn’t all good: Allergan, and the Centre for Obesity Research (CORE) in Melbourne received negative publicity in the media when their plans to target poor and Aboriginal teenagers for their weight loss experiments were disclosed to the media.
  • Between 2011 and 2015, Obesity Australia received just over $1 million in funding. Of this, 80% was spent on “Board Expenses” and ‘consultancy’. Of that, 30% was “Board expenses”. Tax concessions also apply as this is a charity.
  • It’s a LOT of money for all of that independence. And what exactly are these ‘Board expenses”?
  • Many of the Board members of Obesity Australia have also received other money (for consultancy fees etc) from the pharma companies.
  • Since 2015, Novo Nordisk has provided Obesity Australia with ‘unrestricted grants’ to produce reports about how dire the obesity epidemic is, and the URGENT need for interventions, including - no surprises here - pharmacological medicines.
  • It is an urgent need for Novo, because in 2015 they finally got their weight loss drug Saxenda approved by the TGA.
  • They’re not even bothering to hide it - on the Obesity Australia website you can click through to a presentation by Novo Nordisk to Obesity Australia in which they blatantly reveal that Novo are committed to ‘create legitimacy and urgency for the medical management of obesity’.
  • Really, what Novo are after is to have obesity declared a disease: if this happens, they can push their drugs more heavily and even get weight loss drugs on the PBS, a massive potential windfall for them.
  • The principles of Obesity Australia and the principles of Novo Nordisk are very much aligned with each other. Even the Charles Perkins Centre refer to obesity as a ‘disease’, when actually it’s not. In Australia, the Australian Medical Association do not classify higher body weight as a disease, nor do the World Health Organisation. They do talk about weight being a risk factor, but not a disease within itself.
  • There are many people in larger bodies with no or very few health issues, if we classify this as a disease suddenly a whole pile of people become suddenly sick.
  • How we think about our health status can really impact on our actual health status.
  • And the influence of Novo Nordisk does not end with funding for Obesity Australia, and the unlimited funding for their ‘reports’. In the newly formed Obesity Collective, 8 of their academics on their boards receive direct financial benefits from Novo Nordisk, for consultancy, travel costs, etc, another couple of academics work at an institutions that receive funding from Novo Nordisk and a further 4 people on the Board are employed by PriceWaterhouseCooper (PWC). Which is interesting, because Novo Nordisk is a well established and long existing client of the multinational auditors PriceWaterhouseCooper.
  • One of the academics enjoying funding from Novo Nordisk is Professor Stephen Simpson himself - the head of The Obesity Collective, Obesity Australia, and The Charles Perkins Centre. He has just received a grant for his research Ancestral causes of obesity: Understanding epigenetic transmission by spermatozoa; with co-author Romain Barres, Professor, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark. Professor Barres enjoys unlimited research funding from Novo.
  • This information is not being hidden, it is right there on the Charles Perkins Centre website on Professor Simpson’s information page.
  • It’s hard to find academics involved in Obesity Australia who are not being paid by Novo Nordisk in some capacity.
  • And this reaches beyond the Obesity Collective and Obesity Australia, because Novo Nordisk are busily paying our medical doctors and health professionals as well.
  • According to a news article from Crikey, Novo have spent $3.2 million over 3 years on speaker fees and for experts to sit on its medical advisory boards. Novo’s declarations show 1300 separate payments to Australian GP’s, nurses and specialists over 3 years, with recurring payments to a handful of prominent specialists.
  • Basically, Novo are hell bent on creating an air of scientific legitimacy to penetrate a potentially very lucrative market.
  • The Obesity Australia website has a ‘response’ to ‘recent media attention’ which is really talking about the Crikey series of articles. They don’t actually refute anything that was said in the articles, they simply say that Novo is not their only funding source!
  • They also said that Obesity Australia relies mainly on ‘unpaid volunteers’, which Mandy calls bullshit on! Unless these volunteers are working a million hours, this is simply not true! In their financial reports, there are less than a handful of individuals who are actually listed as volunteers.
  • It said that they have strict guidelines about industry funding and that any engagement with ‘third parties’ are passed through their industry guidelines - “Obesity Australia is transparent around funding and projects that are funded by third parties are passed through our engagement with industry guidelines. These consider the nature of the project to be funded in relation to potential conflicts of interest (real or perceived), and the degree of alignment between the commercial interests of the funder and improving the lives of those living with obesity.”
  • We do have to say that we don’t know the ins and outs of Obesity Australia’s funding from 2017 onwards as they have not posted any financial statements yet. From 2015 onwards Obesity Australia’s financial reports became a lot less detailed. In 2015, Obesity Australia changed and was taken into the Charles Perkins Centre: “Obesity Australia, founded in 2011 has now joined with the Charles Perkins Centre, which will be responsible for the day-to-day operations of Obesity Australia. Obesity Australia remains in independent legal entity and will continue to be governed by the OA Board.”
  • So we now have a lot less detailed financial information about the ins and outs of funding for Obesity Australia & The Obesity Collective, but we know that Novo Nordisk are still a major player in The Obesity Collective. Their logo is all over the Obesity Collective website.
