reed is an associate editor for the editorial and review sections. Email: chris.reed@sduniontribune.com. Twitter: @calwhine. Column Archive: sdut.us/chrisreed.
In the late '70s, then-up-and-coming comedian David Letterman liked to poke fun at outrageous headlines in the supermarket tabloids — and the Americans who believed them. A favorite is “How to Lose Weight Without Dieting or Exercise”.After citing it, Letterman would Poker face“That pretty much leaves the disease behind.”
That no longer appears to be the case. While authorities warn that a healthy lifestyle remains extremely important, they also acknowledge that two new anti-obesity drugs appear to allow most users with a high BMI to lose weight quickly and safely without serious side effects. Yes, an article in the Yale University Journal of Medicine last year warned against viewing semaglutide (better known by its brand name Wegovy) and tirzepatide as “wonder pills.” But it also mentions how surprised a participant in a clinical trial was that she became less hungry after using the latter drug. “An Oreo is three cookies, and it's always difficult to stop at three,” she said. “During the experiment, I found it really hard to eat more more than three. “
In an age where technological progress is advancing faster than ever, cathartic change seems to be just around the corner in many ways—artificial intelligence, genetic engineering, even nuclear power. But for the 40 percent of severely overweight U.S. and global adults, developing drugs that induce the brain to reduce hunger may be the most important technological gain for individuals. Given that a high BMI is linked to an increased likelihood of heart disease, stroke and certain types of cancer, a health revolution is imminent.
It can be seen in the reactions of insiders, who appear giddy after mounting evidence of the drugs' efficacy. It was presented at the annual International Obesity Week conference in San Diego in November. Participants knew that anti-obesity drugs that previously had some effect in adults offered little or no help to adolescents. So when researchers at the Danish pharmaceutical company Novo Nordisk (maker of Wegovy) reported that teenagers with a high BMI lost an average of 15% of their body weight after 16 months of treatment with their drug—the same results for adults Much the same — the attendees were overjoyed. They responded with sustained applause, “like you're in a Broadway show,” says Susan Yanovski, co-director of the federal government's Office of Obesity Research.
Government bureaucrats are equally enthusiastic in their own way. Semaglutide, the drug that later became Wegovy, was first created and tested in 2012 to treat type 2 diabetes. That context is important because the notoriously cautious FDA has long been criticized for being slow to accept a drug developed for one purpose for another. This sparked a silent revolt from many American doctors. More than one-fifth of their outpatient prescriptions are “off-label,” meaning doctors give their patients medications in ways the agency disapproves of.
But the FDA warning didn't come in 2021, when the agency approved Wegovy as a treatment for at least one weight-related health condition in obese or overweight adults. The announcement — four years after semaglutide was approved for diabetes treatment — was enthusiastic about the drug's potential. Tirzepatide, made by US pharmaceutical giant Eli Lilly, is also on the same track. It was approved by the FDA last year to treat type 2 diabetes. It was more effective than Wegovy, prompting an average weight loss of 21% in drug trials.
So what if these drugs suddenly became widely available and in huge demand? I think there are at least two developments that probably few saw coming.
First came the backlash from the Fat Acceptance movement, which aims to remove the stigma of being fat and end discrimination based on body size. The unscientific view that having a high BMI is good — and not a health risk — can be seen not only in activists' social media posts, but also in Scientific American blog posts. A 2019 post by an author with three graduate degrees in weight-related science was headlined: “Fat isn't the problem—the stigma of obesity is.”
The second is that the extreme cost of obesity drugs — Wegovy's list price is about $1,500 a month — will limit access to them. If one-third of the more than 100 million U.S. adults with a high BMI expect their health insurance to pay most of their costs, insurers won't be able to comply without massive increases in overall premiums and huge obesity rates — specific common pay. Or they will simply declare that such drugs are not covered by their policy.
So what would happen if drugs were only available to the rich? The emergence of perhaps the largest black market in history. It's not just those willing to buy dubiously sourced drugs to prolong life that's driving demand. Every American who wants to lose 10 pounds or so quickly to look thinner will at least be open to the illegal trade. If the cartel can make $10 million from synthetic fentanyl which costs $16,000 to mass produce, how are they going to deal with 35 million or more Americans wanting one they can't afford Or the case of a drug that cannot be prescribed?
My guess: It's the turn of the cartels to get dizzy.
