View this email in your browser

By Matthew Rees

Food and Health Fact #185:

Weight-loss drugs are not without risks

Follow me on Twitter: @foodhealthfactsI will be participating in a Travelers Institute webinar on January 25 -- sign up hereFind all previously published Food and Health Facts here

The topic du jour in food/health/obesity circles right now is Wegovy – a weight loss medication that acts as an appetite suppressant and that several studies (see here and here) show can drive weight loss of 15 percent or more among a large share of study participants. But it’s far from clear that Wegovy, and other weight-loss drugs, are an unmitigated good.

These drugs are being hailed as a breakthrough everywhere from scientific publications to TikTok. Wegovy shot to prominence in the mainstream media on New Year’s Day thanks to a 60 Minutes segment. The segment was decidedly pro-Wegovy, with interviews of two doctors who touted its benefits – one of whom was a paid consultant for the parent company, Novo Nordisk, which was not initially disclosed. And side effects were only mentioned in passing, but the incidence is significant: nausea (44 percent), diarrhea (30 percent), vomiting (24 percent), and constipation (20 percent).

One of the segment’s most striking moments came when Lesley Stahl asked one of the doctors – Fatima Cody Stanford, an associate professor at Harvard’s medical school – about willpower. “Throw that out the window,” replied Stanford.

Hmmm. It’s striking that someone with her credentials thinks willpower has no role in controlling or preventing obesity. If she’s right, we’re headed for an obesity rate that’s much higher than the historically high rate that exists today. America’s food environment is clearly geared toward weight gain. But it’s quite a leap to say that Americans have no ability to make smart decisions about what to eat.

To bolster her argument in favor of Wegovy, Stanford also asserted that “the number one cause of obesity is genetics.” But if that’s true, why was the U.S. obesity rate only about 10 percent 40 years ago? The notion that there’s been a dramatic change in Americans’ genetic profile over a few decades is rejected by others at Harvard and mainstream thinking about how genes evolve.

There’s one small detail about Wegovy and other weight loss drugs that rarely gets mentioned or emphasized: you have to keep taking them in order to keep the weight off. Thus tens of millions of Americans are potentially starting in on a new medication that they could be taking forever.

This would be expensive, as the out-of-pocket cost for Wegovy injections currently runs to more than $1,000 per month. Morgan Stanley projects that obesity medications could become one of the top 12 medications taken globally – with the sector’s valuation rising from $2.4 billion last year to $54 billion by 2030.

That’s going to be very profitable for the companies manufacturing these drugs, assuming insurance companies provide coverage (which they mostly do not right now). But are there health risks associated with taking more drugs? We know there are risks for people over 65, and we know that many drugs have side effects, particularly when they are taken in combination with each other. Moreover, nearly half of all American adults already take a prescription drug at least once every month, according to the most recent CDC data. (That’s about double the rate in the United Kingdom.)

At the risk of oversimplifying, Americans have far and away the lowest life expectancy of any developed country in the world. Is the volume of drugs we ingest contributing to that low life expectancy? And are we to believe that one more drug, in what is already a highly-medicated population, will be the silver bullet that brings new levels of health and happiness?

The use of weight loss drugs is not just a question for adults to contemplate about themselves. The American Academy of Pediatrics recently endorsed the use of these drugs, as well as bariatric surgery for children. With American children having just about the highest obesity rate in the world, there’s a clear need for action.

But prescribing pills and procedures is risky, given what is now known about the widespread use – and abuse – of Adderall and Ritalin. Is it a coincidence that anti-depressant use among teens increased 38 percent just from 2015-19?

Amid all the zeal about Wegovy, there are two final cautionary notes. One is that the weight loss shown in studies, while noteworthy, is insufficient to get most people back to a truly healthy weight. Lifestyle interventions are still going to be needed.

Second, there’s been a deafening silence about the fundamental driver of obesity: the highly caloric foods and beverages Americans consume in large quantities – and the fruits, vegetables, and whole grains that get consumed in small quantities.

Improving these consumption patterns takes time, of course, and when presented with seemingly effective remedies I understand how physicians and patients would seize on them. But the remedies could also stifle momentum toward a concerted national effort to improve the American diet.

Or maybe we shouldn’t bother with such an effort. Because if Dr. Stanford from Harvard is to be believed, willpower doesn’t matter, obesity is all about genetics, and Wegovy can cause those extra pounds to evaporate – as well as the diseases associated with them.

It would be a wonderful thing if she’s right (about the Wegovy part anyway). But I’m not going to give up on the idea that behaviors can change – through incentives, mandates, and product innovation – and that there’s a way out of the obesity calamity that doesn’t involve medicating tens of millions of American adults and children indefinitely.