  • It is interesting because the Charles Perkins Centre really pride themselves on actually researching the impact of industry funding on how research and how knowledge is produced.
  • None of the Charles Perkins research on the impact of industry funding has been directed towards Novo Nordisk.
  • In September 2018 there was a flurry of media attention to the Charles Perkins research which showed that industry funding had a huge impact on research outcomes.
  • Basically, corporate funding will skew the results towards industry not the people.
  • Disclosure of payments by pharma and industry is important.
  • Professor Simpson himself has had a lot to say about industry funding, coming out against Coke funding research at the Boden Centre for Obesity Research at the University of Sydney.
  • Professor Simpson said that the Charles Perkins Centre had ‘strict guidelines’ regarding engagement with industry. And Louise had a look at these, and they basically say it’s really important for the centre to engage with industry. So there you go!
  • So they are saying as long as we are transparent about our engagement with industry, it’s ok.
  • Professor Simpson is actually also the Director of the engagement with industry committee!
  • To their credit, The Charles Perkins Centre are transparent on their websites about Novo Nordisk funding their launch, about Professor Simpson’s research grant, and the unlimited research grants from Novo to write a series of reports about how awful the ‘obesity epidemic’ is, but there is a lot missing as well.
  • Off the back of these reports came a shit tonne of publicity. Louise counted 11 different news articles in which the contents of these reports were discussed by either Professor Simpson or one of the Obesity Australia board members, and not once is the industry link mentioned in any of these press releases.
  • This means that for the average person, there is no transparency. The average person would need to visit the website and trawl around to see who is funding the Obesity Collective in order to know. This is NOT transparent.
  • There is a narrative being created which is being orchestrated by big pharma.
  • Mandy has been asked to become involved in this world, but as a completely independent dietitian she declined.
  • We will do a whole podcast on Saxenda, because we don’t have time now! Because the way the research is being conducted needs to be discussed. Also, Novo have more weight loss drugs in the pipeline, and Australians are being targeted for their market.
  • With sparkly shopfronts like The Obesity Collective, positioned in prestigious universities, it’s really hard for the average person to figure out what science is really saying, and what marketing and funding is doing to how we think about all of this.
  • Sydney uni and the Charles Perkins Centre even put on an entire event called “fighting truth decay” which was all about how industry funding can get in the way of seeing the truth! And who hosted it - you guessed it - Professor Locust!
  • What a great technique to build trust, to be a university who talk about the corrupting influence of industry funding. But then to still do it???
  • Another of the Charles Perkins Centre events was about lived experience of ‘obesity’, but lo and behold they did not bother to record that!
  • Speaking of lived experience, the Obesity Collective say they have this section called the “Weight Issues Network” which is apparently for people with lived experience ‘and their carers’ (condescending much??). But Mandy and Louise could find no evidence of this actually existing. Louise even emailed them asking to join, and so far - no response…
  • In fact - CRICKETS!!
  • How ironic that the lived experience of people in larger bodies is being erased by the Obesity Collective - who do not seem to have any larger people involved. There’s not even a picture of a larger person on their website, I mean COME ON.
  • On the Obesity Australia website you can click through and see the members and they are all small. This is awful to see a committee writing about what they should do to solve the ‘problem’ of larger bodies…...with no one larger in sight.
  • Maybe The Obesity Collective need to think about the reality of inviting people to be involved in a collective that wants to literally obliterate people who look like them.
  • Representation is important, and this is not happening because this organisation cannot see past their own noses. Still stuck in 1935.
  • We’ll end on a really scary quote from a Reuters story from 2017 about Novo where the CEO is talking about taking a ‘bet’ on obesity. “I see a huge opportunity in obesity and I don’t see a lot of competitors moving into the space,” he told Reuters during a visit to London.” “Saxenda only accounts for 2 percent of Novo’s overall sales but analysts expect it to sell more than $1 billion by 2023, according to consensus forecasts compiled by Thomson Reuters. “
  • So - the big agenda is for companies like Novo Nordisk to provide funding to organisations like Obesity Australia and The Obesity Collective, to push to have Obesity declared as a disease, so they can increase the market for their weight loss drugs.
  • If they can get their drugs on the PBS, there is huge profit involved.
  • What has completely done our heads in throughout are the claims made by Obesity Collective - to be inclusive (no), to de-stigmatise (no), to be mindful of health inequalities (no), to be informed by evidence and prepared to innovate (oh my god), and to DISCLOSE POTENTIAL CONFLICTS OF INTEREST!
  • Which they do - but only if you look really, really hard. The Obesity Collective is a lovely smokescreen, and media reports are still not disclosing the funding.
  • Everyone - please post pics of you eating those ‘lethal’ potato chips!

 

Resources Mentioned

Find Mandy-Lee Noble on her website, on facebook, or email her at mandy@nourishedapproach.com.au