Big Pharma's Playbook: How the Weight Loss Industry Bought the World

The pharmaceutical industry didn't just create a weight loss drug — it created a world in which you cannot escape it. In this episode, I trace Novo Nordisk and Eli Lilly's systematic strategy to buy the guidelines, bribe the charities, train the doctors, and lobby the politicians — and I show you exactly how they copied it from the people who gave us the opioid crisis. This isn't conspiracy theory. It's a paper trail. And once you see it, you cannot unsee it. 

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Transcript

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Hello everyone, and welcome to episode 18 of season 6 of the Fat Doctor Podcast. I am your host, Dr. Asher Larmie. I'm somewhat excited about the fact that my book is coming out a week from today, and everything you're about to hear today is in my book. I'm very excited about that — I just had to tell you. Today we're going to be talking about Big Pharma, and just how Big Pharma influences your life on a daily basis, specifically when it comes to weight, weight loss, and weight stigma. It's gonna be a doozy.

Without further ado, let's just get into it. I don't have to sell this one to you. Hopefully you're invested right from the beginning.

In 2020, Ozempic — the drug Ozempic — and Novo Nordisk: $3.2 billion. In 2020, Ozempic was being prescribed for diabetes, and Novo Nordisk made $3.2 billion. That's nothing to sniff at. $3.2 billion — that's nine zeros, right? It's a lot of zeros, folks. It's a lot of money. By 2025, Ozempic earned Novo Nordisk $19 billion in one year. $3.2 billion when it was being used to treat diabetes. $19 billion when it was used to treat fatness — even though it's not actually licensed for fatness. That is no mean feat. That is special. That is 500% growth. That is not just good fortune. Something terrible had to happen to you and me in order for that to be remotely possible.

Novo Nordisk, the manufacturers of Ozempic, had a very clear strategy. First, create the market. Then pay for the research. Then pay for the guidelines. Then train the doctors. Then lobby the politicians. And market directly to you, the consumer.

We've already talked about how they created the market, and we've already talked about how they pay for the research. Let's talk about the rest.

First of all, the guidelines — that doctors like myself use to treat people in our offices, sitting on that chair, lying on that table, waiting for us to make a diagnosis and pronounce the treatment. Those guidelines are paid for by the drug companies.

For example, the NICE guidelines that approved Wegovy for weight loss — the only people in the room were Novo Nordisk, charities that were funded by Novo Nordisk, patient representatives that had ties to Novo Nordisk, and doctors and experts who had financial ties with Novo Nordisk. So they were basically the only people in the room when the guidelines were created.

The American Diabetes Association guidelines — I told you last week, or the week before — received $10 million in one year. And all of a sudden, the guidelines are saying weight loss, weight loss, weight loss.

They pay for the research and they pay for the guidelines. It's that simple. And if you're a doctor and you fancy it, take a look at the guidelines. Go to the actual evidence, look at who was in the room when it happened, look at the list of stakeholders, look at the disclosures of interests, look at all the people who are on the guidelines panel, on the guidelines committee, and see how many of them declared an interest — how many of them are funded by, or are taking money for speaking fees and conferences from drug companies, specifically Novo Nordisk and Eli Lilly. Go take a look for yourself. It becomes very clear who's in the room.

Then there is the ABPI, which stands for the Association of the British Pharmaceutical Industry. You'll have an equivalent wherever you live. This is just a lobbying group, funded by the drug industry, and they get to be in the room again — as the experts. The ABPI get to sit in on every meeting. They get to influence and shape clinical guidelines.

So they create the market, they pay for the research, they fund the guidelines. Then they train the doctors.

In Novo Nordisk's case, there's a story that shows just how unethical it is. Doctors are used to getting sales pitches from drug reps. That's part of the job. When we know we're getting a sales pitch from a drug rep, we treat it like a sales pitch — we know they're trying to sell us something, and we don't just take their word for it. We don't assume they're correct, and we don't look at that friendly drug rep and think, oh yeah, just because you're giving me a free sandwich, I'm going to trust you. We don't. But that's because we know they're drug reps. The problem is when we don't.

