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Can we drug our way out of the obesity crisis? This 60 Minutes episode certainly seemed to suggest we could. Only later did we learn that 60 Minutes had been paid by the makers of Ozempic to air a 13-minute promotional segment and pass it off as a news story.
Are these GLP-1 drugs the answer to the obesity epidemic? The head of the European Association for the Study of Obesity was pretty bullish, conveniently failing to disclose that his group had received millions of dollars from the drug maker.
But doesn’t getting a tiny weekly injection sound far easier than getting all sweaty in the gym? Do these game-changing new medications “make lifestyle-based treatment of obesity obsolete?” Let’s ask those paid by the two main GLP-1 drug makers, which now have a combined net worth greater than a trillion dollars.
The World Obesity Federation, which evidently just got a million dollars from the Ozempic company, published a consensus statement in one of its journals favoring the definition of obesity as a disease. This designation may not benefit patients, but it will benefit doctors and drug companies when health insurance and clinical guidelines promote treatment with drugs and surgery. A concern is that labelling obesity as a disease risks reducing our autonomy, disempowering and robbing us of the intrinsic motivation that’s such an important enabler of change. It encourages fatalism, promoting the fallacy that genetics are destiny.
But, of course, it can’t be our genes. The obesity epidemic only started a few decades ago. Our genes didn’t somehow magically change in the late 1970s. Others blame lack of willpower, but that doesn’t make any sense either. All of a sudden all of us coincidentally lost our collective self-control?[i]
It’s the food….
The rise in the number of excess calories provided by the U.S. food supply is more than sufficient to explain the obesity epidemic. Obesity is not some moral failing. The battle of the bulge is a battle against biology. We’re living in a toxic food environment, drowning in a sea of excess calories, being bombarded with ads for fast food and candy. Becoming overweight is a normal, natural response to the abnormal, unnatural ubiquity of sugary, fatty foods that are concentrated with calories.
So, the prime cause for the obesity epidemic is neither gluttony nor sloth. Being overweight may simply be a normal response, by normal people, to an abnormal situation. And with nearly three-quarters of Americans overweight—it’s literally normal.
So, if obesity is to be understood as “normal physiology within a pathological environment” there is an argument that drugs like Ozempic really aren’t tackling the root cause of obesity. These drugs will likely have only a modest effect on reducing the rapidly growing epidemic, and may even make it worse, as Big Pharma and its lobbyists try to shift society’s focus to drugs rather than broader public health strategies. The real solution would involve fixing the food system. But why would Big Food change its ways if obesity can be treated with drugs? So, the main actors responsible for creating and perpetuating the obesity-generating world will continue undisturbed.
England’s health secretary was keen to use GLP-1 drugs as a “way of preventing illness without resorting to ‘nanny state’ measures,” but advocates are just talking about things like restricting the thousands of ads kids see every year for candy, liquid candy (soft drinks), breakfast candy, and fast food.
A quarter century ago, the term “Social Determinants of Health” was coined, defined as the nonmedical factors that influence health, too often ignored by the medical establishment, such as poverty. They help explain why the top one percent, for example, live about 10 to 15 years longer than the bottom one percent.
More recently, based on experience with the alcohol and tobacco industries, the concept of “Commercial Determinants of Health” was introduced, which can be defined as “factors that influence health which stem from the profit motive,” also referred to as the Corporate Determinants of Health. The food and beverage sectors spend huge amounts on developing and marketing products packed with sugar, fat, and salt, deliberately designed to lead to addictive consumption that contributes to the increasing prevalence of chronic disease.
Public corporations like Coca Cola have a legal duty to maximize return to their shareholders, and those running the companies are heavily incentivized to achieve this. Many observers are outraged by stories of what some of these companies do to maximize returns. But as people working in the tobacco industry can testify, being the subject of widespread disrepute is more than offset by the financial rewards. And psychological defense mechanisms can take care of any residual unease about contributing to the suffering and death of fellow humans whom they do not personally know. The greatest challenge to improving health may lie in the tension between wealth creation and health creation.
Introducing a temporary weight-loss fix using GLP-1 drugs like Ozempic, without consideration of their wider implications and a long-term plan, has been likened to sprinkling water on a raging blaze. The war against obesity cannot be won without measures to prevent obesity in the first place. That means tackling the food environment, which is based on high-calorie, fatty, salty, sugary junk, rather than relying on medication as a “damage limitation exercise.” Yeah, but limiting damage is a good thing. Sure, these drugs may not make much of a dent on a population scale, but what about on an individual basis?
