When drug manufacturers removed the weight loss drug fen-phen from the market in 1997, my mother was devastated. Not because the FDA warned that the drug could seriously damage her heart or even kill her, but because she had been trying to lose weight ever since she knew she had a body, and the only thing that had ever worked was to get ripped off. with his hands.
This is an extreme reaction. The fact that my mother would rather take a life-threatening medication than face life without it illustrates how frustrating it can be to be told over and over again that you need to lose weight, do your best to do it, but find this absolutely impossible.
For decades, the go-to prescription for weight loss was to eat better and move more – and make lifestyle changes. But these changes have been extremely difficult to follow in the long term. Even when people devoted themselves to them for years, they often produced marginal results. Few people were treated with drugs. Even fewer have opted for surgical procedures.
Now, GLP-1 drugs like Ozempic and Mounjaro have entered the debate. And they have completely changed the way doctors talk to and think about patients. How we think about ourselves and what is achievable. And why we’re stuck in a cycle of “treatment” that has been so frustrating for so many for so long, while obesity rates continue to climb.
In the mid-1990s, public health experts were looking for ways to mitigate rising obesity rates, largely because obesity was linked to diseases like type 2 diabetes and certain types of cancer.
The NIH launched a study in 1996 that would broadly define clinical thinking about future treatment. Researchers studied how to eat and move better in type 2 diabetes. They found that lifestyle changes leading to even modest weight loss had a major impact on preventing type 2 diabetes. Participants who achieved the goal of losing just over 5 percent of their body weight reduced the incidence of type 2 diabetes by 58 percent. To put this into perspective, if a person weighed 300 pounds, they would need to lose about 15 pounds. These were not The biggest loser weighings. These results were supposed to be achievable.
Government officials have issued calls for action. Doctors had concrete evidence of the importance of lifestyle changes. Diet and exercise have become THE prescription for weight management.
“I spent 20 years trying to sell the benefits of 5 percent weight loss,” said Dr. Dan Bessesen, an endocrinologist and director of the University’s CU Anschutz Health and Wellness Center. from Colorado. “It seems like a small change in weight, and yet it had significant benefits.”
Limitations of diet and exercise
The culture, of course, took these findings and quickly reworked them to fit existing beauty standards and narratives about personal responsibility. The argument was no longer, Lose a little weight to be healthier. Instead it became, If only an obese person could control themselves, they could achieve their goal.
But biology is more complicated than that.
“The body has its own idea of what it wants to weigh,” Bessesen said. Weight loss triggers all sorts of biological responses that compromise loss. We become hungrier and hungrier and our bodies accumulate energy (i.e. fat). This was useful when we lived in caves. Now that we’ve domesticated the wolves and are working from home in soft pants, that’s not so much the case anymore.
And so the miracle cure became a kind of disease in itself.
“Doctors mostly have this idea that, ‘Well, Ms. Jones, you should be able to manage (weight loss) on your own,'” Bessesen said. “We don’t do this with diabetes or high blood pressure.”
And maybe we’re about to stop doing it with obesity.
There have been medications to treat obesity for decades. But nothing has proven as effective or culturally appealing as the idea of simply eating better and exercising. Until Ozempic.
Ozempic is one of a series of drugs called GLP-1 agonists that have exploded in popularity in recent years. These injectables mimic hormones that slow digestion and trigger satiety, meaning you eat less and to want eat less. As you might expect, you lose a lot of weight – about 15% on average. And, just like medications for cholesterol or arthritis, they don’t rely on willpower to achieve the desired results.
Which means the conversation has changed. Patients come in asking for GLP-1 by brand name, which just doesn’t happen in most other diseases, Bessesen told me. And doctors can write a quick prescription instead of forcing a person to self-flagellate for months or years before considering medical intervention.
The existence of an effective drug appears to have moved obesity from being a perceived personal failure to being a treatable disease.
There’s an irony worth mentioning here: People who take GLP-1 medications often report a distaste for ultra-processed foods and a preference for fresh fruits and vegetables. And losing weight can help people move more freely. These medications are not a substitute for lifestyle changes. They seem to make them possible.
Not everyone living in a larger body needs to lose weight. And the body positivity movement has helped many people dismantle their own internalized fatphobia and escape a prison of unattainable beauty standards.
But some people feel the need to make changes to prevent type 2 diabetes or manage other health problems. If they choose to take GLP-1 medications, they present certain challenges and disadvantages.
Side effects can be serious: people have reported debilitating constipation and vomiting. The medications are also extremely expensive and most insurance plans do not cover them for the treatment of obesity. And there’s another aspect of taking these drugs that concerns him: the emotional toll they can take.
Eating is often a social activity, so radically changing your relationship with food can also change your human relationships. Noticeable weight loss can trigger uncomfortable conversations about a person’s private health choices that are difficult to navigate. And those who have put a lot of effort into accepting their weight may feel a deep conflict about being able to change the body they have grown to love.
“When we ask someone to have bariatric surgery, we prepare them for that,” Bessesen said. “They see a psychologist; they see a nutritionist. They talk to other people who have had surgery and ask them, “How did it go for you?” » Medications will give this kind of weight loss. But we don’t prepare people for this.
A new era of thinking around obesity and its treatment could help resolve some of the problems of previous times. But there are plenty of new ones to consider now that we’re here.
Prices are expected to stabilize as more companies bring more GLP-1 drugs to market. And there are compelling arguments for insurance companies to eventually cover the drugs. Treatment for type 2 diabetes and cancer is expensive. Preventing these illnesses could save money in the long run. It is a little less clear when we will develop systems to manage the psychological effects of modifying the physical body. But as more people take this route, we will learn more about the unintended consequences of this treatment.