Let me tell you a story. In 2022, Novo Nordisk was found guilty of breaching the ABPI's code of practice. Why? Because they paid a private company to run so-called independent training for up to 13,000 healthcare professionals. 13,000 of them. It was not independent training — it was paid for by Novo Nordisk, and it was a GLP-1 sales pitch.

If you look through the details, I can't remember exactly how many slides were dedicated to GLP-1s versus one slide dedicated to all the other drugs out there. They really slated the other drugs. Basically, they presented GLP-1s as the future — the only thing you should be doing for your patients. And they did more than that. They were very sneaky. Even though there was no mention of the fact that it was Novo Nordisk behind the training, all the details of the people who signed up for this course were passed on to Novo Nordisk.

They also did this whole thing about how much money you could make as a healthcare professional from privately prescribing GLP-1s. So they gave this whole sales pitch — this is how much money you could make — and this was supposed to be independent training.

Basically, the healthcare professionals showed up thinking they were going to learn all about weight management. And instead, they got a sales pitch: if you prescribe GLP-1s, you can make this much money. And beyond that, they were given a particular form that non-doctors can use to prescribe medications — so healthcare professionals who aren't doctors can use this form to prescribe a medication without a doctor's permission. They actually handed them out. That's what they did.

That was in breach of the very strict rules that prevent — I can't remember the exact term they use, it's in the book — but basically, there were multiple breaches between 2015 and 2022. There were also lots of undisclosed payments, they were missing disclosure deadlines, they were doing all sorts of unethical shit.

It was really interesting that this was fairly well known, and people had been talking about it for a while, but it didn't become a formal complaint and wasn't acted upon until the president of the ABPI stepped down — because it turns out he wasn't just the president of the ABPI, he was also the director of Novo Nordisk UK. So the guy in charge of the ABPI just happened to be a Novo Nordisk employee — not just an employee, the top dog at Novo Nordisk UK.

So the ABPI went, that's very naughty, and slapped them on the wrist. They suspended their membership for two years. Only the eighth time they've ever done that in the history of the ABPI. The eighth time! Shocking. It was all very performative.

Very, very performative. They audited them — well, Novo Nordisk had to do their own internal audit. I love this. So Novo Nordisk gets told, you have to do your own internal audit, you have to find all of these undisclosed payments, and you have to write it all out — probably an Excel spreadsheet — and present it to us. And they did. They found £7.8 million in payments between 2015 and 2022. Novo Nordisk said, oops, terribly sorry.

And then independent researchers said, we don't believe you. So they did their own study and found a further £1,244,027 that Novo Nordisk had refused to disclose. After being told off, being suspended, having their wrists slapped, being told they must produce their own internal audit — they still lied. They said £7.8 million; it was actually closer to £8.5 million. Lying dirtbags, because that's what they're like — they lie, and they say, oh, it's a mistake, sorry. It wasn't a mistake. Terribly sorry, my bad, we won't do it again.

And this is the problem. There is no means of penalising companies for doing this. They just get away with it. As I said, they got suspended from the ABPI, which basically means they weren't allowed to sit in on the meetings for two years. There were no fines, no criminal liability, no suspension of their licence to sell their medicines — they were still selling their medicines. They were just basically told to sit on the naughty step for a couple of years. That's it. That's what happens when they do something they had no business doing. 13,000 healthcare professionals. It's very unethical, and it's very typical.

So as I said, they failed to disclose payments to multiple organisations. And this is another thing drug companies do — they pay for training, sometimes unethically and illegally, but they also have financial partnerships — basically funding, sponsoring, whatever you want to call it — charities and healthcare organisations.

One of the organisations they failed to disclose payments to is called the World Obesity Federation. I've probably mentioned them before. I'm a bit of a Trekkie, so I don't like the fact that they call themselves a federation — I think that's wrong and they should change their name. But what is the World Obesity Federation? It's a registered UK charity that operates across the globe. And I'm not going to tell you too much about them, because they are problematic.

