by Lisa Jarvis
This year, the incredible potential of obesity medicines like Novo Nordisk’s Ozempic and Wegovy and Eli Lilly’s Zepbound started to come into view. The drugs work so well for so many that it’s starting to look like they could change the literal and metaphorical shape of society — starting with our waistlines and extending to our overall health and our habits around food and alcohol.
And yet the way we talk about these drugs remains stuck in frustrating binaries. The drugs are either a panacea or an overpriced Band-Aid; they will either solve one of the biggest problems in health care or burden the system with hundreds of billions of dollars in unjustified cost. The extremes keep us from honestly addressing some fundamental questions about these drugs. Most pressingly: What role should they play in addressing a sicker, fatter society?
There are many obstacles to starting to address that necessary question. One is the still-widespread attitude that the drugs make weight loss too easy — that the only meaningful pounds shed are those earned through diet and exercise. Another is the hardened position of some body positivity activists, who refuse to acknowledge any connection between weight and health. Same goes for the clickbait headlines that either hype the drugs’ miraculous abilities or foster fear about their potential dangers.
Meanwhile, there’s the faction that sees these drugs as a costly and superficial solution to the societal ills that have contributed to a more obese, sicker country. They’d rather the money be spent on correcting some of the root causes of the problem, starting with glaring inequities in access to healthy food and preventive health care.
Then there’s the pharmaceutical industry’s eagerness to convince the world that all overweight people — in the U.S., some 100 million — will benefit from an expensive drug that they’ll likely need to take for life. That’s not helping to foster an especially nuanced, constructive conversation. Nor are the analysts practically salivating over a market that could be worth upward of $100 billion per year — a cost that, depending on whom you ask, will blow up health-care budgets or save billions.
In the end, none of these extreme positions feels quite right. Worse, the cacophony doesn’t allow us to appropriately address the most important questions: Who should get these drugs and for how long? And how we can pay for them without exacerbating health inequities or bankrupting the health care system?
One way through would be to start by admitting what we do and don’t know about the drugs, and dig into the nuanced way — good and bad — they could affect individuals and society.
Ozempic, Wegovy and Zepbound are unquestionably revolutionary. Beyond the stunning weight loss they cause, there’s growing evidence that they can affect harbingers of many other diseases. As the number on the scale goes down, often blood pressure, blood sugar and lipid levels drop, too, sometimes so much that they can taper or stop other medications. And many people see benefits that are less easily measured, but deserve to be part of the conversation. For the first time, they are free of the “food noise,” the constant buzz of a brain convinced it is hungry. Or they’ve finally found relief from knee or joint pain; they can now get down on the floor with their kids or hike that trail that has always eluded them.
And yet, there is also so much we still need to learn about these drugs and how they will be used. The wild prognostications about how GLP-1s will affect societal health, not to mention the range of downstream consequences on things like food and beverage consumption, hinge on their long-term use. But given their real side effects and steep cost, it’s not clear how many people will take these drugs even for a year or two, let alone for life. And we will eventually need to better define whose weight puts them at risk of disease, and who is perfectly healthy in their bigger body — and then decide whether it makes sense to pay for the drug for anyone who wants it.
We also need to talk more about what created the modern obesity problem in the first place. The U.S. doesn’t have a great track record when it comes to investing in prevention or the social determinants of health. But we have to imagine a world where both the quick fix and the slower, structural solution can coexist.
This year, the extraordinary possibilities brought by these obesity drugs have become clear. Next year, we need a frank, nuanced conversation about how they should be equitably and responsibly used.
