In 2023, something very strange happened in America. Adult obesity rates, which have tripled since the 1980s, appeared to be declining. This was surprising and unexpected. Just a few years ago, medical experts wrote in one of the world’s most prestigious journals, the New England Journal of Medicine, that obesity continues to rise in the fast-food nation and that half of American adults will be obese by 2030. I confidently predicted that it would be. But now America, the heaviest superpower on the planet, appears to have bent that curve.
No one is sure about the cause of this decline. But the most likely candidates are the drugs Ozempic and Wigovy, two “semaglutide” drugs that have helped obese patients significantly lose weight. in the past While the global demand for these drugs has been remarkable in recent years, uptake in the United States has been particularly dramatic, with one in eight adults trying them.
This is clearly an important moment. You could even say that it is groundbreaking. In the 21st century, obesity has become a bigger problem than hunger. Currently, more than 1 billion people around the world are severely overweight. Moreover, despite all efforts, including educational campaigns, advertising regulations, nutrition labeling, and sugar taxes, no country has been able to reverse the trend. For decades, we have been fighting a losing battle. Finally, here’s something that might change that.
lucky accident
Many of the greatest scientific advances happened by chance. In 1928, Alexander Fleming returned home from a holiday in Suffolk to find a strange mold growing on an unused petri dish left on his windowsill. It became the world’s first antibiotic. Similarly, it was Pfizer’s series of trials for a new angina treatment that alerted the world to Viagra’s potential in the early 1990s.
The discovery that semaglutide may help with weight loss was also unintentional. Ozempic was designed to treat diabetics, and the drug produced insulin, which helped control blood sugar levels. However, it turns out that this process also suppresses appetite, causing weight loss. Sensing an opportunity, Ozempic’s manufacturer, Denmark’s Novo Nordisk, released Wigobee, a new version aimed at people who want to slim down. Novo Nordisk is currently the most valuable company in Europe and one of the most valuable companies in the world.
We are still in the preventive era of semaglutide. This drug has been used to treat diabetes for several years, but its use for weight loss is new. So, while the short-term side effects are fairly well-known, such as nausea, vomiting, and constipation, the long-term effects are unknown. Many users also seem to regain weight quickly when they stop using the drug, raising questions about its sustainability. For example, participants in one study regained an average of two-thirds of the weight they lost after the jab ended.
The health secretary has warned that people should not forget to eat well and exercise in a rush to lose weight.
Reuters
Others worry that “good” weight loss behaviors, such as eating well and exercising, are being forgotten in the rush to lose weight. Health Secretary Wes Streeting said last week: “We don’t want to foster a culture of dependency where people think they can get away without having to go through the trouble of eating healthy and exercising.” You should also be wary of the hype from pharmaceutical companies.
Nevertheless, the results are very impressive. Clinical trials have shown that taking semaglutide for one year reduces body weight by about 15 percent on average. In one trial, a third lost at least 20 percent of their body weight. That’s unusual. To put this into context, WeightWatchers’ promotional materials celebrate participants losing 5 percent of their weight on the program. The only thing more effective is bariatric surgery, an expensive and potentially dangerous intervention.
golden age
Semaglutide’s breakthrough is part of a broader wave of remarkable innovation that has swept the medical profession over the past few years. This year brought the first vaccines against malaria, the leading cause of death in developing countries, and respiratory syncytial virus (RSV), the leading cause of infant mortality worldwide. As American economist Tyler Cowen recently pointed out, we are living in a “golden age of biomedicine.”
This should be a moment of great excitement. And semaglutide in particular offers tremendous opportunity. But the UK still doesn’t take them seriously enough. Our obesity levels are higher than all of our major neighbours. To make matters worse, the problem is concentrated among the poor and young people. Almost a quarter of children in England are obese when they leave primary school. As the Institute for Government points out, every government since 1992 has accepted the seriousness of the problem. But 30 years and 14 health strategies and 689 policy recommendations later, nothing has worked.