Two-thirds of their 2024 income — I went and had a look, I looked at all the data and did all the calculations — came from two sources: Novo Nordisk and Eli Lilly. That's it. So the World Obesity Federation is essentially paid for by two drug companies.

So what does it do? It's a charity — a charity for fat people. What does it do? If it's a charity for fat people, I'd like to think they support fat people, maybe advocate for fat people, maybe help fat people who are being stigmatised or denied medical care — maybe fund private operations if the NHS refuses to do it, or if your insurance company refuses to pay. A charity that goes, don't worry, we'll pay for it, because we're a charity for fat people. That, to me, sounds like a lovely charity. I'm on board with that. That's not what the World Obesity Federation does.

So what do they do? They host an annual international conference, where all the people who work in so-called obesity medicine come together and confer. Ticket prices range from about $500 to well over $1,000, depending on what you're doing and when you buy the tickets. So that's not a free conference, not a charitable conference. You pay a lot of money to go.

They produce four separate peer-reviewed journals — and people pay for membership of those too. Journals aren't free. They run a clinical education programme for healthcare professionals around the world called SCOPE — they love their acronyms. The thing is, it's free or very low cost. That's because the training is — and I'm quoting now — "partially supported by independent medical education grants." From who? Eli Lilly and Novo Nordisk. So it's not independent training. It is funded by them. And they'll say, oh, they have absolutely nothing to do with the content of the training. Sure. If you say so.

If you look at their website and their sponsors, in 2025 their sole platinum supporter was Eli Lilly — described as playing a pivotal role in their endeavours. It's not Novo Nordisk, because it used to be, but it's not anymore because of all the trouble Novo Nordisk got in. What Novo Nordisk do now — it's in parentheses on the website — is sponsor special projects. They're not Platinum supporters. They do things in other ways.

In 2022, they co-hosted an event alongside the World Obesity Federation at the United Nations General Assembly. Sit with that for a moment. At the United Nations General Assembly. This is how pharmaceutical executives get access to politicians and policymakers around the world. Because we have an inherent sense of mistrust when it comes to Big Pharma — oh, it's a bit dodgy to have a pharmaceutical exec talking to policymakers, people are a bit anxious about that. But a healthcare organisation? They can come and go as they please. This is the healthcare organisation, these are the people we trust. I'm talking about Diabetes UK, Cancer Research UK — these are the organisations we trust. But they're getting sponsored by the pharmaceutical industry. It's a way of hiding those financial ties.

Most of you — many of you — won't even have heard of the World Obesity Federation. But you do know about them. You may not realise it, but you do. They're the people who created World Obesity Day. It's held every year at the beginning of March, and it almost every year coincides with Eating Disorders Awareness Week. So — sit with that for a moment.

They have an enormous influence on public opinion. They have an enormous influence on the media. This is how the weight loss industry gets their message out there — through healthcare organisations that they sponsor.

For example, on World Obesity Day this March — I tend to avoid all media that week, but I was doing research for the book — there was a Guardian article that read: more than 220 million children will be obese by 2040. They're obsessed with children at the moment.

That was the article in The Guardian, which is a left-leaning newspaper. It wasn't journalism — they just got a PR statement and recycled it into an article. They didn't do any journalism, per se. They just recited what the World Obesity Federation gave them, because it was a report funded by the WOF — funded by drug companies. This report they were talking about.

Whenever you see these articles, I would advise you just not to read them, but if you're curious, look through — there's always a report somewhere. Try and find the fine print. Click on the link if there's one. Who paid for this report? It's almost always drug companies. This is what's going on.

I just want you to think about it for a moment. Imagine a children's welfare charity — a charity set up to maintain the mental and emotional wellbeing of children — primarily funded by energy drink companies. Would you trust them? Imagine if Gamblers Anonymous was sponsored by betting sites. Would that be okay? What if Cancer Research UK was taking money from the tobacco industry? Would we have a problem with that?

