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By Matthew Rees

Food and Health Fact #172:

Amid policy failures, are pharmaceuticals the solution to America's obesity crisis?

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One of the staples of modern economics is that if you want less of something, tax it. That’s generally the idea behind so-called “sin taxes” on alcohol, cigarettes, and sugar –taxes favored by no less a free-market icon than Adam Smith.

In the United States, taxes on the first two in that toxic trinity have been widespread, but less so for sugar. And one recent attempt fell short. Coming amid no apparent progress in reducing the sky-high obesity rate, some are saying that the solution lies elsewhere; namely, providing insurance coverage for weight-loss drugs.

The sugar tax in question – 1.5 cents per ounce of a sugar-sweetened beverage – was implemented by the city of Philadelphia in 2017. Similar taxes have been imposed throughout the country – reflecting the role these beverages play in contributing to obesity, accounting for more than 41 percent of all added sugars in the American diet.

A University of Georgia study published earlier this month looked at the tax’s impact. The good news? Demand for sugar-sweetened beverages declined about 31 percent – a figure roughly consistent with what a University of Pennsylvania study showed two years ago.

Alas, the tax only applied to beverages sold in Philadelphia – and not to surrounding jurisdictions. The Georgia study took the extra step of looking at those surrounding jurisdictions and found that many consumers simply shopped outside the city to evade the taxes. Nearly 40 percent of the decline was cancelled out by these tax-savvy consumers.

What’s more, consumers started buying more high-sugar food products – both in Philadelphia and in neighboring towns. This cancelled out another 40 percent of the decline in purchases.

The study’s lead author said that while behavior can be influenced through taxation, “only if you enact policy at broader levels of government, such as at the state or national level,” so consumers can’t engage in cross-border shopping.

Researchers have found that the use of statewide taxes on cigarettes has contributed to ongoing declines in the smoking rate. But taxing cigarettes is also destined to be more successful than taxing sugar-sweetened beverages because, as the University of Georgia study demonstrated, consumers can buy other products to satisfy their sugar fix. But until Juul and others entered the consumer market, there were no real alternatives to the nicotine hit delivered by traditional cigarettes.

Some will argue that given the unlikelihood of high taxes being applied statewide (or nationwide) to sugar-laden foods and beverages, and given the absence of other viable policy options, it’s time to focus on pharmaceutical solutions.

The pretext for this view is that the United States has reached a point where there’s no hope for people losing the weight they’ve gained. “The problem with diet and exercise,” writes journalist Matthew Yglesias, in a thoughtful piece on obesity treatments, “is that while it is a useful framework for preventing obesity (especially in terms of establishing children’s habits) essentially nobody successfully loses weight in a sustainable way through this method.”

That’s not quite right. The most recent meta analysis of 29 long-term weight loss studies showed that more than half of weight lost is regained within two years and about 80 percent is regained within five years. But this does demonstrate the difficulty of keeping the weight off, which underscores the importance of keeping it off in the first place.

Yglesias and others point to drugs that the Food and Drug Administration has approved over the past 18 months and that show promising results. Wegovy, by Novo Nordisk, has been associated with an average of 15 percent weight loss. Trial data from Tirzepatide, by Eli Lilly, show a weight loss of 22.5 percent after 16 months.

And the word is out. GQ, a men’s magazine, has just published an article under the headline, “Is the World Ready for Extremely Effective Weight-Loss Drugs?” An offshoot of Wegovy, called Ozempic, has been written up in Town & Country, Glamour, and Variety. (“[Ozempic] has saturated the [entertainment] industry in recent months,” reads the breathless Variety article, “helping the beautiful and wealthy shed extra pounds in the never-ending Los Angeles pastime of optimizing appearances.”)

The next battle will be getting private insurers and Medicare to cover these drugs, given their expense (Wegovy is more than $1,600 per month). The argument for doing so is that obesity is a disease and should be treated like one – and there will be massive benefits – economic, health, and otherwise – from getting people to lose weight (or, in the case of Hollywood, “optimizing appearances”).

Perhaps, but it’s worth remembering that these are not short-term medications – they need to be taken in perpetuity for the benefits to continue. This raises a thorny question: Is the United States going to, in effect, throw in the towel on diet-focused interventions to reduce our weight problem?

Amid the push for pills and procedures (Ozempic is injected), it’s worth remembering that close to half of all Americans already take at least one prescription drug monthly – a reflection of the atrocious state of the nation’s public health. Sharply increasing this figure (given that 70 percent of Americans are overweight) hardly seems like a viable long-term solution to an epidemic that is eminently preventable. And when it comes to medications, let’s remember what the FDA points out: 20-30 percent of prescriptions are never filled, and of those that are filled, half are not taken as prescribed.

There are no easy answers to reducing obesity, but the University of Georgia study highlights the limits of locally focused remedies. A national epidemic seems to merit national policies – focused not on devouring more drugs but rather discouraging the production and consumption of the foods and beverages that are at the root of the problem.