Nearly a decade has passed since the American Medical Association first classified obesity as a chronic disease, which may require medical interventions beyond diet and exercise.
Now, as blockbuster drugs Wegovy and Ozempic grow in popularity, they are attracting more attention and adding complexity to cultural and medical conversations about weight and weight loss.
Both drugs are brand names for semaglutide, a drug that can lower blood sugar and suppress appetite. Ozempic is approved to treat type 2 diabetes in adults, while Wegovy is approved for weight loss in two groups: people 12 years and older who are obese, and adults who are overweight and also have at least one weight-related health problem, such as high blood pressure. or cholesterol.
Patients and doctors say the results they see with the drugs further underscore the consensus that lifestyle changes alone are often not enough for people trying to lose excess weight.
“Two-thirds of Americans haven’t woken up one morning and have chosen to be overweight or obese. It’s not a behavioral choice or a behavioral disease. It’s a chronic disease – a chronic disease and treatable – and we should treat it like we treat any other disease, with drugs and with interventions that target disease mechanisms,” said Dr. Ania Jastreboff, associate professor at the Yale School of Medicine. scientific advisory to Novo Nordisk, which manufactures the two drugs.
Stacey Bollinger, Account Manager in Maryland, said that when she started taking Wegovy last January, she had exhausted most other options for improving her physical health. She was pre-diabetic, her joints ached and her asthma was exploding. But she worked with a nutritionist, followed a healthy diet, and did regular weight training and cardio exercises for about a year.
“I went there for my physical and it’s one of those things where it’s like, I know the doctor is going to tell me I’m overweight. It’s not shocking,” he said. she stated. “I see it. I feel it physically. But also, I feel miserable. Let’s discuss my options.”
On Wegovy, Bollinger said she lost more than 50 pounds, down from 266. She said she felt more energized, her asthma was better controlled, and her feet, ankles, and knees didn’t hurt. hurt at the end of the day. During a recent examination, her blood tests showed that she was no longer prediabetic.
“I really don’t think I would have suffered this loss without Wegovy,” she said.
Novo Nordisk describes Wegovy as a long-term treatment, noting that just as a patient with high blood pressure sees an increase after stopping the drug, people on Wegovy may regain weight if they stop taking the drug.
“Obesity is a chronic, progressive and little-known disease that requires long-term medical management,” he said in a statement.
“One of the major misunderstandings is that it’s a disease of willpower, when in fact there’s an underlying biology that prevents people from losing weight and keeping it off,” said added the company. “Like any other chronic disease, such as high blood pressure or high cholesterol, obesity should be treated as such.”
Why obesity has become more common
Semaglutide is in a class of drugs called GLP-1 agonists, which mimic a hormone that signals to the brain that a person is full.
“This particular drug stimulates the pathway in your brain that tells you to eat less and store less, and then it downregulates the pathway in your brain that tells you to eat more and store more,” said Dr Fatima Cody. Stanford, an associate professor of medicine at Massachusetts General Hospital.
Learn more about Ozempic and Wegovy
She said more important than inducing weight loss, the drugs can reduce the risk of health problems associated with obesity, including diabetes, heart disease, stroke and certain types of cancer.
“A lot of people assume we’re targeting one size” when prescribing drugs, Stanford added. “I never target a size with a patient. I target their health.”
Obesity rates have been increasing in the United States since the 1980s. In the four years prior to 1980, the obesity rate was 15% among adults and 5% among children and adolescents. Those numbers jumped to 42% and 20%, respectively, during the period between 2017 and early 2020, according to the Centers for Disease Control and Prevention.
The reasons for this increase are complex, but medical experts generally attribute it to interactions between genetics and societal and environmental changes.
One of the main explanations for obesity is that bodies try to maintain a particular baseline, or set point, of fat. At the population level, changes in environment and behaviors increased fat set points over time, Jastreboff said.
On average, people now engage in less physical activity, eat more processed foods or larger portions, sleep less, and experience more stress than previous generations, which may prompt bodies to maintain a higher fat base. high.
This could explain why some people struggle to lose weight through lifestyle changes, or why others regain lost weight through dieting.
Individual genes can determine how the body reacts to external factors, so they can trigger obesity in some but not in others. A theory known as the “thrifty genotype hypothesis,” for example, suggests that some people store more energy as fat through genes inherited from ancestors who needed this storage to survive famines.
Ozempic and Wegovy can help lower a person’s fat set point, Jastreboff said. Semaglutide has been shown in trials to reduce body weight by approximately 15%. In contrast, a 2018 study found that at best, diet, exercise, and behavioral counseling help people lose an average of 5-10% of their body weight.
“Some people can lose weight with just behavioral changes, but some people can’t. Why do we have a problem with that?” said James Zervios, vice president of the nonprofit Obesity Action Coalition. “Why do we keep leaning to one side and saying, ‘Well, we’re just going to tell someone to rate their food. We’re just going to tell someone to go for a walk in the evening after dinner. If it works, you wouldn’t be dealing with the number of people who are obese or severely obese right now.”
Obesity drug debates continue
However, the idea that obesity should be treated through diet and exercise alone is still pervasive.
“Unfortunately, the public view is that if a person is on a drug, they’ve taken the easy way out to lose weight,” said Rebecca Puhl, deputy director of the University’s Rudd Center for Food Policy and Health. from Connecticut.
Even some doctors still don’t feel comfortable prescribing the new obesity drugs. Stigma can play into those decisions: Research has shown that doctors have similar levels of weight-related bias as the general population, and medical school training rarely addresses weight-related stigma, Puhl said.
On the other side of the coin, some people active in the fat acceptance movement say that many of those who are considered “overweight” by medical definitions are healthy and don’t need fat. interventions.
A 2017 study of 3.5 million health records in the UK found that although obesity increased the risk of diabetes, high blood pressure or high cholesterol, around 15% of obese people did not suffer from it. of these conditions.
In a BuzzFeed op-ed last month, Evette Dionne, a culture reporter and MSNBC columnist, suggested that the medical establishment is now focusing more on weight-loss drugs than addressing systemic issues related to obesity risk, such as food deserts.
“It is objectively a good decision to dissociate the idea of moral virtue from being overweight. However, in these attempts to complicate our cultural understanding of being overweight, the remedy remains the same: losing weight rather than changing the how our society interacts with and treats fat people,” she wrote.
Puhl said that while obesity treatment debates are important, decisions about drug use should be made between a patient and a physician.
“We don’t want drugs to be used as a default strategy and we definitely want the risks and side effects to be considered,” she said. “But we also have to respect that, for some people, drugs can be very helpful.”