Because this is a conflict of interest. This is literally the definition of a conflict of interest. If you are an organisation that is financially dependent on private companies whose agenda directly contradicts your stated mission, then that's a conflict of interest. And that is exactly what is happening here. Because this so-called obesity charity claims that they are advocating for fat people, that they are interested in the health and wellbeing of fat people — but they're not. They're interested in selling weight loss drugs. That's not cool. It's not okay.

The World Obesity Federation is not interested in advocating for fat people who don't want to engage in weight loss. So it's not an obesity charity, it's a weight loss charity. Except that it's not a charity, because they're not giving anything away for free.

According to an article in the Observer newspaper, Novo Nordisk spent £27 million over a period of three years on experts and charities who publicly championed Wegovy around the time it was approved for weight loss. Many of these experts who were paid for this refused to declare their financial ties. They just went on record — interviewed in newspaper articles, on the news, on the radio, on social media, everywhere you turned — saying, oh, these drugs are amazing. And they were paid for by the drug company. £27 million over three years is a lot of money, but it's nothing compared to how much money they earn from that drug.

So we've got paying for the research, paying for the guidelines, paying to educate doctors, paying for these healthcare organisations that get allowed into every room — and then we've got the actual lobbying. Because don't forget, drug companies lobby politicians.

In the UK, where the rules are a little bit stricter, they do so through the direct funding of all-party parliamentary groups. If you don't know what APPGs are, look it up. That's how drug companies like Novo Nordisk and Eli Lilly come along and pay for the All-Party Parliamentary Group on Obesity. That's how it works. That's how drug companies lobby politicians.

In the US, it's a little different — in the UK, we're talking less than £100,000. In the US, millions. Drug companies are spending millions annually on federal lobbying, on campaign donations. They hire teams of lobbyists who influence legislation, all sorts of things.

According to one article I read, pharmaceutical and health product makers — so basically Big Pharma — spend more than any other industry on lobbying the federal government. That's from an article in JAMA, the Journal of the American Medical Association. Another article found that Pfizer, Amgen, and Eli Lilly were the biggest corporate spenders. In 2025, Eli Lilly spent over $11 million in federal lobbying alone. $11 million in federal lobbying alone in 2025. They also spent however many millions on all the other things.

Between 2010 and 2021, they spent $96 million on federal lobbying — not a billion, I made a bad maths error and corrected it — but $96 million is still a lot of fucking money. This figure does not include state lobbying. Eli Lilly lobbied at least 46 states in 2021 — basically all the states. Eli Lilly also lobbies abroad, spending roughly a billion on lobbying in Europe in 2021, for example. Lobbying is huge.

They have ties to politicians, and that is a problem, because it very much influences how the world works — what drugs get approved, what drugs are used in certain situations, what drugs get approved by insurance companies, et cetera.

So I want you to put all of that together — all of this that's going on — and now I'm going to remind you of a very recent lesson we learned. We don't have to go very far back in history. I just want you to see the similarities.

In 1996, the FDA approved Purdue's drug OxyContin for moderate to severe pain. The thing that made OxyContin different from other painkillers was that it was a slow-release drug. They took their slow-release formula and applied it to a very run-of-the-mill opioid — oxycodone isn't even in the top tier, it was an average opioid — but they applied their slow-release formula and, crucially, got it approved for moderate to severe pain. Not just cancer pain. Moderate to severe pain.

Over the next five years, Purdue conducted more than 40 conferences at resorts across the US, attended by thousands of physicians, pharmacists, and nurses. They funded more than 20,000 pain-related educational programmes through direct sponsorship or financial grants. They ordered their drug reps to downplay the harms and reassure doctors the drugs were safe, despite growing concerns about addiction risk.

You probably all know this story. Hopefully you've watched the TV shows, or read the book, or watched a documentary. This happened in very recent history. You were probably alive when it happened. By 2004, OxyContin had become one of the most prevalent drugs of abuse in the United States. It sparked an opioid epidemic that we are still very much living with today, decades later.

