Perspective | Will weight-loss drugs put diet charlatans out of business? I hope so. – The Washington Post

I want to talk about the new weight-loss drugs, but first I have to get something off my chest.

I’ve been writing about diets and weight for a good couple of decades now, I fight my own weight every day and I am capital-A Angry.

Americans have been sold a bill of goods, coming and going. First was a food environment stocked with cheap, convenient foods, deliberately designed to be overeaten, in our face 24/7. They were engineered to override ordinary human willpower and — surprise, surprise! — that’s exactly what they do.

Then, once we were lulled into a sense that buying and eating those foods, in those quantities, was totally normal, along came the diet peddlers, telling us if only we pay them for the secret, we can lose that weight we gained from eating those foods, in those quantities.

The result? Not only do we gain weight, and then fail to lose it, but we come out the other side with the sense that this is our failure, not a failure of a system in which most of us can’t possibly succeed.

If you’re one of the successes, mazel tov! But I don’t want to hear about how if you can do it, everyone can.

I’m one of you. At my heaviest, I weighed about 50 pounds more than I do now, and I’ve been able to keep it off for 25 years now. And it’s still hard, even though I have absolutely everything going for me: flexible schedule, good cooking skills, excellent kitchen, ample grocery money, family appreciation and participation, ninja-level nutrition chops. If it’s hard for me, it’s nigh on impossible for people with none of those, or just a few.

According to the National Institutes of Health, nearly 75 percent of American adults are overweight or obese, and it’s safe to say the vast majority would prefer not to be. When three-quarters of humans can’t navigate the system successfully, the problem is the system, not the humans.

Weight-loss diets boil down to one thing, and it’s not science jargon

I am angry at all the people who created that system. I’m angry that so many food company executives, caught between their fiduciary responsibility to shareholders and their social responsibility to their fellow citizens, don’t even seem to view it as a moral dilemma as they roll out another Cheetos brand extension. I’m angry at the food scientists who engineer that brand extension and the marketers who sell it. I’m angry at the retailers who, no matter what they sell in the rest of the store, put those Cheetos at the checkout. I’m particularly angry at the people — who I think should be unemployable — selling junky food to children.

I’m angry at the restaurateurs who lure people in with piles of pasta the size of Mount Vesuvius. I’m angry at the diet book authors who sell way more books than I do by promising weight loss if you just do this one thing. I’m angry at everyone who told people weight loss was a complicated, biological phenomenon that they couldn’t figure out for themselves.

Those new weight-loss drugs? You know, the ones that actually seem to be working? They’re a stick in the eye to all of those people. Take that!

That’s not the best thing about them, of course. It’s just an ancillary benefit. The best thing about them is that they’re changing people’s lives.

If weight-loss drugs aren’t something you pay much attention to, it looks like we have some that are, so far, both safe and effective. They’re called GLP-1 agonists (Wegovy, Mounjaro and Ozempic are all in the category), and they mimic a hormone (glucagon-like peptide-1) that stimulates insulin secretion and slows stomach emptying. The drugs affect several aspects of your biochemistry, but the net result is that, if you’re like most people who take them, you just don’t feel like eating.

Since weight-loss drugs have a long and sordid history of being deadly (remember fen-phen? ephedra?), optimism here should be cautious. But these drugs aren’t new; they’ve been used to treat diabetes for many years, so we have a body of evidence to fall back on to evaluate risk. Pancreatitis and thyroid cancer, for example, are pretty scary, so it helps to know just how rare they are. (A 2021 meta-analysis shows no increased pancreatitis risk from the GLP-1 agonists, and thyroid cancer numbers were too low to draw conclusions.

None of this means we have a safety guarantee! But here’s the question I have for you: Do you want them to work?

Many years ago, I was interviewing Harvard psychologist Steven Pinker (then at MIT), and he asked me whether I’d be in favor of a pill that would allow people to eat anything they wanted without gaining weight. To my enduring shame, I hedged and mumbled something about side effects.

There is only one reasonable answer to the question. That pill would be a godsend.

But I see a lot of hedging and mumbling about side effects in the public conversation about these drugs. Usually, there’s some kind of tepid acknowledgment of their utility but then a lot of emphasis on the Bad Things that could happen. This is a symptom of not wanting them to work.

Okay, I get it. If you make a living selling some kind of diet or supplement, you’d understandably root against these drugs. Ditto if you think fat people should have to work hard for their thinness and don’t deserve a shortcut. But I’m having a hard time coming up with another reason you’d prefer that these drugs don’t pan out.

Me, I’m cheering for them, loudly. I’ve heard from a lot of people who are taking them, and marvel that, beyond making weight-loss possible, these meds change their relationship with food.

One Wegovy patient wrote to me, “The thought of things like pizza or pasta (things I used to CRAVE but would try to limit) are easy to dismiss, and when I do ‘give in’ to those cravings it’s a mental decision not one that feels driven by need.” She described the shift to being in control of, rather than being controlled by, food.

For some, the experience has been profound. A Mounjaro patient wrote: “I find it hard to fully express how broken and defective I felt as a person before going on this medication, and how furious I was for a while when I finally had to accept that this was never something I could have fixed on my own. Yet I had taken the blame for failing at it for so long.”

She’s lost 40 pounds, and said “it’s been a strange, upsetting, and mildly radicalizing experience,” but also just plain “fabulous.” Accounts from both doctors and patients, weighing in on social media, are often along the same lines.

Some people can’t tolerate the side-effects (nausea is often the problem). Some people can’t get hold of the drugs at all, a particular problem for diabetes patients out of luck because people are using their drugs to lose those pesky 10 pounds. Some people can get them but can’t pay for them if their insurance doesn’t cover them or after their coverage runs out. Long-term success is going to depend on getting the price down and the access up, particularly because going off the drugs often results in re-gain, so this may be a lifelong proposition.

But there’s a fight-fire-with-fire aspect to these drugs that I really like. We’re fat because we’re not equipped for engineered, industrial-strength temptation. These drugs confer industrial-strength resistance.

And if they put diet peddlers out of business, well, that’s just gravy. Heh heh.