Sarah Harte: Our broken food culture is driving us towards weight loss drugs
Societally, we have allowed transnational companies to aggressively market ultra-processed foods which have displaced healthy diets globally.
Is the age of body positivity gone? The waif is back on the catwalk with millions embracing weight-suppressant drugs known as GLP-1 agonists. Hardly surprising that people turn to drugs to shrink themselves when weight bias is so heavily ingrained in society and being fat is so highly stigmatised.
It’s baked into our psyches that it’s better to be thin, and when you fall short of this mark, it can be a source of intense shame. This is true for all genders, although it’s particularly pernicious for females, such is our cultural bombardment from birth about the necessity of being thin.
What makes people overweight or in some cases obese is complex and varied, with drivers including disordered eating, genetics, a dysregulated part of the brain priming a person to overeat, socioeconomic factors including poverty and lack of education around and access to healthy food.
However, the elephant in the room is that a broken food culture has much to answer for. Societally, we have allowed transnational companies to aggressively market ultra-processed foods (UPFs), which have displaced healthy diets globally. Scientists have long warned that these foods are driving “the pandemic of obesity and other diet-related chronic diseases, such as diabetes.” Instead of tackling the source of the problem, we are turning to biochemical engineering to solve obesity.
These ‘miracle’ weight loss drugs mimic the action of a natural hormone, promoting the feeling of being full. No day is complete without somebody famous or otherwise posting snaps on social media of their reduced girth. Good luck to them.
Yet, what is the cost of all of this, and how should the State respond? As reported in this newspaper on Friday, the Irish Medical Organisation (IMO) conference discussed last week how the Irish State’s medicines bill could double if we funded weight loss drugs for all those who need or, in some cases, want them.
Weight loss injections Wegovy (the brand name for a GLP-1-based medicine called semaglutide) and Mounjaro (the brand name for tripeptide) are currently being assessed for reimbursement under State schemes.
Apparently, we have over one million obese people in Ireland who are potentially eligible for the drugs. Professor Michael Barry, clinical director of The National Centre for Pharmaoeconomics, posed a valuable public health question (somewhat ironically saying that big decisions had to be made): “Do we fund them [the drugs] or fund them only for a subgroup of people?” Utilitarian policy decisions made by people like Professor Barry must balance the array of needs of the citizenry. Who gets what drugs, weighing the efficacy versus the financial cost to the State?
Another question I have is: If we overfund these drugs, what resources might be diverted from other essential health areas? There are other considerations quite apart from cost.
Two people I know are currently losing weight. One uses weight loss medications and seems very optimistic about her journey. The other is losing weight through the time-honoured method of exercise and pushing back from the table because she is dubious about the possible long-term effects of weight-loss drugs. Maybe she is right to be.
As these drugs are relatively new, the potential adverse side effects in the wider population are still being studied. So far, it appears that patients ultimately have to remain permanently on medication to avoid weight regain. Lean body tissue, meaning muscle mass and bone, is also lost. Common side effects include vomiting, diarrhoea, and constipation, with some reports of hair loss. Where they are abused, more dangerous side effects occur, like inflammation of the pancreas.
There are legal actions currently under way in the USA about the side effects, including gastrointestinal injuries. It will be interesting to see where liability will lie, whether it will be with the drug manufacturers, healthcare professionals who prescribe them, etc.
Earlier this month, the Trump Administration announced that Medicare and Medicaid will not cover anti-obesity drugs, which the Biden Administration had planned to do. More than two-thirds of Medicare beneficiaries are classified as obese. Health Secretary Robert F Kennedy has criticised the drugs.
This public health crisis is a global problem. A recently published Global Burden of Disease Collaborators on Obesity report shows that rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. Strikingly, in that period, the prevalence of overweight and obesity in children and adolescents doubled, with obesity alone tripling.
In terms of our response, surely banning ultra-processed foods high in salt, fat and sugar or at least curtailing food companies' ability to advertise them must be part of the equation, particularly where children are concerned. Some years ago, one Southern Mexican State implemented a ban on selling fizzy drinks and sweets to children. Deeply unpopular, the ban was never enforced.
Coca-Cola is the most popular soft drink in the world and, for the last twenty years, the biggest-selling brand in the Irish soft drinks market. One 12-oz can of Coke has 39 grams of sugar, which equals 10 teaspoons.
I’m never madly keen on being part of the fun police. My default position tends to be ‘you do you,’ and whatever gets you there is your own business, provided it doesn’t involve minors and doesn’t hurt anyone. But this does involve minors, rapidly expanding ones with all the problems that weight gain brings.
And where are the public education campaigns warning of the health hazards of fizzy drinks, cereals, ultra-processed foods, and fast meals, as we had with tobacco?
Consider the following as an example of the profound ignorance of the current approach. In the month that the HSE’s National Clinical Lead for obesity, Donal O’Shea, voiced concerns about the inclusion of ultra-processed foods in school meals for which 475,000 children are eligible, Minister for Social Protection Dara Calleary responded that products high in fat, salt, and sugar would be removed from meals. Then, in the same month, at the IMO conference, it was debated how many adults we could subsidise for weight-loss drugs.
Weight loss drugs are a revolutionary development that can improve human health as part of a suite of measures. Our clear focus, though, should be on the primary prevention of excessive weight gain, which includes reining in companies that produce UPFs rather than intervention through creating a culture of drug dependency for weight loss.
The question is how we intelligently prevent the onset of obesity and diet-related diseases, particularly in children. We owe it to them at least to try.
