Building H #74: Ozempic Nation

Back in May we covered the buzz about a new class of weight loss drugs that were showing great promise in clinical trials. Fast forward seven months and there’s a new buzz: demand for the diabetes drug Ozempic and the weight loss drug Wegovy (which is based on a higher dose of semaglutide, the active ingredient in Ozempic) is through the roof – leading to shortages.

In its story, What Is Ozempic and Why Is It Getting So Much Attention? The New York Times covers the social phenomena behind the explosion of demand. While Ozempic is designed for people with type II diabetes to manage their insulin, shortages of Wegovy have led to a run on Ozempic for off-label, ordinary weight loss uses, fueled by word of mouth, celebrities (Elon Musk is one high-profile user) and, of course, by going viral on TikTok. The Wall Street Journal, naturally, looks from the business angle in their story, Why You Can’t Find Wegovy, the Weight-Loss Drug, noting manufacturer Novo Nordisk’s failure to prepare for the unprecedented demand, which is “unlike anything I’ve ever seen in my time in medicine,” says one physician. And we apparently haven’t seen anything yet: The market for anti-obesity drugs is expected to reach $50 billion by 2030. All this for drugs that cost over $1,000 a month, are typically not covered by insurance (to treat obesity), have a high rate of unpleasant side effects and, in many cases, need to be continued indefinitely to maintain their effects. The demand, despite these conditions, speaks volumes.

In our May commentary, we noted the dilemma that reliance on this particular medical solution poses: that while the immediate need was great and the drugs would provide valuable treatments to many people, the use of this approach as a principal solution falls into the “dysevolution” trap described by evolutionary biologist Daniel Lieberman:  to the degree that drugs like Ozempic and Wegovy can begin to make the consequences of an unhealthy food system and increasingly sedentary lifestyles more tolerable, it could reduce pressure to reckon with them. And to be clear, urging people to eat better isn’t a viable strategy either. Mark Bittman, the former food columnist turned advocate, argues that we simply cannot expect Americans to follow healthy diets unless we change the supply of food that is offered to them in his opinion piece, Telling Americans to ‘eat better’ doesn’t work. We must make healthier food. Shifting the food system to prioritize health will require some level of government leadership and, at least according to an external review of the FDA’s foods program, that is noticeably absent. As Helena Bottemiller Evich writes in her Food Fix newsletter Things are not OK at FDA, “there is no one in charge of food at FDA, an agency with jurisdiction over nearly 80 percent of our nation’s food supply."

The emphasis on pharmaceutical solutions highlights the incentives of our economic system. While the precise causes of obesity seem increasingly murky, they certainly involve the peculiarities of our food system, combined with lifestyles that have grown more sedentary. But the industries, such as food, entertainment and transportation, that create the obesogenic environment thrive, as will those that supply the medications to counter the effects of the first set of industries. From this economic point of view, obesity can be seen as a win-win. It’s also classic case of privatized gains (for the companies that sell the products and services that shape our environment) and socialized losses (the cost of poor health outcomes). Until these losses can affect the incentives of the companies whose products people consume, we can expect more of the same. Hence the need to measure and to make visible the health consequences of these products.

This is our last issue of the year, folks. We hope you’ve enjoyed reading this newsletter and we thank you for your ongoing support. Be well.

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