It would be great if people ate healthfully enough to prevent and treat heart disease, high blood pressure, and diabetes too. But until that happens, drugs for those conditions can literally be life-saving.
Obesity so dramatically decreases one’s lifespan—reducing life expectancy as much as a decade, that these GLP-1 drugs—like bariatric surgery—should be considered as a last resort for those unwilling or unable to treat the cause of their obesity. Put diabetics on Ozempic, and they eat less high-fat and sweet foods. Put nondiabetics on Ozempic, and they eat less high-fat and savory, non-sweet foods. So, diabetics on Ozempic are eating fewer pastries and donuts, and nondiabetics on Ozempic are eating fewer ham, cheese, and sausage sandwiches.
The problem is, people eat too much crap; so, anything that gets people to eat less crap can be beneficial––including surgically rearranging our digestive organs with bariatric surgery. But we don’t need to go under the knife, or take a $1,000-a-month drug to decrap our diet.
But what about the cravings, though? The obesogenic environment—that is, the obesity-generating toxic food environment—can overwhelm even substantial efforts to enact individual behavior changes. After ramping up for three months to high-dose Ozempic, people are able to cut nearly 1,000 calories out of their daily diet. How could you possibly do that without drugs, unless you were on some sort of liquid diet meal-replacement shakes or something? Or, you could eat a diet centered around the healthiest foods on the planet?
If you put people on a diet packed with fruits, vegetables, whole grains, and beans and allow them to eat as much as they want, they end up eating about 50 percent fewer calories than they might have otherwise. Just as full, on half the calories? Wait, how can people be satisfied after cutting more than 1,000 calories out of their daily diets? By eating more high-bulk, low-calorie-density foods (vegetables, fruits, whole grains, and beans), and fewer calorie-dense foods (like meats, cheeses, sugars, and fats). No wonder a whole food plant-based diet apparently achieved greater weight loss than any other diet.
So, could good nutrition present a safer and cheaper approach to weight loss for most patients? Not only can the ingestion of a plant-based meal more than double GLP-1 secretion, compared to a same-calorie meat meal, but plant-based diets can also cause weight loss by virtue of calorie-trapping, high-fiber foods, which flush calories away, or by boosting our resting metabolic rate––which helps explain why the largest study of vegans to date showed that those eating strictly plant-based are about 35 pounds (16 kg) lighter on average. And, in contrast to the costs of these drugs, one randomized trial found that a strictly plant-based diet may reduce annual food costs by about $500. Healthier, more plant-based, diets may be about 25 percent less expensive.
And eating groats and greens, maybe even spicy groats and greens, may be able to provide an extra GLP-1 boost. For more healthy weight-loss tips, check out my evidence-based weight loss book, for which all proceeds I receive are donated to charity.
The Drug and Therapeutics Bulletin, which is also independent and doesn’t accept any advertising, concluded that more data on Ozempic’s long-term safety and efficacy are needed before it can be recommended for routine use for the treatment of obesity, reminding readers that historically, nearly all the drugs approved for weight loss have later been pulled from the market because of safety concerns.
But wait. Obesity so dramatically decreases one’s lifespan, that even if these drugs ended up shaving years off of people’s lives, wouldn’t they still be worth it? Well, that assumes these drugs cure obesity. But if you remember from the drug’s own package insert, in all the major trials, people started out obese and ended up obese, after the drugs effectively stopped working and body weight plateaus. Then, you’re paying to take the drug for the rest of your life just so you don’t lose ground and regain everything, while continuing to face any and all long-term side effects.
Historically, the medical profession has offered a sorry collection of harmful or downright dangerous weight-loss interventions. Caution about long-term side effects is, therefore, warranted. If you look at the post-approval withdrawal of anti-obesity drugs, pulled from the market because of safety concerns only discovered years later, it took an average of a decade before dangers came to light. And in one case, we didn’t discover a weight-loss drug’s long-term adverse effects until 38 years after it hit the market. What’s more, even after that first report of danger, it takes an average of another decade to actually get banned. It can even take as long as another two decades, even though people died in about a quarter of the cases. As one critic said about how long it takes regulators to act: “It would probably take the system two years to ban cyanide.”
Just recently, a French drug maker was fined nearly half a billion dollars for fraudulently and relentlessly promoting its appetite-suppressing weight-loss drug while covering up known harms, causing hundreds or thousands to die from heart valve problems.
At least it learned its lesson, though.
What other drug company would conceal the harms of appetite suppressors after a fine that big? After all, it was only making up to 20 million euros a year. Let me do the math real quick…. That’ll teach ‘em! These days GLP-1 drug makers are worth more than a trillion dollars. I’m sure they would never try to cover anything up.
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