Doctors say RFK Jr.'s anti-Ozempic stance perpetuates stigma and misrepresents evidence

Robert F. Kennedy, Jr. speaks before Donald Trump at a campaign event, Sept. 27, 2024 in Walker, Mich. (AP Photo/Carlos Osorio)

Robert F. Kennedy Jr. has pledged to tackle high rates of chronic diseases such as diabetes and obesity as President-elect Donald Trump’s pick to lead the U.S. Department of Health and Human Services. They’re goals that many in the public health world find themselves agreeing with — despite fearing what else the infamous anti-vaccine activist may do in the post.

Just don’t suggest that he tackle those goals with medications like Ozempic.

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“They’re counting on selling it to Americans because we’re so stupid and so addicted to drugs,” Kennedy said in an appearance with Fox News’ Greg Gutfeld that he posted to Instagram last month, concluding that Ozempic, a wildly popular medicine approved to treat type 2 diabetes and used off-label for weight loss, is not going to “Make America Healthy Again.”

Kennedy claimed that Novo Nordisk, which makes Ozempic, doesn’t market the medicine in its home country of Denmark, where “they do not recommend it for diabetes or obesity; they recommend dietary and behavioral changes.”

In fact, Denmark does use Ozempic, so much so that the Danish Medicines Agency said in May that it would restrict its use until after people had tried less expensive medications to treat diabetes. Instead of a shift to forego medication in favor of lifestyle changes, as Kennedy suggested, it was a cost-cutting move, since more than 100,000 people had received the drug or others in its class, known as GLP-1 receptor agonists.

Denmark also uses Ozempic’s sister drug approved for weight loss, Wegovy, and has similarly grappled with the cost, questioning whether its benefits justify them. It’s a debate also taking place in the U.S., where the drugs are priced far higher.

Kennedy said in the same appearance that the European Union “is right now investigating Ozempic for suicidal ideation,” although the European regulator concluded in April that available evidence doesn’t suggest Ozempic and other GLP-1 medicines cause suicidal thoughts or actions.

The U.S. Food and Drug Administration, which Kennedy would oversee as HHS secretary, also reached that conclusion, although it’s continuing to monitor for potential risk.

Those kind of confident but false or misleading assertions are Kennedy’s signatures, said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. And they can be especially dangerous, he said, when applied to public health bedrocks like vaccines.

“He acts like he knows what he’s talking about when he doesn’t, and he says things with a definition that makes people convinced he has the data to support his statement,” Osterholm told CNN. “Trying to follow him and understand what he’s talking about is often like trying to nail Jell-O to the wall.”

Kennedy’s anti-vaccine stance put public health experts on edge even before Trump announced Thursday that Kennedy was his choice to run a department encompassing the FDA, the U.S. Centers for Disease Control and Prevention, the National Institutes of Health, the Centers for Medicare and Medicaid Services and more.

Kennedy claims he’s not anti-vaccine, but he has falsely said they cause autism, may cause more deaths than they prevent and could have sparked some of the world’s deadliest pandemics.

“It will hurt children all across America” if Kennedy’s put in charge of HHS, said Hawaii Gov. Josh Green, a physician who helped with a vaccination effort in Samoa after a deadly measles outbreak there in 2019 that’s been linked to misinformation spread by Kennedy — a connection that Kennedy denies. “Let’s rethink this. Let’s pull back this nomination and let him go be some part of the Environmental Protection Agency.”

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Many in the public health world see Kennedy’s focus on pesticide regulation or rethinking agricultural subsidies as potentially positive moves and a safer place for him to work than the department that oversees vaccine regulation.

Even as they agree that it’s important to address growing rates of diabetes and obesity, doctors in that field say Kennedy’s plans miss the mark.

“It is wrong to assume that people with high body weight and BMI just sit around and eat low-quality food,” said Dr. Jody Dushay, an assistant professor of medicine at Harvard Medical School and an attending physician in endocrinology at Beth Israel Deaconess Medical Center. “Taking medication to treat obesity should not be demonized.”

Kennedy claimed in the same Fox segment that if the US spent a fraction of what it would cost to treat every overweight person in the U.S. with Ozempic — not something anyone’s suggesting, as GLP-1 drugs aren’t approved for everyone who’s overweight — on “giving good food, three meals a day to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight.”

Dr. Angela Fitch, co-founder and chief medical officer of Knownwell, a provider specializing in health care for people with obesity, said Kennedy’s suggestion that diet and exercise alone can solve obesity “overnight” would set back hard-won efforts to better address the condition.

The injectable drug Ozempic is shown Saturday, July 1, 2023, in Houston. (AP Photo/David J. Phillip, File)

“We’ve been trying to bust that stigma a lot of years,” Fitch told CNN. “What we’ve heard a lot of in his rhetoric is, ‘I want people to just eat less and exercise more.’ And what we know is, that doesn’t work.”

Dr. Daniel Drucker, a pioneer of research into GLP-1, the hormone Ozempic and similar drugs mimic, agreed.

“I don’t think anyone who is in the health care business or area would ever argue against lifestyle modification, diet and exercise and healthy foods as the cornerstone of improving people’s health and weight management,” Drucker told CNN. “The challenge we have is that there have been multiple trials that have tried to see: Can we markedly improve people’s health and get substantial weight loss with diet and exercise? And the answer’s been no; people lose a little bit of weight.”

The GLP-1 class has revolutionized the way doctors approach weight-loss treatment because it offers therapy that works – clinical trials showed 15 to 20% loss of body weight, on average – after decades of meager options with often severe safety issues. Doctors don’t argue the medicines alone are the solution to growing rates of obesity, but nor do they think they should be abandoned, and they’re recommended on top of lifestyle changes including healthy diets and exercise.

Not everyone with obesity will want the drugs, and for some, they may have strong side effects such as nausea. Additionally, many people don’t have insurance that will cover them, or obesity care generally — a problem that Fitch argues would go a lot further to tackling obesity in the US, if addressed.

In a social media post in September, Kennedy acknowledged “that weight-shaming is cruel and that obesity is not a failure of character” and suggested instead that “our sickening food system” is partly to blame.

Doctors who treat people with obesity suggest that fixing the food system shouldn’t be mutually exclusive with using weight-loss medications, when appropriate.

Kennedy’s views on Ozempic don’t appear to be shared universally throughout Trump’s orbit. In a post on Friday, Elon Musk, the billionaire who’s been tapped to cut government spending in the Trump administration, suggested making GLP-1 drugs “available at low cost to Americans who wish to use them would greatly improve health and reduce health-care costs.”

Musk said in October of 2022 he had been using Wegovy.

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Kennedy told NPR that Trump expects him to show “measurable impacts on a diminishment of chronic disease within two years.” He has suggested getting there through measures including prohibiting beneficiaries of the Supplemental Nutrition Assistance Program to use those benefits to buy soda or processed foods, and revisiting “pesticide and other chemical-use standards.”

It’s a goal Osterholm expressed skepticism he’d meet.

“We all agree it’s a very important issue,” Osterholm said. “But a lot of his thinking is like ‘A plus B plus C plus miracle, and you’ve got an answer.’”