One drug company. A group of very greedy, selfish, cruel, despicable human beings — the Sackler family — who cared only about profit, and were willing to go to any length, most of them illegal, definitely unethical, to make money at your expense. And you're still feeling it. Even if you are not somebody who is addicted to opioids, even if you don't know anyone who is — which is lucky, because most people know at least one person — you no longer have access to opioids when you need them, when it's clinically indicated, because of this.

They had to throw the baby out with the bathwater. Literally nobody gets adequate access to opioids anymore. And sometimes — not always, but sometimes — opioids are really important and very useful. But our use of them is very much limited because of what's happened, because of a legitimate fear of addiction. A fear that exists because of what happened.

So in my opinion, Novo Nordisk and Eli Lilly have studied the Purdue playbook and gone: that's clever, let's do that. And they've literally copied it. The conferences, the education programmes, the financial partnerships, the charities, the patient organisations, the professional societies, the drug reps downplaying the risks — it's all the same. It's all exactly the same.

The lines between independent medical advice and pharmaceutical marketing are completely blurred. It's incestuous, if I'm honest. It's quite gross. Everybody knows everybody. Everyone goes to the same conferences, sits on the same panels, they all know each other — bring my friend on board, talk to this politician, lobby that person, pay for that political campaign — and it's just all gross. It's really, really fucking gross. Because this is healthcare. None of that should be involved. There is literally no reason why the pharmaceutical industry should have any influence whatsoever on clinical guidelines. They just shouldn't be allowed in the room.

To borrow a phrase: build a wall. Build a fucking wall, and put the drug companies on one side and the medical profession on the other side, with a big wall and nobody gets to cross it. They don't belong in any of the rooms. It should be illegal for them to sponsor healthcare organisations. It should be illegal for them to sponsor experts. If you are somebody who is going on record as saying that a drug is good, you should have to be able to prove that you have no financial ties to that drug company. I have never taken a penny from them, and I still think the drug is good — that's okay. You've looked at the evidence, you've decided for yourself, fine. But not if you're getting paid by them. You don't get to be interviewed on national television, in newspaper articles all over the world, as a doctor, staking your professional reputation — professional reputation in my ass. You're taking thousands, sometimes millions from drug companies. Fuck you. How dare you?

That is beyond unethical. They shouldn't be allowed to do anything. No sponsoring of education programmes, no financial partnerships with healthcare organisations that are involved in healthcare decisions. There should just be a very explicit line, and nobody gets to cross it. There is literally no reason for them to be there. None whatsoever. They don't need to be there.

We have been allowing this to happen for so long that most of us — and when I say us, I'm talking about healthcare professionals — we don't question it anymore. We're just like, oh yeah, that's how it is. Why? I remember when I was in medical school, I joined an organisation that would simply say no to a free lunch. All you had to say was: I'm not going to accept a free lunch from a drug company, because I want to remain ethical. I'm not going to take a pen, or post-it notes, or any of the other merch they send out. And in the UK, there are stricter laws than in some countries — like, they fly you off to the Caribbean elsewhere, not in the UK. Here you just get tat. They give you tat. And still: no, why should I?

It's like we just refuse to learn the lessons of history. With OxyContin, it took years for the full scale of the harm to become clear, by which point millions of people were addicted and thousands had died. And then it was like, oh, mea culpa, mea culpa, terribly sorry. As far as I know, although Purdue no longer exists — although they eventually filed for bankruptcy — the Sacklers are doing fine. Still got their yachts and their houses and all that. Nothing happened to them.

You are the one who suffers.

With weight loss injections, we're still very much in the early years. We are circa 1999, 2000, 2001 — at most — in the story of OxyContin. That's where we're at. Just wait until all the data comes out. Just wait until we suddenly go: oh shit. Rather like every other weight loss drug on the planet, this drug is causing the very condition it's supposed to be treating. Just like every other drug. Just wait till it all comes out. And then a lot of people will say, oh, that's bad. But if you're the unfortunate one who developed the side effect, who developed the long-term issues that this drug caused — it's too late for you. Nothing you can do about it.

