Pens for the diabetes drug Ozempic sit on a production line to be packaged at Danish drugmaker Novo Nordisk’s site in Hillerod, Denmark. (Reuters file)
A blockbuster, a miracle and a breakthrough. Nothing but hyperbole is being used to talk about the new class of weight loss and diabetes drugs as they come with the promise of ending the obesity epidemic across nations. At the moment, an injectable pen is basically manna from heaven, considering it can lower our body weight without the slightest sweat and protect us from diabetes and heart disease, the two silent killers. However, the problem with the epic sweep of the word “miracle” is that it glorifies the projection of wishful thinking and ignores some disturbing facts.
The real problem is that these drugs have become an aspirational luxury that feeds the myth of their invincibility as fat killers. Nobody looks at the preventive and long-drawn route of diet and exercise anymore. This is because research shows that these drugs, known as GLP 1 receptor agonists, which stimulate the body to produce more insulin and curb hunger, resulted in weight loss between 15 and 20 per cent. This may even go up to 24 per cent with upgraded versions by next year, almost equivalent to a bariatric surgery. There has been more research on benefits than side-effects for a favourable cost-benefit analysis. Although results have linked their results to lowering blood pressure, cholesterol and even kidney disease, it’s still unclear whether these benefits are from the drug or the weight loss.
The fact is, despite negligible risk projections, there is too much anecdotal evidence of how some users have not been able to continue with these drugs, suffering from severe nausea, vomiting, stomach paralysis and depression. Besides, side effects may take up to a decade to be seen as an area of concern. Or not. Evidence has already shown how these drugs may trigger thyroid cancer and pancreatitis in those with a gene history.
Most seriously, however, the sales pitch is changing. Once conceived to address diabetes primarily and weight loss secondarily as calorie restriction, the emphasis now is more on weight loss. The conversation has shifted from Danish drug manufacturer Novo Nordisk’s primarily diabetes drug Ozempic to the primarily weight-reducing Saxenda and Wegovy. US maker Eli Lilly’s Zepbound has been approved by the FDA for chronic weight management in adults with or without diabetes and is topping prescriptions.
While a weight loss economy flourishes with both Novo Nordisk — Bloomberg has put its market capitalisation of over $570 billion as bigger than the Danish economy — and Eli Lilly finding it tough to overcome supply shortages, the demand continues to feed on what makes us most vulnerable as social beings, fat anxiety. And that has sent drug prices northward, even fuelling a grey market with the unscrupulous seller and the uninformed buyer. A Reuters analysis in December reported how Novo Nordisk spent $25.8 million over a decade in fees and expenses of US medical professionals who in turn recommended weight loss drugs as an elixir of life to their patients, laying the base for the current drug boom.
Yet, most credible endocrinologists say such drugs are not the magic bullet, that while they may get you off the weight cliff initially, your body hits a plateau without the more difficult diet and exercise disciplines. Some research has already shown that the weight comes back. The drugs do not work the same way for all — reports indicate about 25 per cent of people experience significant weight loss and reduction in HbA1c levels (three-month average of blood glucose levels), 25 per cent experience only weight reduction or drop in HbA1c levels and the other 25 per cent do not experience either. Besides, can these expensive injections be taken life-long? That’s not known. Yet. Besides, the degree of weight loss achieved with surgery usually lasts longer than medication.
Most disturbingly, the new miracle equates thinness as the only guarantor of good health at a time when we are trying to restore diet and lifestyle discipline from our early years. This is particularly significant for India, which is not yet in the weight trap of the processed food industry, though it is getting there rapidly.
But the larger issue is how all this has made us more obsessive and myopic about how we see our bodies. If we thought this would put an end to fat-shaming and body dysmorphia, the drug only sets a new qualifying benchmark of a fat-free world, where you have to afford to be slender and smart. The nomenclature of “anti-obesity drug” makes fatness seem like a bug that can be exterminated at will and distorts our perception of how we become fat in the first place — hormonal imbalances, underlying conditions, eating disorders, stress and mental health issues. A drug just flatlines these complex triggers as non-entities in any discussion on obesity. Fact is, it can’t.
Weight loss and gain depend on your own agency and motivation to commit to balancing your own life rather than resorting to artificial means. Unobtrusively, such drugs, which are undoubtedly a panacea for those with morbid obesity, are also creating a flawed measure of health.
rinku.ghosh@expressindia.com
