Obesity: how drugs for it will change our relationship with food

This ad (and the reaction it generated) is a clear reflection of our personal views on obesity and what needs to be done to combat it.

Here are a few questions I would like to ask the reader.

Is obesity something that people bring upon themselves and simply require them to make better decisions in life? Or is it a social failure with millions of victims that requires stricter laws to control what food we eat?

Are effective weight loss medications a smart option in the obesity crisis? Are they used as a convenient excuse to avoid the bigger question: why are so many people overweight?

Few diseases generate such heated debate.

I cannot answer all these questions for readers; It all depends on your personal view on obesity and what kind of world you want to live in. But while you’re thinking about it, there are a few more things to consider.

Obesity is highly visible, unlike conditions such as high blood pressure, and has long been accompanied by a stigma of guilt and shame. Gluttony is one of the seven deadly sins of Christianity.

Now let’s look at semaglutide, which is sold under the brand name Wegovy for weight loss. It mimics the hormone that is released when we eat and tricks the brain into thinking we are full, reducing appetite so we eat less.

This means that by just changing one hormone, “you suddenly change your whole relationship with food,” says Professor Giles Yeo, an obesity specialist at the University of Cambridge.

And this has all sorts of implications for the way we think about obesity.

This also means that many overweight people are “hormonally deficient.”argues Professor Yeo, resulting in them being biologically hungrier and more vulnerable to weight gain than naturally thin people.

This was probably an advantage 100 or more years ago when food was scarcer, causing people to consume calories when they were available due to the uncertainty of what food would be available tomorrow.

Our genes haven’t changed profoundly over the last century, but the world we live in has made it easier to gain weight thanks to cheap, high-calorie foods, ever-increasing portion sizes, and cities that make it easier to drive than to walk or ride. bicycle

These changes began in the second half of the 20th century, creating what scientists call a “obesogenic environment,” one that encourages people to eat unhealthy foods and not exercise enough.

According to the World Health Organization, one in eight people in the world is obese.

Wegovy can help people lose about 15% of their initial body weight before the effects reach their peak.

Although it is constantly called a “weight loss drug”, it can help a person who weighs 127 kilograms lose up to 107 kilograms. Medically, it will improve your health in areas such as reducing your risk of heart attack, sleep apnea, and type 2 diabetes.

But Dr Margaret McCartney, a GP from Glasgow, warns: ““If we continue to place people in environments that promote obesity, we will only forever increase the need for these drugs.”

Currently, the UK’s National Health Service only plans to prescribe the drugs for two years due to cost. Evidence shows that once the injections are stopped, appetite returns and weight returns.

“My biggest concern is that preventing people from becoming obese is not being taken into account,” Dr McCartney says.

We know that obesity-promoting environments start early. WHO reports that in 2022, at least 37 million children under 5 years of age were overweight.

And we know that poor communities are hit harder than wealthier ones, in part because of the lack of cheap, healthy food in these less affluent areas.

But there is often a tension between improving public health and civil liberties. You can drive but must wear a seat belt; You can smoke, but with very high taxes and restrictions on age and where you can smoke.

So here are a few more things the reader should pay attention to. Should we also address the environmental problem that causes obesity, or just treat people when it starts to harm their health? Should the government be tougher on the food industry by changing what we can buy and eat?

Should we be encouraged to become Japanese (a rich country with a little obesity) and eat less food based on rice, vegetables and fish? Or should we limit calories in ready meals and candy bars?

What about taxes on sugar or junk food? What about broader bans on the sale or advertising of high-calorie foods?

Professor Yeo says that if we want change, “we will have to make concessions somewhere; we will have to lose some freedoms.”.

There have been formal initiatives to tackle obesity in England. Fourteen of them over three decades and they have very little to show for it.

These included five-day campaigns to promote fruit and vegetable consumption, calorie labeling of foods, restrictions on unhealthy food advertising to children, and voluntary agreements with manufacturers to reformulate foods.

But while there are preliminary signs that childhood obesity in England may be starting to fall, none of these measures have changed the national diet enough to turn the tide on obesity overall.

There is a school of thought that believes that weight loss medications may even cause us to change our diet.

“Food companies make a profit, that’s what they want; The only ray of hope I have is that if weight-loss drugs help many people stop buying fast food, could that trigger some of the environmental change,” asks Professor Naveed Sattar from the University of Glasgow. .

As weight-loss drugs become more widely available, it will soon be necessary to decide how they will be used and how they fit into our broader approach to obesity.

At this point we are just dipping our toes in the water. Supplies of these drugs are limited and, due to their enormous cost, they are available to relatively few people and for short periods of time.

The situation is expected to change dramatically over the next decade. As new drugs like tirzepatide emerge, drug companies will lose their legal protection – patents – meaning other companies will be able to make their own cheaper versions.

In the early days of blood pressure-lowering drugs or cholesterol-lowering statins, they were expensive and few prescribed them. Millions of people are currently taking them.

Professor Stephen O’Rahilly, a leading researcher in obesity and metabolic disease, says blood pressure could be addressed with a combination of drugs and social changes: “We did blood pressure screening, advised lower blood pressure levels with low sodium (salt) foods nutrition.” and developed cheap, safe and effective blood pressure medications.”

That’s what needs to happen with obesity, he says.

It’s still unclear how many of us will end up taking weight loss medications. Will this only be available to those who are obese and at risk? Or will it be preventative to prevent people from becoming obese?

How long should you take weight loss medications? Does it have to be for life? How widely should they be used in children? Does it matter that people taking these medications still eat unhealthy junk food, but in smaller quantities?

How quickly should we start using weight loss medications if we don’t yet know the side effects of long-term use? Do we agree that healthy people take them solely for aesthetic reasons? Could its private availability widen the obesity and health gap between rich and poor?

So many questions but There are few clear answers yet.

“I don’t know how this will end: we live in times of uncertainty,” says Professor Naveed Sattar.

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