It's the same bullshit, the same prioritisation of profit over safety. Same playbook, same tactics. The only difference is the drug.

And this is why, when you put all of that together, you feel so overwhelmed right now. If you're sitting there thinking, it's all I can think about — everyone talks about weight loss and GLP-1s, and wherever I go there it is, weight loss, weight loss, weight loss, every celebrity, every this, every that, it's all I can think about, I wish I could switch it off but I can't — it's intentional.

These drug companies are paying to keep it in the news, paying to keep it on social media. They are bribing politicians. They are bribing healthcare organisations to approve and push these drugs. They are marketing directly or indirectly to you, the customer. Intentionally.

And yes, I said bribing. Give me another word that best describes it. Influencing? They give money, and then they say the drug is good. What is that? If you take money to give evidence on a witness stand in court, it's illegal and you go to prison. If you take money to give evidence in the court of public opinion — on really important, life or death issues, medications — you don't even get a slap on the wrist. You get a pat on the back.

This has been a long game. A long game. It has been happening for a really long time — from before you were born. The pharmaceutical industry got in on it from before you were born, and certainly since the end of the last century. First, they paid to make obesity a medical condition. Then they sponsored all of these healthcare organisations, lobbied all of the politicians, funded the research, et cetera. They're spending millions, but they are making billions, and those two things don't compare.

So you're the one who suffers.

And you might be thinking, okay Asher, what am I supposed to do about it? This is actually one of the struggles I had when writing my book. I'm exposing all of the lies, all of the deception — and then I thought, when you're reading it, you want to know: well, what am I supposed to do? You essentially want me to say, but it's okay, it's alright, don't panic, there's hope. But it's quite hard to say that, because I don't want to lie to you.

So what can you do about it? Here are some things. Number one, you can challenge your doctors. If a doctor is recommending a GLP-1, ask them — which study did that come from? Can you name it specifically so that I can go and research it? You can ask your doctor: how much money do you take from drug companies? Are you receiving any money in sponsorship? Are you getting paid? Are you letting them pay for conferences? You could ask them flat out. You can ask: where did you get all of this information about GLP-1s from? Did you research it yourself? You can challenge them if you want to. That's okay, you're allowed to do that. I think a lot of people would find that really hard, but you can absolutely do it.

Another thing you can do — and I think this one works quite well — is opt out. Just say: I'm not interested. You can say to your doctor, I am not interested in GLP-1s. Full stop. That is the end. Do not mention it again. I refuse my consent. Do not mention it. If they have the audacity, after you've said that, to mention it again, say: I'm sorry, I refused my consent. Are you forcing me to endure a conversation against my will? Are you making this consultation dependent upon my acceptance of your weight loss lecture? Is that what you're saying? Are you saying that you will only treat me if I sit here and listen to a lecture about GLP-1s, even though I told you I didn't want to discuss it? Because then I want you to document it in my notes, because that is fucking illegal.

It is not okay — illegal, unethical, whatever. I'm not a lawyer, but it's definitely unethical. It's definitely a breach of their duty of care. If you say I do not consent to discuss this, you don't consent to discuss it. They don't get to discuss it. No means no. So just say: no, I'm not interested. GLP-1s — no, not taking them. You don't have to defend your decision, don't explain why. Just no.

Another thing you can do is join the NoWeigh movement, and keep an eye on your inbox. If you're not on my mailing list, why not? Come and join it. Join the NoWeigh movement. The whole point of this movement — I don't need anything from you, I'm not trying to get anything out of you — but I want you to feel like you're part of something. I want you to feel like, yeah, look, the pharmaceutical industry is a Goliath. They're scary as fuck. But we're strong too. And we can do something. Together. As a community. In our own way.

Don't forget that NoWeigh will be available on the 20th of May, which is a week from today. You can still pre-order it on Amazon right now — there's a link in the show notes — and I am really excited for next week's episode. I'm not going to give anything away, it'll come as a surprise. Thanks so much for joining me, and take care.