Separating science from morality in the new anti-obesity medications

A safe prediction right now is that medicine will prioritize advanced drugs that are more effective but also pricier. This will pose challenging dilemmas for public health systems that must constantly weigh the value of life and the cost of saving it. Doctors refer to this as screening — a vain attempt to gloss over the real goal. But our civic duty is to gain a better understanding of the future that we will inhabit, and not tolerate such obfuscation. The new anti-obesity drugs are a great example to use as we examine how to better understand our future.

Ozempic is the most widely known brand name in this booming sector of the pharmaceutical industry. While there are competing products, they mainly consist of dose variations or similar molecules. The key ingredient in all of them is semaglutide, a medication that mimics the GLP-1 hormone that is naturally released in the gastrointestinal tract in response to eating, creating a sense of fullness and reducing the urge to eat. It also stimulates insulin secretion by the pancreas, effectively lowering blood sugar levels. As an analogue, semaglutide is an effective medication for Type 2 diabetes, which is often linked to obesity.

Semaglutide also affects obesity itself. By mimicking a natural hormone, it comprehensively targets various mechanisms related to the body’s energy management, including hunger, satiety, metabolism, fat generation and energy expenditure. This leads to more effective and consistent weight loss compared to previous drugs of this type. Ozempic quickly gained popularity, earning the nickname “the Hollywood drug” when Kim Kardashian, Oprah Winfrey and Elon Musk began endorsing it. News outlets and social media have been buzzing about it ever since.

But the “Hollywood drug” label doesn’t mean that Ozempic belongs in the realm of quantum psychology, of tricking your brain to achieve a personal goal. Semaglutide is not only effective against obesity and Type 2 diabetes, but it also reduces the risk of heart attack by 20% even in individuals without diabetes, and Science recently named anti-obesity drugs the scientific breakthrough of the year.

Scientists have also found that new anti-obesity drugs show potential in addressing addiction, Alzheimer’s, and Parkinson’s. The treatment involves a weekly injection costing approximately $225 each (without insurance), and may need to be continued indefinitely. Most prescription plans cover some or all of the cost of drugs like Ozempic when used to treat Type 2 diabetes, but it’s not often covered for weight loss. This is where the dilemma arises.

The debate surrounding obesity carries an undeniable moral undertone. People (especially public health officials) often hold a preconceived bias that blames obese people for their condition. The common belief is that weight loss can be achieved simply by eating less and exercising more. However, this oversimplification fails to acknowledge complexities like socioeconomic factors. Economically disadvantaged families often depend on affordable but high-calorie options like double hamburgers with triple cheese, trans fat-laden donuts, and pizzas heaped with bacon and pepperoni. The appeal lies in their unbeatable calorie-to-price ratio.

At the same time, we are continuously gaining a deeper understanding of numerous genetic conditions. These conditions can intensify hunger, reduce satiety, predispose individuals to addictions, or directly exacerbate the efficiency of adipogenesis — the process of converting food into body fat. In the past, these genes served us well during times of famine and scarcity. However, in our current era of excess and sedentary lifestyles, these genes have become adversaries. It’s just evolution, friends.

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