The UK government is moving very slowly. Semaglutide has been available on the NHS from September 2023, but is targeted at people who are extremely obese (BMI 35 or above) or, in exceptional circumstances, less obese people (BMI 30 or above) with weight-related symptoms. ~34.9). This restriction is based on advice from the National Institute for Healthcare Excellence (Nice). The agency is tasked with determining whether an individual’s life expectancy and quality of life have improved enough to justify the cost of the drug. (List price for a month’s supply of Wegovy is £175.80 for a 2.4mg dose.)
But a focus on individual gain ignores opportunities for society as a whole. The NHS is overwhelmed by current health costs, many of which are caused by obesity. Obesity will cost the NHS £11.4 billion in 2021, equating to 8% of the health service budget, according to new research from the Tony Blair Institute.
There are also a wide range of opportunities here. The UK economy is stagnant due to low productivity and high unemployment. These twin problems are caused in part by obesity. It is perhaps no coincidence that the regions with the highest obesity rates, particularly in the north of England, also have the highest rates of economic inactivity. Loss of productivity due to obesity is thought to cost the economy an additional £8.9 billion a year.
The road ahead
So what should we do? First, political leaders need to challenge the increasingly common view of semaglutide, that it is a beauty treatment for the privileged and lucky few. This view is understandable to a certain extent. The drug is expensive and coveted by high-profile figures, with everyone from Oprah Winfrey and Elon Musk to Robert Jenrick giving it a try.
Conservative leadership candidate Robert Jenrick and his wife Michal Berkner slimmed down this month.
getty
This view distracts from the possibility that we have a potential blockbuster drug on our hands. Policymakers are now talking speculatively about the potential of using technology to solve the NHS, including AI-powered diagnostics and Singapore-style apps. However, it is important to remember that semaglutide is also a new technology and has the potential to transform healthcare as well.
Next, we need to deliver this drug on a larger scale. At this time, provision levels are focused on individuals with significant and immediate health risks. This may be a prudent way to decide which interventions to offer when a disease only affects a small number of people (for example, a rare form of cancer). But when we talk about a disease that affects the nation, undermining the success of the NHS and the economy as a whole, we should consider the wider benefits available, and that means greater access. These potential benefits are so great, not just for overweight people, but for society as a whole, that it’s worth taking greater action.
Further experiments are also needed. As with any drug, this is to better understand the drug’s possible side effects, and also to understand exactly why the drug works so well. (This is still something of a mystery; experts disagree on whether the drug affects the gut or the brain.) But experiments are also being done to explore other uses for semaglutide. It’s essential. Interestingly, the list keeps getting longer.
For example, we now know that semaglutide not only helps with weight loss, but may also reduce your risk of heart attack, stroke, and cardiovascular death by up to 20%. The FDA has currently approved this drug for that purpose. Potential benefits continue to emerge, including sleep apnea and kidney disease, fatty liver and addictive behavior, fertility and Parkinson’s disease, Alzheimer’s disease, and cancer. This drug may even slow the aging process.
But above all, we need a greater sense of urgency. Obesity is an ongoing scourge for the UK, and with the same sense of excited possibility as other technologies from AI to quantum computing, we’re looking to see if this drug delivers on its early promise. We should do everything we can.
Earlier this year, Nice suggested that further semaglutide drugs, including Munjaro, should be made available to people struggling to lose weight. But last week NHS England responded to the idea, asking whether the rollout of the drug could be delayed for more than nine years due to fears of “high demand”. This shows a lack of ambition.
In the coming weeks, the government is expected to announce changes to fiscal rules that will allow it to borrow more for investment. This investment is likely to go toward traditional investments such as wider roads, more housing, and faster rail. But we must also remember to invest in the British people. Just as antibiotics helped fight bacterial infections in the 20th century, semaglutide could help fight obesity in the 21st century. Given the challenges facing the UK, this is an opportunity that cannot be ignored.
Daniel Susskind is an economist at the University of Oxford.
