Imagine if you could eat your fill on Christmas day then dial down your appetite for January. Good news: such a prospect may be within sight.
This past year has seen the rise of myriad weight-loss drugs that are getting better and achieving results where decades of hectoring and dieting have failed – in yet another miracle of biomedical science.
Not that you’d know it: eliminate the positive, accentuate the negative – that, all too often, is the way medical news works. Yes, there’s a worsening trend in some illnesses and a worrying side effect from some cures; cancer, dementia and anxiety are on the rampage; there’s ever more addiction to drugs and alcohol; there’s a pandemic just around the corner and there’s far too much obesity thanks to processed food.
Yet, in general, we have never been healthier. We live longer, rarely go hungry, feel younger, catch fewer infections, get cancer later and have far more options of 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 slim down after saying she had struggled with her weight for many years
But there is no denying that we are almost all getting fatter – and it is one of the greatest threats to human life expectancy today.
Problematic obesity was once very rare, when food was more expensive and work more laborious. Today, to be dangerously fat is common and is the tip of an iceberg of the more moderate flab many of us sport. No matter how hard the nanny state exhorts us to take more exercise, eat more vegetables and lay off the fizzy drinks, our waistlines continue to expand relentlessly.
Or do they? In America, the trend of increasing obesity has stalled and even slightly reversed. In 2021-2023, 40 per cent of American adults were obese, down from 42 per cent in 2017-2020. This is just the start of a public health revolution that will only 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. Around 12 per cent of Americans have already tried these drugs, and the fall in obesity is most marked in the social class most likely to take them.
More than any other product of the pharmaceutical industry in recent years, these injections really have 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.
True, the firm took a $100million hit to its market value last week when its latest weight-loss drug slightly underperformed in a clinical trial.
Nonetheless, more and more analysts think we are approaching an inflection point where these medications really take off.
In the next few years, we will see a veritable flood of appetite-suppressing drugs coming to market.
Many pharma companies are developing their own versions in clinical trials. Novo and Lilly, as well as at least five other firms, are developing oral weight-loss drugs. Soon, people will be able to take a pill rather than inject themselves – and there will be dramatically more takers.
To general surprise, weight-loss drugs are proving to have beneficial side effects against other illnesses, too. They seem to reduce the risk of heart disease, stroke, kidney disease, high cholesterol and perhaps even brain disorders such as Parkinson’s and Alzheimer’s. It looks as if they reduce inflammation, independently of effects on body weight. They even appear to reduce the death rate from Covid.
‘These are health promoters,’ says Harlan Krumholz, professor of medicine at Yale University. ‘It wouldn’t surprise me that improving people’s health this way actually slows down the ageing process.’
It’s not all good news. For some people the nausea and other side-effects are intolerable, and doctors are warning about the risk of slim people using them to become too slim. Plus you can pile the fat on again once you stop the drug. For those with a puritanical bent, these drugs let us off the hook of responsible abstinence. But for many diabetics and obese people, they are a godsend.
Television sensation Oprah Winfrey has trimmed down in recent years thanks to Ozempic
The story behind these drugs has all the usual themes of innovation: it’s a gradual, incremental, collaborative tale with serendipitous bursts of luck and a lot of trial and error. No one person deserves a statue, although three may be singled out (probably a bit unfairly) for a Nobel prize one day.
Bizarrely, it begins with angler fish – those hideous bottom dwellers that lure their prey by dangling a fake morsel in front of their huge mouths. Angler fish have discrete organs for making insulin.
In the 1980s, scientists from Massachusetts General Hospital travelled to Cape Cod and asked fishermen if they could have lots of these little organs for experiments. From them, they isolated a gene that makes a hormone called glucagon-like peptide-1 or GLP-1. It proved an effective way of regulating blood sugar and appetite.
Then, to make GLP-1 last longer in the body, another scientist working for the US department of veteran affairs, John Eng, suggested looking at a similar hormone used by gila monsters: fat black and yellow lizards from Mexico with venomous bites. They regulate their appetite so well they need to feed only a few times a year. By studying the lizard molecule, pharma firms were able to make synthetic versions of the hormone that could be injected daily and then weekly.
Britain, of course, lags behind America in the adoption of weight-loss drugs, with the NHS put off by the high cost of patented drugs. But Health Secretary Wes Streeting has announced a trial to prescribe Zepbound to the workless obese to try to get them back to work.
And there is nothing to stop us buying the drugs privately as many a celebrity has already demonstrated.
‘If an otherwise healthy middle-aged man displays sudden weight loss,’ reasoned Boris Johnson about several of his ministerial colleagues, ‘there are only two possible explanations. Either he has fallen hopelessly in love, or else he is about to mount a Tory leadership bid.’ Then he realised that no, they were in fact injecting 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 finger-wagging about fizzy drinks and junk food. Drugs could undermine their campaign for ever more restrictions on advertising such products on television. For these folk, semaglutide and tirzepatide are existential threats akin to the effect electric lights had on candle wick trimmers. Puritans prefer pain to technical fixes.
In the world of public health, failure is routine. Low-fat diets, artificial sweeteners, sugar taxes, advertising bans, dieting advice: none have worked well. As Chris Snowdon of the Institute of Economic Affairs points out, the public health lobby demands that the same efforts be redoubled anyway – an approach that would be regarded as quackery in the private sector.
Drugs do not address the underlying reason we are all getting so fat. But here, too, there is promise. In a powerful new book called Blind Spots, surgeon Marty Makary draws attention to the way the medical establishment has largely ignored multiple, detailed studies showing that it is almost certainly the promiscuous prescribing of antibiotics to young children that triggers a tendency to be obese, probably by changing the microbes in our guts.
Restoring healthy microbiomes is the long-term solution – and Makary has been nominated by Donald Trump to head the Federal Drug Administration.
