We are now in the era of weight loss drugs.

Decisions about how these drugs will be used have the potential to impact our future health and even the shape of our society.

And, as researchers are finding, they are already dismantling the notion that obesity is merely a moral failure of weak-willed people.

Weight loss drugs are already at the center of the national debate. This week, the new Labor government suggested they could be a tool to help obese people in England get off benefits and return to work.

That announcement – ​​and the reaction to it – mirrors our own personal opinions about obesity and what needs to be done to tackle it.

Here are some questions I would like you to consider.

Is obesity something that people bring on themselves and they just need to make better life choices? Or is it a societal failure of millions of victims that requires stronger laws to control the types of food we eat?

Are effective weight loss drugs a wise choice in the obesity crisis? Are these being used as a convenient excuse to avoid the bigger issue of why so many people are overweight?

• How do drugs like Vegovi and Monjaro work?
• NHS needs better planning for weight loss measures, experts warn
• Why can weight loss medicines prove to be a panacea for obesity?

individual choice versus the nanny state; Realism vs. Idealism – There are few medical conditions that give rise to such heated debate.

I can’t solve all those questions for you – it all depends on your personal views about obesity and the country you want to live in. But when you consider them, there are a few more things to consider.

Unlike conditions like high blood pressure, obesity is very obvious, and has long carried a stigma of blame and shame. Gluttony is one of the seven deadly sins of Christianity.

Now, let’s look at semaglutide, which is sold under the brand name Vegovy for weight loss. It mimics a hormone that is released when we eat and tricks the brain into thinking we are full, reducing our appetite so we eat less.

This means that by changing just one hormone, “suddenly you change your whole relationship with food”, says obesity scientist Professor Giles Yeo of the University of Cambridge.

And that has all kinds of implications for the way we think about obesity.

Professor Yeo argues that this also means that for many overweight people “there is a hormonal deficiency, or at least it does not increase as much”, which makes them more likely to gain weight than someone who gains weight naturally. Biologically it makes you more hungry and leads to weight gain. Thin

This was probably an advantage 100 or more years ago when food was less abundant – people were motivated to consume calories when they were available, since none might be available tomorrow.

Our genes haven’t changed much in a century, but the world we live in has made it easier to gain weight due to the rise of cheap and calorie-dense foods, increasing portion sizes, and towns and cities that Driving has become easier. Walk or cycle.

These changes began in the late 20th century, leading to what scientists call an “obesogenic environment” – that is, one that encourages people to eat unhealthy and not get enough exercise.

Now one in four adults in Britain is obese.

Wegovi can help people lose about 15% of their starting body weight before gains plateau.

Despite being constantly labeled a “thinning drug”, it can reduce a person weighing 20 stone to 17 stone. Medically, this will improve health in areas such as heart attack risk, sleep apnea, and type 2 diabetes.

But Dr Margaret McCartney, a GP in Glasgow, warns: “If we keep putting people in environments that create obesity, we will forever increase the need for these drugs.”

At present the NHS plans to only prescribe the drug for two years due to cost. evidence shows When the injections are stopped, appetite returns and weight increases again.

“My big concern is that people are losing focus on preventing excess weight gain in the first place,” says Dr. McCartney.

We know that obesity starts early in the environment. one in five When children start school they are already overweight or obese.

And we know that this impacts poor communities (including) 36% adults There are more obese people in England than among wealthier people (where the figure is 20%), partly due to the lack of availability of cheap, healthy food in those less affluent districts.

But there is often a tension between improving public health and civil liberties. You can drive, but you must wear a seat belt; You can smoke, but there are very high taxes as well as restrictions on age and where you can do it.

So here are some more things for you to consider. Do you think we should also deal with the obesogenic environment or treat people when it starts harming their health? Should the government get tougher on the food industry, changing what we can buy and eat?

Should we be encouraged to go to Japan (a wealthy country with low obesity) and eat smaller meals based on rice, vegetables and fish? Or should we limit calories in ready meals and chocolate bars?

What about sugar or junk-food taxes? What about broader restrictions on where calorie-dense foods can be sold or advertised?

Professor Yeo says that if we want change “we will have to compromise somewhere, we will have to lose some freedoms” but “I don’t think we have reached a decision within society, I don’t think” That we have debated it.”

In England, the official obesity strategies have been – 14 of them in three decades And it has very little to show for it.

These included a five-day campaign to promote fruit and vegetable eating, food labeling to highlight calorie content, a ban on advertising of unhealthy food to children, and voluntary agreements with manufacturers to reformulate foods.

But although there are tentative signs of child obesity in England maybe start to fallNone of these measures have led to substantial changes in national diets to address obesity.

There is a theory that weight loss medications may also be the event that causes changes in our diet.

“Food companies make profits, that’s all they want – the only ray of hope I have is that if weight loss drugs help stop a lot of people from buying fast food, could that trigger a partial change in the food environment Can?” asks Professor Navid Sattar of the University of Glasgow.

As weight loss drugs become ever more available, deciding how they will be used and how this fits into our broader approach to obesity will soon need to be addressed.

Right now we’re just dipping our toes in the water. These medicines are in limited supply and, because of their high cost, they are available to relatively few people on the NHS and for short periods of time.

This is expected to change dramatically in the next decade. New drugs like tirazepide are coming out and pharmaceutical companies will lose their legal protection – patents – meaning other companies can make their own cheaper versions.

In the early days of drugs to lower blood pressure or statins to lower cholesterol, they were expensive and given to the few people who would benefit most. About eight million people in the UK are now taking each of these medicines.

Professor Stephen O’Rahilly, director of the MRC Metabolic Disease Unit, says blood pressure was tackled using a combination of drugs and social change: “We checked blood pressure, we gave advice about less sodium (salt) in foods. And we developed affordable, safe and effective blood pressure medicines.

He says this is the same as it should be with obesity.

It’s still not clear how many of us will take weight loss drugs. Will it be only for people who are very obese and at medical risk? Or will it become a preventive measure to keep people from becoming obese?

How long should people take weight loss medications? Does it have to be for life? How widely should they be used in children? Does it matter if people who use drugs are still eating unhealthy junk food, just in less quantity?

How quickly should one adopt weight loss drugs when we still do not know the side effects of long-term use? Do we agree with healthy people taking these purely for cosmetic reasons? Could their availability personally widen the obesity and health gap between rich and poor?

Lots of questions – but, so far, few clear answers.

“I don’t know where it will end up – we are on a journey of uncertainty,” says Professor Navid Sattar.

Top image: Getty Images

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