This appeared in The Daily Mail; https://www.dailymail.co.uk/health/article-14239533/MATT-RIDLEY-Ozempic-weight-loss-drugs-end-obesity-illnesses.html
Imagine if you could eat your fill on Christmas day then dial down your appetite for January. Good news: such a prospect may be within sight. Weight-loss drugs are getting better and achieving results where decades of hectoring and dieting have failed – in yet another miracle of biomedical science.
Eliminate the positive, accentuate the negative – that, all too often, is the way medical news works. There’s a worsening trend in some illness and a worrying side effect from some cure; cancer, dementia and anxiety are on the rampage; there’s ever more addiction to drugs and alcohol; there’s a pandemic just around the corner and there’s far too much obesity thanks to processed food.
Yet in general we have never been healthier. We live longer, rarely go hungry, feel younger, catch fewer infections, get cancer later and have far more options of life-saving operations, injections and pills than any previous generation. For all the sins of Big Pharma, we now have some kind of cure for the vast majority of afflictions.
But there is no denying that we are almost all getting fatter. Problematic obesity was once very rare, when food was more expensive and work more laborious. Today to be dangerously fat is common and is the tip of an iceberg of the more moderate flab many of us sport. No matter how hard the nanny state exhorts us to take more exercise, eat more vegetables and lay off the fizzy drinks, our waistlines continue to expand relentlessly.
Or do they? In America, the trend of increasing obesity has stalled and even slightly reversed. In 2021-2023, 40.3% of American adults were obese, down from 41.9% in 2017-2020.
The reason is the spread of the weight-loss drugs produced by Novo-Nordisk and Eli Lilly. Novo’s drug is semaglutide, known as Ozempic for diabetics and Wegovy for weight loss; Lilly’s is tirzepatide, known as Mounjaro or Zepbound. Around 12% of Americans have already tried these drugs, and the fall in obesity is most marked in the social class most likely to take them.
More than any other product of the pharmaceutical industry in recent years, these injections really have taken the world by storm. Demand has outstripped supply, while Novo Nordisk’s valuation now exceeds the annual GDP of Denmark, where it is based.
True, the firm took a $100 million hit to its market value last week when its latest weight-loss drug slightly underperformed in a clinical trial. None the less, more and more analysts think we are approaching an inflection point where these medications really take off. We are about to see a veritable flood of appetite-suppressing drugs coming to the market.
Many pharma companies have their own versions in clinical trials and some are now testing oral versions. If you could take a pill rather than inject yourself, there would be dramatically more takers. As well as Novo and Lilly, at least five other firms have oral weight loss drugs under development.
https://edition.cnn.com/2024/09/17/health/glp-1-pills-weight-loss-treatment/index.html
To general surprise, weight-loss drugs are proving to have beneficial side effects against other illnesses. They seem to reduce the risk of heart disease, stroke, kidney disease, high cholesterol and perhaps even brain disorders such as Parkinson’s and Alzheimer’s. It looks as if they reduce inflammation, independently of effects on body weight. They even appear to reduce the death rate from Covid.
“These are health promoters,” says Harlan Krumholz, professor of medicine at Yale University. “It wouldn’t surprise me that improving people’s health this way actually slows down the ageing process.”
https://www.thetimes.com/uk/healthcare/article/ozempic-weight-loss-drug-fix-heart-problems-7tzlbfrp9
It’s not all good news. For some people the nausea and other side-effects are intolerable, and doctors are warning about the risk of slim people using them to get too slim. Plus you can pile the fat on again once you stop the drug. For those with a puritanical bent, these drugs let us off the hook of responsible abstinence. But for many diabetics and obese people, they are a godsend.
The story behind these drugs has all the usual themes of innovation: it’s a gradual, incremental, collaborative tale with serendipitous bursts of luck and a lot of trial and error. No one person deserves a statue, although three may be singled out (probably a bit unfairly) for a Nobel prize one day.
Bizarrely, it begins with angler fish, those hideous bottom dwellers that lure their prey by dangling a fake morsel in front of their huge mouths. Angler fish have discrete organs for making insulin. In the 1980s scientists from Massachusetts General Hospital travelled to Cape Cod and asked fishermen if they could have lots of these little organs for experiments. From them they isolated a gene that makes a hormone called glucagon-like peptide-1 or GLP-1. It proved an effective way of regulating blood sugar and appetite.
https://www.wsj.com/articles/ozempic-mounjaro-gila-monster-anglerfish-8c9c1ff2
Then, to make GLP-1 last longer in the body, another scientist working the for the US department of veteran affairs, John Eng, suggested looking at a similar hormone used by gila monsters: fat black and yellow lizards from Mexico with venomous bites. They regulate their appetite so well they need to feed only a few times a year. By studying the lizard molecule, pharma firms were able to make synthetic versions of the hormone that could be injected daily and then weekly.
https://www.businessinsider.com/what-is-ozempic-glp1-drugs-developed-by-gila-monster-2023-3
Britain of course lags behind America in the adoption of weight-loss drugs, with the NHS put off by the high cost of patented drugs. But Wes Streeting, the Health Secretary, has announced a trial to prescribe Zepbound to the workless obese to try to get them back to work.
And there is nothing to stop us buying the drugs privately as many a celebrity has already demonstrated. “If an otherwise healthy middle-aged man displays sudden weight loss,” reasoned Boris Johnson about several of his ministerial colleagues, “there are only two possible explanations. Either he has fallen hopelessly in love, or else he is about to mount a Tory leadership bid.” Then he realised that no, they were injecting the new drugs.
Another obstacle here, however, is the dominance of the public-health lobby. There is a well funded industry with a vested interest in finger-wagging about fizzy drinks and junk food. Drugs could undermine their campaign for ever more restrictions on advertising such products on television. For these folk, semaglutide and tirzepatide are existential threats akin to the effect electric lights had on candle wick trimmers. Puritans prefer pain to technical fixes.
In the world of public health failure is routine. Low-fat diets, artificial sweeteners, sugar taxes, advertising bans, dieting advice: none have worked well. As Chris Snowdon of the Institute of Economic Affairs points out, the public health lobby demands that the same efforts be redoubled anyway – an approach that would be regarded as quackery in the private sector.
“The contrast between the medieval approach of nanny-state chancers and the rigorously evaluated, highly effective weight-loss drugs now available could not be starker,” he wrote recently. “If semaglutide only reduces obesity rates in the US by two percentage points, it will still have achieved infinitely more than all the public-health policies designed to tackle obesity combined.”
Could obesity, such an intractable curse for so many people, soon be a curable affliction?