Ozempic — today’s Nicotine patch?
Around 15.5 million U.S. adults have used injectable medicines like Ozempic (for diabetes) and Wegovy (for obesity) to lose weight, according to a May 2024 Gallup poll. This means six percent of Americans have tried these drugs, known as GLP-1 receptor agonists, which work by mimicking hormones that regulate appetite and blood sugar, and affect both the gut and the brain. Three percent of Americans are currently taking these weight loss drugs. I expect this number to increase as digital health companies continue to market white-label versions of GLP-1s and new forms, like oral tablets, become more widespread.
I was on the PATH train to New Jersey, and the entire train car was papered with overweight people smiling and inserting an injectable pen into their biceps and folded stomachs. I had to look away, in part, because I’m queasy around needles, in part, because I didn’t want to internalize the messaging.
Something I’ve only appreciated recently is that Ozempic is the new nicotine patch. I’ve read two books recently that have really brought to light today’s food crisis: Magic Pill by Johann Hari and Ultra-Processed People by Chris Van Tulleken.
Both speak to the rise in obesity rates in the 1970s, rising from 13% to 23% by 1990, to 42% in 2020. This coincides with the rise of ultra-processed food, packaged foods made from many manufactured ingredients that are designed to be convenient, cheap, and hyper-palatable. They are also designed to push past the point of satiety so that we are always hungry for more, more, more.
Currently, the ultra-processed food market grosses $2 trillion globally and is expected to rise to $3.2 trillion in 2032, at a seven percent compound annual growth rate. This growth is enough to make any analyst’s mouth water. Major companies like PepsiCo, Nestlé, and Kraft Heinz each generate tens of billions in annual revenue in U.S. sales alone.
UPF companies spend $14 billion on advertising in the U.S. annually. Something that struck me in Van Tulleran’s book was that it makes sense to market UPF because you can capture the value of marketing a Big Mac, KFC bucket, or Kraft macaroni and cheese. With the exception of market leaders in product categories like Cargill for beef, even with extremely powerful ad campaigns like “Got Milk” or “Beef, it’s what’s for dinner” specific companies or products aren’t getting a sales uplift from general, compared to trademarked, product marketing. Who has a monopoly on red peppers or salmon or rice or any of the other “whole foods” that present an alternative to UPF?
Studies have shown that, even with the same caloric and nutritional content, people eat more calories on UPF. Anyone who has breezed through a pack of chips or cookies and laughed at the number of servings on the package understands this.
Both books also do a great job of dispelling other possible explanations for the rise of obesity, such as the rise in sedentary lifestyles. There was a fascinating study mentioned in Van Tulleran’s book that found that a tribe of hunter gatherers in Tanzania burned the same number of calories per day as most Western desk workers, as the body regulates exertion with intense rest. Both authors emphasized that, while exercise does not often lead to weight loss, it delivers immense physical and mental health benefits, from reduced stress to increased cardio-vascular health. But a sedentary lifestyle is not the driving force of the obesity crisis.
Something I appreciated about Hari, who himself is on Ozempic, is that he was honest about his weight and food struggles. His genuine love of fried chicken came through the page. He provides a balanced account of the acute risks of obesity, such as risk of stroke, with the emerging risks of weight loss drugs, such as thyroid cancer and depression. Ultimately, he concludes that if your BMI is above 27, the risks of the weight may outweigh the risks of a drug that hasn’t been tested outside of 18 years of testing on diabetics. This is even more true if you’re obese (BMI>30) or severely obese (BMI>40).
To be clear, I am not suggesting, nor am qualified to suggest, that the health risks of Ozempic are parallel to the health risks of a nicotine patch. What I am suggesting is that it’s a synthetic (and money-making) solution to a synthetic (and money-making) problem.
So much of the conversation around these drugs has focused on the risks to the body positivity movement, something I’m very passionate about. This tension became personal recently when I received an email from the founder of the body positive dance studio I teach at, as she “came out” about going on a “Hers weight loss journey.”
But beyond the body positivity debate lies a broader systemic issue: we’re allowing companies, both pharmaceutical and digital health, to become stupid rich off of a food crisis created by profit-driven food companies. Just look at the rise in share price of pharmaceutical manufacturers of the drug like Novo Nordisk and Eli Lilly or distributors like Hims & Hers Health.
Both authors agree that the preferred attack would be to address the problem at the source, regulating the food companies that make their supply attractive and available to the population. Changing the way that people eat may seem like an impossible lift, but Hari compared it to the public health crisis of smoking, which led to widespread lung cancer. In a generation, regulations banning smoking in restaurants, taxing cigarettes, and implementing public health alerts on packaging resulted in the number of American smokers dropping from 42% of the population in 1965, to 12% in 2021. This is directly inverse to the obesity trend over the same period.
In another of Hari’s books, Lost Connections, he suggests that the pervasiveness of anti-depressants is because other strategies to reduce anxiety and depression are not able to be monetized. Who is making money off of meeting up with friends or spending time in nature or having greater autonomy over one’s work?
I’m a sucker for UPF. I adore frozen mac and cheese, low-calorie “ice cream” that encourages you to eat the whole pint, and dessert-flavored protein bars. That said, I’ve done Whole 30 (admittedly, with some liberal interpretations) the past three Januarys and have learned to love coconut water and zoodles. I wouldn’t say this new knowledge has transformed my eating habits, but it has influenced it.
As we grapple with the growing prevalence of weight loss drugs in our society, we must continue to examine and challenge the food system that created this crisis. The solution to ultra-processed foods shouldn’t just be ultra-processed medicines — we need to address the root cause while ensuring access to necessary medical interventions for those who need them most.
