We’re on the Verge of Reversing Obesity
Why public health beliefs are closer to ideology than science.
When I first heard about Semaglutide a year ago, I was skeptical about its potential as a miracle cure for obesity. In the realm of problem solving, there are generally no ideal solutions, only compromises. Especially when you consider the history of weight-loss drugs, which haven't seen a medical revolution that led to significant outcomes. Previous treatments had little effect, and those that were more effective were often removed from the market due to concerning side effects. However, the case of Semaglutide seems to be an exception to this rule. The drug was originally marketed by Novo Nordisk under the brand name Ozempic as a type 2 diabetes treatment, but the company discovered that patients in trials reported significant weight loss, leading them to develop a weight loss drug using the same molecule, called Wegovy.
A growing number of studies report promising results, with a mean 15% loss of body weight after only 68 weeks. Some participants in the studies reported mild side effects such as nausea or diarrhea, but for the most part, these were transient and resolved quickly. If you're wondering what these numbers mean, 10–15% loss of body weight is basically considered the “holy grail” in obesity treatments. The only existing treatment more effective than that is bariatric surgery, which reduces body weight by about a quarter and costs about $20,000. Because it's expensive and involves major surgery, only 1 in 400 Americans undergoes it, but the long-term health benefits are more than impressive.
Relative to people of similar weight who do not undergo bariatric surgery, those who do undergo surgery experience:
83% lower risk of developing diabetes
44% lower risk of developing cancer and dying of it
29% lower risk of having a heart attack
29% lower risk of dying from any cause
78% of people reverse established diabetes
The reason why Semaglutide is so effective is due to its stomach emptying delay properties, which prolong the feeling of satiety and reduce cravings for high-caloric foods, and even more surprisingly, can reduce a wide range of dopamine-fueled behaviors, including drinking alcohol and shopping. And even in the case of mild side effects, they are largely outweighed by the health benefits that come with avoiding long-term obesity. Such findings are usually extremely rare in medical research, and in this regard Semaglutide can be considered a breakthrough discovery. While other, more potent analogues are already approved, it marks the beginning of a new generation of obesity treatments.
However, this recent medical advancement has not been well received by the media, and some reputable newspapers have repeatedly expressed criticism. Some of the backlash could be roughly boiled down to two categories of disagreement: adherents of the body positivity movement, who tend not to view obesity as a disease and believe that obese people shouldn't be encouraged to lose weight – if you identify with this view, you should probably read this instead. The second group is more idealist; they understand the benefits of obesity treatments, but are skeptical that they can be effective in the long run. Instead, they suggest fixing the problem at its core with drastic measures to regulate the food industry, such as eliminating all processed foods, or creating healthier urban planning to make cities more walkable and bikeable.
The latter category is probably right in believing that nudging people's behavior toward healthier lifestyles is certainly a more sustainable approach to tackling the problem. This view is largely supported by the unmistakable uneven distribution of obesity rates around the world when comparing a country like Vietnam, where an estimated 2% of people are obese, to the United States, where 42% of the population is affected by obesity. The disparity in obesity rates is due to a variety of reasons, but the most obvious are probably environmental factors such as food culture (diet) and frequency of physical activity.
Given that two-thirds of obese Americans attempt to lose weight each year with little success, suggests that living in an unhealthy environment makes it more challenging to lose weight. This brings up the question of whether obesity should be addressed primarily through lifestyle changes. Yet the main problem with obesity is that it's deeply ingrained and immune to most forms of government intervention. There is no such thing as a major change in the food industry, other than a radical shift in consumer preferences, which frankly seems quite unlikely. Especially in rural areas, where obesity is even more prevalent, the notion of adopting the organic-store-and-bike-lane model is merely a luxury belief. In addition, very few health education programs are beneficial, and in most cases people already know what is bad for them but do not necessarily have the willpower to change their habits – and the countless health influencers on social platforms do not help. Therefore, claiming that obesity can be addressed through policy is closer to wishful thinking, because it's based on the premise that governments can change a culture.
The whole idea that investing billions of dollars in health campaigns is an effective solution is a misconception. The tobacco industry is an interesting case study: a lot of effort was put into labeling every pack of cigarettes with warning slogans and disgusting pictures, which had very little effect on reducing smoking habits. The most effective way to stop smoking is still not to smoke in the first place, and governments are not good at making something unpopular. Conversely, the introduction of e-cigarettes has been much more effective in reducing smoking harm. But I still meet people who don't believe that e-cigarettes are a much safer alternative, rehashing urban legends like popcorn lungs. What they fail to understand is that e-cigarettes are 95% less harmful than combustible cigarettes. Although this number is controversial, the accumulating evidence suggests that the real figure is probably very close. Regardless of what people think of e-cigarettes, their growing popularity will dramatically improve the long-term health of smokers.
Obesity follows a similar trend, driven by genetics and cultural factors over which governments have little control, and democratizing convenient substitutes seems far more effective than trying to address behavior. Semaglutide may not be the ultimate cure for obesity, and the criticism that it represents a quick fix rather than a sustainable solution is valid. Nevertheless, it may lead the path to reversing the obesity curve within the next decade. In this regard, the advent of new treatments for obesity should be welcomed. They may fail to address the underlying cause of obesity, but the health benefits of preventing its long-term effects are too great to ignore. Part of the skepticism about weight loss drugs, I suspect, is driven by a sense of fatalism. A view in which unintended consequences are always lurking around the corner to make things worse. What this view fails to acknowledge is that throughout history, many diseases that once caused millions of deaths have been defeated.