Hello, Peptide Purgatory fans! Today’s issue was inspired by the WHO, who keep spouting that now all too familiar mantra: “Obesity is a chronic, relapsing disease requiring lifelong treatment.” I hit that subject hard before; however, as counterpoint to WHO’s Special Communication published today (December 1, 2025) in JAMA, I have a few more things to say. Opinions are a dime a dozen (or there’s that other characterization I won’t repeat in polite company), so draw your own conclusions. Normally, this kind of thing would find its way to Bullshit Corner (it already has done so), but I felt it was a worthy feature for this week’s issue.
After lambasting the WHO, I’ll give you an update on my forthcoming medical event: hernia repair surgery, coming up on December 9.
Opinion: Follow the Money, Not the Molecules
WHO’s GLP-1 Guideline: Equity Theater Meets Pharma Economics
The World Health Organization has finally dropped its long-gestating guideline on GLP-1 therapies, and—stop me if you’ve heard this tune before—it reads less like a clinical document and more like a global financing prospectus dressed in a lab coat.
Yes, of course WHO repeats its favorite talking point—obesity is a “chronic, relapsing disease requiring lifelong care.” They love that line. It’s the tent pole that holds up the circus. Without the “lifelong” part, there’s no justification for the pharmacological mortgage they’re proposing.
But here’s where things get interesting, and fortunately, new.
This time, it’s not about the biology. We’ve beaten that horse so thoroughly it’s donating its organs. This time, the game is financing.
The WHO Playbook, Page One: Declare It a Disease
Once you call obesity a chronic, relapsing illness, you open the door to chronic, relapsing payments. It’s elegant, in a dystopian way. Especially when you simultaneously add GLP-1s to the Essential Medicines List—a move that magically transforms $1,000/month injectables into something the world is now entitled to.
If insulin in sub-Saharan Africa is still hit-or-miss, imagine the logistical chess involved in delivering weekly refrigerated incretin cocktails to communities where electricity isn’t a full-time employee.
But don’t worry, WHO has a plan: You pay.
“Equitable Access” = Your Wallet, Their Need
WHO talks a big game about “equitable access,” “universal coverage,” and “tiered pricing.” To the untrained eye, this looks like compassionate global health policy.
To anyone who has ever read a balance sheet, it’s obvious what they mean: First World taxpayers underwrite GLP-1 access for the developing world while Big Pharma’s margins remain gloriously untouched.
They spell it out in bureaucratese:
- “financial coverage under national insurance schemes”
- “tiered pricing”
- “pooled procurement”
- “universal health coverage frameworks”
Translation: “Rich countries, please open your checkbooks, because we’re about to scale a class of drugs that most of your own citizens can’t afford.”
It’s global health Robin Hood, except the Sheriff of Nottingham (Novo/Lilly/Pfizer) keeps the purse.
The Real Problem: WHO’s Priorities Are Upside Down
Let’s be blunt:
Many countries still struggle to provide reliable access to
- insulin
- antihypertensives
- antibiotics
- clean drinking water
Yet WHO is now preparing a framework to deploy weekly GLP-1 injections as a global public good.
This is health-policy absurdism.
It’s the global-health equivalent of buying everyone a Peloton when you still can’t fix the potholes.
The Conclusion Nobody Asked For, But WHO Delivered
WHO keeps insisting “medication alone cannot solve the problem,” then spends twenty-two paragraphs laying out a global financial system for scaling medication.
At this point, the contradiction is so blatant you could bounce a basketball off it.
If this guideline represents the “new obesity ecosystem,” it looks suspiciously like the old one—except now it comes with a moral lecture about solidarity and an invoice addressed to taxpayers in countries that already can’t afford their own GLP-1 copays.
But hey—at least it’s “equitable.”
My Week on [no] Mounjaro
As you know if you’ve been following my boring trajectory, my numbers have been stable for quite a while, with BP < 120/70, HbA1c around 5.6%, and average glucose somewhere in the 105-110 range. Enough said there.
I promised that I would update you on the forthcoming hernia repair surgery, so if you’re squeamish, bored, or simply don’t care, stop reading.
The surgery on December 9 is to be performed laparascopically by the Da Vinci robot—UNLESS they have trouble getting past my old gall bladder surgery incision scar from 1984. In that case, it will be open surgery with a longer recovery time, which will piss me off.
The recovery time is already too long. I have an eight-week restriction that allows me to lift no more than 10 lbs. Every time I cough, sneeze, or laugh, I’ll get lightning-bolt jolts of pain. Sound like fun?
My Pre-Op Call
I got a call today from the very-Indian sounding OR nurse with a non-Indian name. She reviewed my prescription drugs, told me which ones I could continue taking and which I needed to stop. My primary care physician had already told me to discontinue Mounjaro and Farxiga two weeks prior to surgery, with which Hannah agreed. She also told me to discontinue all supplements from now until after the procedure.
She reviewed my prior surgeries and chronic illnesses, and then reviewed my bathing instructions for the night before and morning of surgery. I’ll need to take a Hibiclens shower, use freshly washed towels, and sleep in freshly washed linens. In the instructions Hannah sent me, I was directed to bring my CPAP machine, tubing, and mask, if I use such an apparatus at home. Well, I do, so I will, but I wonder how they’ll ensure it is free of contaminants.
She confirmed who would be taking me home after the procedure and that they would be staying with me for 24 hours. No Uber drivers or bus drivers are allowed to be that person, though, so my wife will suffice.
Butbutbut, When Is It, Already?
Then, she asked me if I had any questions. Yes, one BIG one: no one gave me a time for when to show up at the surgical unit. Little omission there. Well, it turns out that I’ll be contacted by the surgeon’s office THE DAY BEFORE surgery to give me that little tidbit. Oy, vey! Modern hospital scheduling! They’re worse than Spectrum or Terminix! Maybe they’ll give me a window between 12 and 4.
What do I fear the most? I worry about losing muscle mass, given the eight week no-lifting restriction. But I’ll be able to walk, climb stairs, drive, and do some stretching and body weight strengthening exercises. No doubt that I’ll need to take it easy for a couple of weeks, as 79-year-old bodies don’t recover from surgery like they did when they were 39.
Sendoff
So there you have it: another week in which the WHO sermonizes about “equity,” Big Pharma quietly measures your inseam for a permanent financial wedgie, and I prepare to let a robot rummage around my abdomen like it’s defusing a bomb.
If all goes according to plan, I’ll crank out next week’s issue before I’m reduced to a post-op blob in pajama pants, mumbling about lifting restrictions and the good old days when a man could sneeze without seeing God. If things get delayed, chalk it up not to sloth but to the fact that I’ll be temporarily sidelined by modern medicine—ironically the same circus I spend every week lampooning.
In the meantime, take care of yourselves, watch your step on the WHO/GLP-1 slip-and-slide, and pray that the da Vinci robot has a steadier hand than the folks scheduling my check-in time.
See you on the other side—preferably still in one piece and with most of my muscle mass intact.
Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!
For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.
