Doomsday in the land of the obese: Can weight loss drugs make a difference?

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RESEARCH TRIANGLE PARK – If you are reading this article and you live in the United States, chances are that you are overweight or obese. The obesity numbers are especially worrying, because they keep rising in the United States and today about 40% of adults are obese.

There is a new class of drugs that aim to solve the American obesity epidemic. But there is a problem. This article describes the problem in two sentences:

“Patients I see want their knees to feel better, their hips to feel better, their blood pressure to get better, their diabetes to get better,” Levy said. “But when they come in, I have to tell them, ‘I’m sorry, I’d prescribe this for you, but it’s going to be $1,200 a month because your insurance doesn’t cover it.’ It’s sad.”

Before we get to the drugs and the problem, let’s take one quick tangent and look at the obesity epidemic that is engulfing America.

America has not always been obese

If we could get in a time machine and go back 40 years, we would find that obesity was quite rare in America. A video like this can help you understand how obesity has spread across the country: https://www.youtube.com/watch?v=v7uDc2yI5JE&t=14s

As you watch the video, you will notice that the obesity rate is quite low in 1985 – less than 10% in many states. But now America has a 40% obesity rate. The remarkable thing is that we don’t really understand why. There are a lot of theories, but no smoking gun:

Maybe it is the rise of fast food, and the saturation of the American landscape with fast food places?
Maybe it is the rise of highly processed foods?
Maybe it has to do with food scientists and their improving ability to make more “addictive foods”?
Maybe it is the invention of cheap high fructose corn syrup (HFCS) to replace sugar?
Maybe it is the addition of sugar and HFCS to so many foods today, to the point where Europeans think of American bread as cake because of the sugar content?
Maybe it is the huge advertising budgets spent by every food purveyor, constantly reminding us to eat?
Maybe it is large portion sizes, especially in restaurants, and the increase in restaurant eating?
Maybe it is a change in gut bacteria?
Maybe it is a move toward more sedentary lifestyles, spurred on by cable TV and then the Internet and then smart phones and Tik Tok?
Maybe it is some form of pollution or contamination in the air or water, be it PFAS or microplastics or something similar?
Maybe it is the decline in the rate of smoking, as smokers tend to be thinner?
Maybe it is a combination of several of these?
And so on

Even though we do not know the definitive reason for it, obesity has been spreading and it is now epidemic in the United States.

The new drugs to combat obesity

Since 2021, there are several new drugs that can have a real effect on obesity. They are:

Semaglutide – the generic name for the molecule found in Wegovy and Ozempic.
Wegovy from Novo Nordisk, approved by the FDA in 2021 for weight loss.
Ozempic from Novo Nordisk, currently approved for treatment of Type 2 diabetes and awaiting approval for weight loss.
Tirzepatide – the generic name for the molecule in Mounjaro.
Mounjaro from Eli Lilly, approved for treatment of Type 2 diabetes and awaiting weight loss approval.

This article points out:

“All three drugs [Wegovy, Ozempic, Mounjaro] — which are given as injections — work in a similar way: They’re a class of drugs called GLP-1 agonists, which mimic a hormone that helps reduce food intake and appetite. However, Eli Lilly’s tirzepatide also imitates a second hormone, called GIP, which along with reducing appetite, may also improve how the body breaks down sugar and fat. A phase 3 clinical trial found a high dose of tirzepatide helped patients lose 22.5% of their body weight on average, or about 52 pounds, better than any medication currently on the market. Most patients in the trial had a body mass index, or BMI, of 30 or higher. In trials, Wegovy and Saxenda reduced body weight by around 15% and around 5%, respectively.”

The GLP-1 agonist helps people to feel less hungry. The GIP enhances the process and has an amplifying effect on weight loss. See this video for details: https://www.youtube.com/watch?v=8Aiw0yWu9jU

In this article , the author describes what it feels like to be obese:

“What health professionals call my morbid obesity—that “morbid” is a helpful reminder—is what you see. But it’s a side effect of what I am, which is insatiable. Literally: I never seem to feel full. In practice this means that at certain times of day, I watch in horror as my body reaches for the cheapest, easiest calories nearby—out of the pantry, out of a vending machine, at a party. I scream, “Stop!” But the hand keeps reaching.”

If a person feels insatiable, they overeat and they eat too often. There is also a tendency to prefer highly processed junk foods and fast foods. The author then describes going on Mounjaro and having the insatiability disappear. The constant need to eat vanishes. Suddenly there is no need to eat constantly, because there is no desire to eat, no constant hunger.

Obese people can lose a fifth, sometimes even a quarter, of their body weight.

This all sounds great, but there are at least four problems with these new obesity drugs:

These drugs are expensive, costing $12,000 to $14,000 per year
Insurance, at least right now, is unlikely to cover the cost of the drug when it is used for obesity. Even if insurance covers it, the patient might still be on the hook for several thousand dollars a year depending on how their coverage is written.
At least right now, there can be problems obtaining the drugs. There is not enough of a supply to meet the needs of diabetes patients and newly prescribed obese people.
People who lose weight will likely need to stay on the drugs to keep the weight off. See this video for details – https://www.youtube.com/watch?v=_rXANcA01C0

What if you want to lose weight but you do not have $13,000 a year to spend on it?

If a person happens to be in the upper income brackets, and therefore has a spare $13,000 laying around to spend on drugs like Wegovy, Ozempic, and Mounjaro, then these drugs can be great. But if you don’t have that kind of disposable income, then you need to rely on more traditional weight loss techniques such as:

Diet and exercise. Also known as eating less and exercising more. Also known as CICO, or Calories in and Calories out, where you try to burn more calories per day than you take in. Typically you use a food diary to track the calories eaten and the calories burned, and you try to hit a negative number each day. A problem with this approach can be binging. It is possible to do great for a week or two, and then one night of binging can ruin all of the progress.
Intermittent fasting. The goal is to have periods of time when no food is eaten. So a person might eat for 8 hours a day and then fast for the other 16 hours. Or eat during the week and do a 48-hour fast on the weekend. A problem with this approach, besides the threat of binging, is that some people simply cannot maintain the discipline of fasting.
Ketogenic diets. The Atkins diet, the Dukan diet, and many others limit carbohydrates. The limit might be 20 grams or 50 grams of carbs per day (where a normal American consumes 5 times that or more). Limiting carbs can diminish appetite and cravings and therefore lower food intake. Ideally, a person’s metabolism switches over to ketosis to burn fat since there are so few carbs available. The problem here is that many humans love carbohydrates (sugars and starches), and giving them up for a long period of time is difficult or impossible.
And many others

Given the state of the obesity epidemic in America, it is apparent that these techniques are not very successful. In addition, most people who do lose weight then gain it all back when they stop dieting.

What is the real solution? Scientists need to discover the root cause of the obesity epidemic described earlier. What has caused America to become so obese over the last 40 years? If we could discover this and reverse it, then we might not need the drugs or the diets.