Shining spotlight on shadow weight-loss drug campaign

The Australian Diabetes Society has been linked to a shadow advertising campaign for blockbuster new weight-loss drugs launched by a Danish pharmaceutical giant.

A Facebook weight-loss post from Danish pharmaceutical giant Novo Nordisk.

The Australian Diabetes Society – the nation’s leading body for research, medical practice and education in diabetes – has been linked to a shadow advertising campaign for blockbuster new weight-loss drugs launched by a Danish pharmaceutical giant, which is accused of exerting a heavy influence on Australian obesity policy.

Novo Nordisk, the manufacturer of the drugs Ozempic and Wegovy, has been bombarding consumers on Facebook and in Instagram with ads about weight and exercise which link to a ­website that promises to reveal “the truth about weight”.

Consumers are linked to a website – truthaboutweight.global – where articles state obesity is a chronic disease and people are urged to “find a local weight management provider” via a drop-down menu.

They are then directed to ­another site, entitled Find My GP, which is a joint initiative of the ADS and Novo Nordisk that links consumers with a network of “independent” doctors who have been trained in weight-management programs.

While doctors on the Find My GP site “are not incentivised by Novo Nordisk”, all the GPs are said to have “expressed an interest and received training in weight management, according to criteria developed in collaboration with the National Association of Clinical Obesity Services and the ADS” which both get funding from Novo Nordisk. The website is branded with the ADS logo.

The medicines regulator has declared the advertising campaign to be “disease education” that does not fall foul of laws that ban ad­vertising medicines directly to consumers.

Pharmaceutical companies are banned from advertising medicines directly to consumers in Australia but the Novo Nordisk ads are positioned as providing education and resources and do not mention specific drugs.

Novo Nordisk’s Truth About Weight website states that obesity is a chronic disease, and “when you know the truth about weight, you can start getting the help you need”. “Chronic diseases require ongoing medication attention, or limit activities and daily living, or both,” the website states.

“The science is clear that obesity is not just a result of poor choices. While misinformation and stigma continue to impact society’s understanding of obesity, more healthcare providers are beginning to recognise obesity as a chronic disease – one that demands medical attention and potentially treatment.”

The ADS, which is a membership organisation made up of doctors and scientists and led by senior endocrinologists, did not respond to extensive questions regarding its collaboration with Novo Nordisk.

The organisation’s revenue comes from membership, the provision of diabetes services and care via the National Association of Diabetes Centres and the National Diabetes Services Scheme, and major scientific meetings.

It is a member organisation of Diabetes Australia, which is contracted to administer the $140m NDSS and has a suite of drug companies as its corporate partners.

NACOS president Samantha Hocking said the association had nothing to do with the website and had simply provided advice to Novo Nordisk to develop criteria about what constituted weight-management training for GPs.

Payments to doctors

Novo Nordisk made 1214 payments totalling $1,492,976 to 469 medical professionals in Australia between May 2019 and April 2022, mostly for attending educational meetings, according to disclosure logs. The company has risen to be a corporate giant based on its development of diabetes drugs and has now pivoted to the weight-loss market.

Doctors contacted by The Australian were not aware they were listed on “the truth about weight” website and said they were not trained or paid by Novo Nordisk in accordance with this website.

Yet they acknowledged they had been approached via email by one of these organisations for expressions of interest in weight management before signing up to Find My GP.

Sydney GP Chee Khoo, who has presented educational lectures for 10 years for Novo Nordisk, said: “What do you do with people who are unfairly given lousy genes? This is a drug that can fix that. It’s not just a lifestyle thing. Sure, some people could do better with lifestyle but for those people carrying 20, 30, 40kg of weight or more, how do they lose that weight?”

However, he said he would not prescribe the drug to someone who didn’t need it.

The Novo Nordisk ads have been given the green light by the Therapeutic Goods Association, which said: “the website Truth About Weight does not refer to particular anti-obesity medications and states that they are only one a range of scientifically proven weight-loss strategies that consumers can discuss with obesity-care providers to find a plan that works for them”.

“In this instance, we are of the view that, on balance, the material is disease education rather than advertising of a therapeutic good.”

But Monash University publish health researcher Grant Ennis said the ads were clearly a shadow drug ad campaign. “It doesn’t matter if it’s specifically the product of the company or not being advertised, as long as it’s promoting a therapeutic approach to a problem that … needs to be prevented, I would say it should be seen in violation of the (Therapeutic Goods Act).”

Novo Nordisk is ramping up marketing to the public and doctors ahead of a global restock of Ozempic. The Semaglutide injection has been in short supply since April after it gained popularity on social media as a “miracle” weight-loss drug and doctors prescribed it extensively off-label.

Novo Nordisk is also launching Ozempic’s sister weight-loss drug Wegovy in Australia after it was approved by the TGA late last year specifically for weight management, but it has also been unavailable for purchase. Many patients are reporting their GPs are currently being visited by Novo Nordisk drug representatives.

Asked about its latest PR campaign ahead of the wide availability of its drugs, Novo Nordisk said it was obligated to provide information and resources.

“As leaders within the science of obesity, we have a responsibility to use our clinical expertise and available resources to support the broader healthcare community to tackle this significant challenge, in line with the objectives of the National Obesity Strategy,” a Novo Nordisk spokesperson said.

“We see ourselves as a partner in a collaborative solution to help Australians living with overweight and obesity and we support external organisations because we believe it will take a united, collaborative and multi-factorial approach to address the obesity problem.”

Novo Nordisk’s marketing campaign and its links to mainstream health groups have alarmed researchers who are concerned at the influence of the processed food industry and pharmaceutical industry on health policy.

Many doctors disagree with obesity being characterised as having a genetic cause requiring pharmaceutical treatment.

Mr Ennis said the ads were in line with the food and pharmaceutical industry’s extensive efforts to influence public policy on diabetes and obesity through “education”, which deflected from the main causes of these conditions: sugar-laden foods and beverages and highly processed foods.

“We can’t solve a pandemic caused by an unhealthy food environment by treating it with drugs,” said Mr Ennis, the author of Dark PR: How Corporate Disinformation Harms our Health and the Environment. He said there were extensive links between pharmaceutical companies and diabetes and obesity groups in Australia, via direct funding and sponsorship, the sponsorship of research, and payments to attend education seminars and conferences.

“By funding these health organisations it risks making them front groups,” Mr Ennis said. “I’m unaware of any policy in Australia for obesity or diabetes that has any substance. I’ve never seen a country where nutrition and health groups appear so captured.”

Power of drug firms

UQ Centre for Community Health and Wellbeing senior research assistant Fiona Willer said pharmaceutical companies “can afford to get in the room where things happen”.

Dr Willer is critical of the “obesity as a disease” paradigm in her practice as a dietitian.

“These medications do not help people become better nourished … they just help people to temporarily avoid weight stigma. That’s a society problem, that’s not an individual problem,” she said. “What I’ve observed is rather than Novo Nordisk reaching out and looking for people to promote the product, people who agree that obesity is a disease or at least it’s a medicalised characteristic, people with that way of thinking that is aligned with Novo Nordisk … have flocked together.”

“Novo Nordisk is no different to the rest of the weight loss industry, selling a ‘thin me’ dream”.

Pharmaceutical advertising expert Barbara Mintzes said these kinds of “help-seeking” advertisements were difficult to regulate.

“Unless it has a direct link to the product, the company would not be seen as advertising prescription medicine. The message may be that it’s useless to try and exercise but it’s not something that the TGA on its own would see as being illegal,” she said.

Additional reporting: Georgina Noack