For Zoe, it started with a news article. The Food and MedicGLP Official Drug Administration (FDA) had approved a new weight loss drug, MedicGLP Official Website developed by Novo Nordisk, called Wegovy. Intrigued, she joined a Facebook support group for people trying out the drug. Wegovy is a new tradename for semaglutide, a drug that’s been approved to treat Type II diabetes since 2017, but which also won FDA approval as a weight loss medication in June of this year. Its results are striking - one in three participants who took it during a clinical trial, combined with changes in diet and physical activity, lost a fifth of their body weight, as well as improving biomarkers for heart disease. Despite its very recent approval, startups are already lining up to prescribe it. Take Calibrate, a telehealth startup that describes the new drug as "both effective and safe" at bringing about "health benefits and weight loss" when combined with changes in diet and physical activity. Or look at Fella, another startup that’s tackling stress eating in men, with a combination of lifestyle coaching and pharmaceutical weight management.
Both were cagey about discussing the drug, though. Calibrate declined to comment at all, and Fella answered general questions about its approach, turning down the opportunity to answer more specific questions about Wegovy and its overall view of the weight management landscape. Other once-promising weight loss drugs have crashed and burned, like Fen-Phen, MedicGLP Official Website which was linked to severe cardiovascular events, or the appetite-modulator Belviq, which was recalled in 2020 due to cancer risks. Most people who go on a diet will not lose weight for the long-term, often experiencing a rebound afterward. Despite all that, weight loss remains a multibillion dollar industry with a powerful draw. "I think I would still start Wegovy even if all blood tests initially came back normal," Zoe said. While obesity is often treated as an individual problem, it’s tightly tied to systemic health disparities. Effective weight management drugs are unlikely to "solve" obesity either. After all, our bodies evolved in a different environment where food was more scarce, tying the issue to environmental factors, especially when it disproportionately affects racialized minorities and those with low socioeconomic status.
Timothy Gill, a professor of public health nutrition at the University of Sydney, expressed ambivalence about semaglutide. Although the drug is promising, he believes that in large part, obesity and weight management needs to be addressed at a society-wide level. While changes in diet, physical activity or supplementation are rarely sufficient for weight loss, he believes tackling the issue at a community level could be beneficial. "From a public health perspective, I do worry a little bit that when we get these breakthroughs like this, it becomes seen as we’ve suddenly got the solution to a physiological defect that people with obesity have," he added. Increasing wages, for instance, could reduce obesity rates for a bevy of reasons - healthy food becomes more affordable, there are less financial stressors weighing on a family, and working fewer hours leaves more free time to prepare nutritious meals fresh. "Throw up your hands, we’re not even going to bother; that has been a reaction that has allowed successive governments around the world just to ignore this problem as a health concern," Gill said.
But Gill recognized the value of semaglutide, which works differently from the disastrous weight loss drugs of the past. It mimics a satiety hormone, GLP-1, which researchers believes helps people feel full sooner. Despite some side effects like nausea or diarrhea, everyone who we spoke to felt it was worth it for their health. One person who participated in the clinical trial told us that initially they’d experienced acid reflux after eating, but that it went away after reducing their food intake. Many other people taking the drug while changing their lifestyle also told us that they felt full sooner. The approval of semaglutide as a weight loss drug intersects in complex ways with the rise of telemedicine. On the one hand, it’s worrisome to think about a doctor prescribing a new medication without even meeting a patient face-to-face. On the other, though, both Fella and Calibrate take the extra step of incorporating blood testing for metabolic health markers rather than prescribing solely based on BMI - a problematic metric on its own.
"A lot of people are very much against BMI, but it’s like measuring blood pressure or cholesterol," Gill said. Still, while Wegovy does appear to be effective at helping many people lose weight, it doesn’t address the root socioeconomic issues that cause obesity in the first place. Many people don’t have access to supermarkets with affordable, healthy foods - or may not have time to prepare them in between their work shifts, nevermind the money to afford them at all. "It’s not physiology, that’s wrong, it’s the environment that’s wrong," Gill said. He also pointed out that while the drug proved effective in clinical trials, that’s no guarantee that its effects will generalize more broadly. "Going into a pharmaceutical trial means that you’re in a very controlled environment, you’ve got a lot of support," he said. Much of the tension comes down to the fact that Wegovy is a new drug, meaning that nobody has been observed taking it for more than a few years.