- Alberto Noronha
Game changer drug for obesity?
In recent weeks a drug has been making the headlines as a “game-changer” in the battle against the obesity epidemic. I wanted to share some thoughts as this news has added a chapter to the debate on what should be the focus of the fight against obesity: focus on the development of drugs and treatments or preventive approaches.
The clinical trial
The study titled "Once-Weekly Semaglutide in Adults with Overweight or Obesity" has been published in the renowned The New England Journal of Medicine. Semaglutide is a drug developed by the Novo Nordisk Foundation currently used as a treatment for Type-2 diabetes. In this trial, nearly 2000 individuals received injections of either semaglutide or placebo for 68 weeks. Patients receiving the semaglutide injections saw an average weight loss of 15% compared to 2.4% on placebo.
There are still some concerns over the safety of the drug, with gastrointestinal side-effects being observed. These are very encouraging results, especially considering that a third of the participants lost more than 20% of their weight, a result that is comparable with bariatric surgery.
The Obesity epidemic
Obesity is one of the greatest public health challenges of the 21st century. Its prevalence has tripled in many countries of the WHO European Region since the 1980s, and the numbers of those affected continue to rise at an alarming rate.
World Health Organization Europe
Obesity is a difficult and complex problem. Typical weight management strategies are often not successful, drugs have limited effects, and even with bariatric surgery, the long-term results are often not that great.
As such, the results of the semaglutide trial are very encouraging to researchers and obesity patients as this can provide an additional useful tool in disease management. However, I have also observed that there is some push-back on results such as this. The idea is that the focus on drugs takes away from the essential fight that should be on preventive approaches and healthy nutrition.
A more dark aspect of this debate is the take that it all boils down to willpower. Those who fail to manage their weight, do so because of some character flaw or lack willpower. I find this view too simplistic and essentially displays a lack of empathy.
The graph above shows the prevalence of obesity in the US over the years. We can see an upwards trend starting around the 1980s. Does that mean that people in the US (and the world) collectively lost their willpower around that time? That does not sound right to me.
The obesity epidemic is caused by many factors but I want to emphasize the importance of the food environment. Food has become easily accessible, in quantities and forms not available before. In particular, foods that have high caloric content and are highly palatable, not necessarily good for our health. Coupled with this, our schedules are becoming more demanding, and our lifestyle more sedentary.
Biologically, humans did not evolve to navigate such an environment - quite the opposite, we have evolved in an environment of scarcity. From an evolutionary perspective, it makes sense to binge eat because in the wild we do not know when the next meal will present itself. To make things worse, the food industry spends billions to overwhelm our willpower: from marketing to the composition of their products, all to create a desire to consume more. There is a spectrum of how susceptible we are to this environment and how much we can resist the instinct to overheat.
If you are interested in this topic, I can personally recommend the book The Hungry Brain: Outsmarting the Instincts That Make Us Overeat by Stephan J. Guyenet.
There are additional factors that influence our ability to navigate the food environment, socioeconomic status, our genes, our environment, etc. Not being able to recognize that is very problematic. Personal circumstances can make this task remarkably difficult: how busy we are, having to take care of children, being on a budget, etc. We should not take away from the experience of those who struggle. Instead, we should show compassion, and if possible, try to help.
The solution(s)?
As such, there is not a single solution to this problem. It is all about tools. A drug like semaglutide is a useful tool with the potential to help a lot of people! In the same light, approaches, initiatives, and products that support a healthier lifestyle also have an important place.
The biggest challenge is changing the food environment. I believe that it is possible to contribute to that change. We can create better tools to help people navigate the food environment, making healthy choices easy. If we create an environment where consumers prioritize healthy and sustainable food, the industry will follow suit.
This is also why we are building Nutrida. We know we can't solve the whole problem by ourselves but we can be part of the solution. It will take a community effort, more compassion, and less blaming. We need to focus on what is important: to give people more control over their diet and support them in a transition to a healthier and sustainable lifestyle.