Imagine if you could eat your fill on Christmas Day and then reduce your appetite for January. Good news: such a prospect may be on the horizon.
The past year has seen the rise of countless weight-loss medications that are improving and achieving results where decades of bullying and dieting have failed – in yet another miracle of biomedical science.
Not that you’d know: Eliminate the positive, accentuate the negative: that’s all too often the way medical news works. Yes, there is a tendency for some diseases to worsen and a worrying side effect of some cures; cancer, dementia and anxiety are raging; there is more and more addiction to drugs and alcohol; There is a pandemic around the corner and there is too much obesity thanks to processed foods.
However, overall, we have never been healthier. We live longer, rarely go hungry, feel younger, get fewer infections, get cancer later, and have many more options for life-saving operations, injections, and pills than any previous generation. For all the sins of Big Pharma, we now have some kind of cure for the vast majority of afflictions.
Sharon Osbourne has spoken openly about using Ozempic to lose weight after saying she had struggled with her weight for many years.
But there is no denying that almost all of us are getting fat, and it is one of the biggest threats to human life expectancy today.
Problematic obesity was once very rare, when food was more expensive and work more laborious. Nowadays, being dangerously fat is common and is the tip of the iceberg of the more moderate flab that many of us have. No matter how much the nanny state exhorts us to exercise more, eat more vegetables, and give up soda, our waistlines continue to expand relentlessly.
Or them? In the United States, the trend of increasing obesity has stalled and even reversed slightly. In 2021-2023, 40 percent of American adults were obese, up from 42 percent in 2017-2020. This is just the beginning of a public health revolution that will continue next year.
The reason? The spread of these weight loss drugs, produced by Novo-Nordisk and Eli Lilly. Novo’s drug is semaglutide, known as Ozempic for diabetics and Wegovy for weight loss; Lilly’s is tirzepatide, known as Mounjaro or Zepbound. About 12 percent of Americans have already tried these drugs, and the decline in obesity is sharpest in the social class most likely to use them.
More than any other product from the pharmaceutical industry in recent years, these injections have truly taken the world by storm. Demand has outstripped supply, while Novo Nordisk’s valuation now exceeds the annual GDP of Denmark, where it is based.
Admittedly, the company took a $100 million hit to its market value last week when its latest weight-loss drug slightly underperformed in a clinical trial.
However, more and more analysts think we are approaching a tipping point where these drugs really take off.
In the coming years we will see a veritable avalanche of appetite suppressant drugs hit the market.
Many pharmaceutical companies are developing their own versions in clinical trials. Novo and Lilly, as well as at least five other companies, are developing oral weight-loss drugs. Soon, people will be able to take a pill instead of injecting themselves, and there will be many, many more users.
To general surprise, weight loss medications are proving to have beneficial side effects against other diseases as well. They appear to reduce the risk of heart disease, stroke, kidney disease, high cholesterol, and perhaps even brain disorders such as Parkinson’s and Alzheimer’s. They appear to reduce inflammation, regardless of the effects on body weight. They even seem to reduce the death rate from Covid.
“These are health promoters,” says Harlan Krumholz, a professor of medicine at Yale University. “I wouldn’t be surprised if improving people’s health in this way slowed down the aging process.”
It’s not all good news. For some people, nausea and other side effects are intolerable, and doctors warn of the risk of thin people using them to lose too much weight. Additionally, you may gain fat again once you stop taking the medication. For those of a puritanical bent, these medications free us from responsible withdrawal. But for many diabetics and obese people, they are a blessing.
The story behind these drugs has all the usual themes of innovation: it’s a gradual, incremental, collaborative story with fortuitous bursts of luck and a lot of trial and error. No one person deserves a statue, although three may one day be chosen (probably a little unfairly) to receive the Nobel Prize.
Curiously, it begins with monkfish, those hideous bottom dwellers that lure their prey by dangling a fake morsel in front of their enormous mouths. Anglerfish have discrete organs for producing insulin.
In the 1980s, scientists from Massachusetts General Hospital traveled to Cape Cod and asked fishermen if they could have many of these small organs for experiments. From them, they isolated a gene that produces a hormone called glucagon-like peptide 1, or GLP-1. It turned out to be an effective way to regulate blood sugar and appetite.
Then, to make GLP-1 last longer in the body, another scientist working for the US Department of Veterans Affairs, John Eng, suggested looking at a similar hormone used by Gila monsters – fat lizards. black and yellow from Mexico with poisonous bites. They regulate their appetite so well that they only need to be fed a few times a year. By studying the lizard molecule, pharmaceutical companies were able to make synthetic versions of the hormone that could be injected daily and then weekly.
Britain, of course, lags behind the United States in taking up weight-loss drugs, and the NHS is put off by the high cost of patented drugs. But Health Secretary Wes Streeting has announced a trial of prescribing Zepbound to unemployed obese people to try to get them back to work.
And nothing prevents us from buying medicines privately, as many celebrities have already demonstrated.
TV sensation Oprah Winfrey has shrunk in recent years thanks to Ozempic
“If an otherwise healthy, middle-aged man shows sudden weight loss,” Boris Johnson reasoned of several of his ministerial colleagues, “there are only two possible explanations.” Either he has fallen madly in love or he is about to mount a candidacy for the Conservative leadership. Then he realized that no, they were actually injecting themselves with the new drugs.
Another obstacle here, however, is the dominance of the public health lobby. There is a well-funded industry with a vested interest in denouncing soda and junk food. The drugs could undermine his campaign to impose even more restrictions on advertising such products on television. For these people, semaglutide and tirzepatide are existential threats similar to the effect that electric lights had on candle wick trimmers. Puritans prefer pain to technical solutions.
In the world of public health, failure is routine. Low-fat diets, artificial sweeteners, sugar taxes, advertising bans, dietary advice: none have worked well. As Chris Snowdon of the Institute of Economic Affairs points out, the public health lobby is demanding that the same efforts be redoubled anyway, an approach that would be considered quackery in the private sector.
Drugs do not address the underlying reason why we are all getting so fat. But there are promises here too. In a powerful new book called Blind Spots, surgeon Marty Makary calls attention to how the medical establishment has largely ignored multiple, detailed studies showing that it is almost certainly the promiscuous prescribing of antibiotics to young children that is which triggers a tendency towards obesity, probably by changing the microbes in our intestines.
Restoring healthy microbiomes is the long-term solution, and Donald Trump nominated Makary to head the Federal Drug Administration.