A ONCE WEEKLY treatment with semaglutide the active ingredient in Ozempic can produce sustained weight loss for up to four years in adults who are overweight or obese and do not have diabetes, according to new research, published in Nature Medicine and presented at the European Congress on Obesity (ECO), in Venice, this week.

A second study examined the relationship between weight measures at baseline and change in weight over two years with cardiovascular outcomes. The study included 17,604 adults – aged 45 and older in 41 countries who were overweight or obese and were treated with semaglutide or placebo for an average of 40 months. The findings showed that treatment with semaglutide delivered cardiovascular benefits.

But are these weight loss drugs creating an astoundingly effective artificial solution to a market-driven artificial problem?

‘Magic pills’

In the 1970s, when I was growing up, there were almost no obese people in Ireland and hardly any children that were overweight in schools. Today, almost one in four (23%) adults are obese and a third (37%) are overweight. Among those aged 65 and older just one in four (25%) have a normal weight almost three quarters (74%) are overweight or obese.

This transformation in body size didn’t happen because of some new disease. It happened because of a toxic combination of factors that changed the way we eat, the way we move around towns and cities; and a societal response to stress with cheap comfort food.

To get a better understanding of what these drugs really mean, Johann Hari, author of ‘The Magic Pill,’ interviewed over a hundred experts suggesting that this new wave of obesity drugs come with huge potential benefits but also with huge potential risks.

Hari expands by explaining how these drugs work to manipulate a tiny hormone called GLP-1 that exists in the gut and the brain. A new generation of diabetes drugs known as GLP-1 receptor agonists (GLP-1s) including Novo Nordisk’s Ozempic (semaglutide) are now a standard part of treatment in high-income countries. This treatment was found not just to affect insulin and blood sugar in people with diabetes. It seemed to have effects that boosted satiety – the sensation of feeling full so that they ate less.

Researchers at Hammersmith Hospital in the UK got funding from Novo Nordisk to investigate if these drugs could be used for the treatment of obesity as well as diabetes. The answer was a resounding yes. In 2022, a major trial of the use of semaglutide in people with obesity lost 15% of their body weight, compared to just 2.4% who had been given a placebo.

The researchers identified that the gut hormones create the natural signals in the body that tell people to stop eating. But Hari discovered that the drug seemed to change more than people’s bodies – it seemed to change their minds too. Not only did people feel full they no longer had much interest in the foods they previously craved.

The scientists believe these are very early days with these drugs. Eli Lily have begun experiments with a drug called Mounjaro, that contains GLP-1 agonist but also another gut hormone called GIP. People taking this drug lost even more weight in clinical trials, on average 21% of their body weight.

Another drug, ‘Triple G’, also developed by Eli Lilly, which simulates GLP-1, GIP and a third hormone called glucagon. A new wave of anti-obesity drugs are emerging with more than 70 in development. It is likely that in a few years, these drugs will be given by pills, not injections, making their use even more feasible.

Fighting the wrong battle

The concern with these drugs is that while they are transformative in managing obesity, they do nothing to alter the food environment that has caused this disease. The World Health Organization confirm that obesity has nearly tripled since 1975. The real question is — why are we not fixing the food market instead of indirectly manipulating our gut and brain to alter our response to this fake highly processed food?

One outcome from industrially processed food is the impact on satiety. Harvard adjunct professor Jerold Mande told Johann Hari: ‘There’s something about the food we’re eating and the redesign of food, that’s telling us to keep eating, even though your body should have told you to stop.

‘This effect is at the core of why so many of us feel we now need weight-loss drugs.’

But why do processed foods leave us feeling like we want more where traditional diets left us feeling full? Foods like biscuits, breakfast cereals, croissants, white bread – just one more, just another slice.

Ultra processed foods trick the brain. Alamy Stock Photo Alamy Stock Photo

Tim Spector, professor of genetic epidemiology at King’s College, London and author of Unprocessed explains that ultra processed food undermines satiety or fullness for a number of reasons. You chew it less, the amount of chewing sends signals to the brain that you are full. Soft, mushy processed food – less chewing, less fullness. The combination of fat, carbs and salt is manna to human brains – the ‘bliss factor’ is carefully manipulated by the food industry to maximise the combination of tastes and textures that surpass any feeling of having had enough. Foods high in sugar lead to short glucose peaks followed by rapid troughs that give you the signal you need to eat again.

Highly processed foods lack protein and lack fibre – both essential to satiety (protein) and slow absorption and digestion (fibre). No fibre means you get hungry again more quickly.

Processed foods also impact the gut microbiome — the home for microbes in the gut that break down food, releasing chemicals that are essential to the immune system, metabolism, energy control and digestion. ‘The healthier it is, the healthier you are, according to Prof Spector.

After four decades of consuming food that dramatically downplays our satiety, we have come to a point where we are now lauding the ability of a whole new generation of (very expensive) drugs to make us feel full and curtail our cravings for the processed food that caused the problem.

Hari is on the button when he states that ‘if this transformation in our food supply had not happened, the market for weight loss drugs would be confined to a tiny number of people.’

Professor of Clinical Psychology at Drexel University in Philadelphia and leading researcher in hunger, Michael Lowe, told Hari these weight loss drugs are ‘an artificial solution to an artificial problem.’

“Obesity is an artificial problem in the sense that we now eat highly energy-dense food that normally don’t exist in nature.”

The answer to a toxic food system is to fix the food system. Very challenging, but of course it can be done. That means robust regulation to control the sale and marketing of very cheap food that impacts on health, and to incentivise markets for fresh home-produced foodstuffs – stuffed to the gills with protein, fibre, vitamins and minerals. But the profit-consumed market-driven economy has other ideas, as we live whatever way we want and depend on the pharmaceutical industry to come up with ingenious ways to fix us.

Professor Lowe says the alternative is to try to solve the problem “so that 50 years from now, 80% of us aren’t on weight loss drugs”.

Unless we challenge the status quo, that is the farcical reality we are faced with.

Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition, safefood.