Novel weight loss drugs: friend or foe?

Ozempic, Wegovy and similar products will soon be the norm. But is this major new player in the fight against obesity a miracle drug or should we be skeptical?

As a scientist and genetics Professor, I am excited by this real breakthrough, which after decades of failing to find the single obesity gene and then trying to decipher the hundreds of minor obesity genes for possible treatments, offers a totally different solution. Much like viagra was originally a blood pressure lowering drug, its the side effect that made it famous and marketable. This group of drugs called semaglutides mimic hormones (GLP1) that naturally suppress appetite.  With drugs like Ozempic (or Wegovy), originally a diabetes drug which works by stimulating more insulin production, the side effect of rapid and measurable weight loss of 15-20 percent is what’s making it a blockbuster.

Photo by Dima Mukhin

But is it really all a happy coincidence with no down sides?  On the plus side, it clearly shows scientists like me that one of the major mechanisms for obesity is through the brain: suppressing appetite is a major key. We previously and wrongly blamed ‘metabolism’ and people having ‘slower metabolism’ for weight gain and persistent obesity, with plenty of people (and products) trying (and failing) to speed up metabolism in order to restore a healthy weight.

For obesity, drugs that target appetite now seem to be a good tactic: and novel drugs in the future will likely be even more effective and safer. We may even have appetite targeted probiotics and prebiotics. But it is our food environment that is responsible for this global increased appetite. Kevin Hall’s clinical trial on the effects of ultra-processed foods (UPF) clearly showed that being on a UPF diet led participants to consume 500 extra calories every day without noticing it, which is a massive overconsumption of energy. This is because UPFs cause both an increase in appetite and fail to satiate i.e they don’t send signals of fullness. This double pronged effect is caused by the excessive processing and loss of structure and artificial tastiness plus the negative effect on our gut microbes and is the reason we are killing ourselves with poor quality UPF food. 

It is easy for those of us without weight problems to dismiss these drugs. For very obese individuals, diets simply dont work for the vast majority and the only effective option is bariatric surgery. But for many people who suffer with severe obesity the hunger drives are overpowering. Patients who have been prescribed the drug have told that it has transformed their lives. One person told me that they could now think more clearly because their mental space wasn’t taken up with thoughts of hunger, guilt around food and planning meals ahead of time. For people who have struggled for decades with food and their health, this is a very real and potentially very effective lifeline. For those living with major obesity their life expectancy is similar to having  a cancer diagnosis and quality of life is drastically lowered. 

Of course, there is also a negative side. The number one problem is that it only works as long as you keep taking it.