How will American health care accommodate weight loss drugs?

We’ve historically thought of weight as the result of deliberate choices we make about diet and exercise. We haven’t generally thought of weight as a disease. But in the last 18 months, there has been an extraordinary revolution in weight loss drugs, which has put in our hands a therapy that can help people lose weight easily without major side effects. You may have heard these drugs going by the names Vegovy or Ozempic.

What happens when you take a nation obsessed with self-image and diets and tell it that the secret to weight loss now boils down to a single daily injection? You change in much more than body mass index. You change the society. Today’s guest is Susan Jade Yanovsky. She is co-director of the Office of Obesity Research and program director of the Division of Digestive Diseases and Nutrition at NIH. We talk about the stakes of anti-obesity medicine, why diet and exercise don’t work for so many people, and how these weight-loss drugs could help American health care, straining American insurance. and revolutionize America’s sense of will, responsibility. and diet.


In the following excerpt, Susan Z. Yanovsky discusses the potential impact of weight loss drugs on American society.

Derek Thompson: I want to talk a little bit about how this changes the future. I feel like if you tell the American public, “This is a weight loss drug, and it really works. It seems to be extraordinarily effective. programs to reduce like we’ve never seen before without surgery,” you’re going to change the world. You’re about to change the world in some ways that are obviously brilliant and some ways that are a little more complicated. Obviously on the bright side, it seems to be the case with statins or drugs that lower cholesterol and reduce the chance of heart disease. It’s frankly amazing to see the death rates for certain types of diseases drop over the decades after these types of drugs came online, which can be caused by obesity. There is nothing wrong in this.

At the same time, in a society that greatly values ​​thinness, it seems inevitable to me that more people are going to try to use these drugs to avoid weight stigma, even if they are not obese. They want to lose 10 pounds. They are not overweight or they are slightly above average in terms of their BMI. They just want to lose weight. They want to have it easy, and they want to keep eating ice cream and bread, because they love ice cream and bread. And so they consume these pills. And they don’t need them, but they can afford them. And it changes the way that society thinks about thinness and body type, because we’ve got to take into account this incredibly complex matrix of what you eat and how much you eat and whether you exercise and How long do you work and how much willpower do you have and how responsible are you, and you reduce this extraordinary array of factors down to one pill. It changes the world, I think. I wonder, does any of this worry you about how weight loss pills may change the mainstream in a way that stigmatizes society’s values ​​and even body types?

Susan Jade Yanovsky: Obesity is already a stigmatized condition, and what we don’t want these drugs to do is increase the stigma for anyone, which I think is what we really need to focus on in order to change health, people’s health, to help them. is required. To live a more healthy life. So I think we really need, to get that message out: that obesity, it’s not a matter of willpower. This is not a moral fall. It is a biological condition, which certainly has environmental contributions. Once people develop obesity, physiological changes occur that actually make it harder for them to lose that weight and keep it off long-term. So I think we really need to get that message out there.

The second thing I think we want to get out is that this is not a magic bullet or a magic pill. You mentioned that people say, “I want to be able to eat ice cream and eat bread and take a pill.” What these drugs can do is help people make healthy changes to their diet and physical activity. They are not allowing people to eat whatever they want and not exercise and be healthy. And in fact, things like physical activity can improve health regardless of your weight. So I think we want to move the conversation away from appearances and toward health.

The other thing is these drugs are not going to work for everyone, and I don’t want to see people who can’t lose weight with semaglutide or tirazepaitide again thinking there is something wrong with them , that if only they were a better person that it could work. And obesity is a very heterogeneous condition, and what we really want to do is be able to understand more about the mechanisms of why some people develop obesity, why some people are able to lose weight with a given treatment. Trouble happens, so that we can really help match the appropriate treatment to the appropriate patients.

This excerpt was edited for clarity.

Host: Derek Thompson
Guest: Susan Jade Yanovsky
Producer: Devon Manze

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