The weight loss drugs Wegovy and Ozempic portend a massive impact on the “obesity epidemic.” Users may even be able to get insurance coverage, as the FDA just approved a third drug specifically for weight loss treatment, signaling greater coverage for all drugs in the class. Sounds promising, right? But, alas, there are unintended consequences.
Obesity costs the US healthcare system 1.73 billion dollars a year, and more than 40% of Americans have been diagnosed with the condition. For the sufferers, it threatens their self-esteem, negatively affects their lifestyle, and invites shaming, which diminishes their well-being. So maybe we should ban unhealthy foods?
Much has been written on ACSH pages about the prudence, feasibility, and legality of bans or mandates, i.e., laws compelling behaviors like drug or alcohol use or imposing vaccination requirements. Many of the readership strongly oppose interference with personal liberty – a dastardly result they claim as unconstitutional (not realizing that individual freedom ends where other’s life, health, or safety are involved, at least legally speaking). So, we effectively regulate speed limits and mandate pre-boarding TSA airline inspections. So why not ban Oreos? Or sugary drinks?
There’s a big difference here. Personal consumption implies behavior one chooses, which impacts only the chooser. There is a strong constitutional right to individual liberty -- as long as the choices don’t compromise others. To cement effectiveness, regulation must be enforceable. Prohibition didn’t work, not because it was terrible (although it may have been) but because enforcement wasn’t possible or feasible.
But we can surely prohibit the manufacture or limit the distribution of unhealthy foods? OK, maybe not. NYC tried something like this. Didn’t work. Didn’t help. We can’t even ban cigarettes. But what about the obesity epidemic? Something must be done.
Over the last weeks, Oprah Winfrey, now morphed into the “obesity guru,” has been touting and publicizing the amazing impact of glucagon-like peptide-1 (GLP-1) receptor agonists, using their efficacy to substantiate her view that obesity is a disease, not a choice or a failure of willpower. Others might disagree. But the FDA has just approved Mounjaro specifically for weight loss (that drug will be called Zepbound). This opens the door for insurance coverage, and we expect more people to avail themselves of this new and successful weight reduction approach. And with more medical evidence establishing that weight gain is causally related to metabolic failures, hopefully, fat-shaming should be a thing of the past.
While Ozempic and Wegovy are “miracle” modulators leading to a 12% decrease in body weight, Zepbound promises to be a paradigm changer. Zepbound, targeting both the GLP-1 and GIP hormones (the other two drugs only target GLP-1), has shown a 21% weight loss in trials. (Let’s call these all these the ZOW group). For someone weighing 175 pounds, that can mean going down two dress sizes. And, as a fashion-conscious, formerly svelte clothes-horse, I can categorically state that going from a size 16 to a size 12 is a game-changer.
One pharmaceutical approved for diabetes type 2 is currently being considered for weight loss. It’s called retatrutide, a triple hormone receptor agonist (targeting receptors for GLP-1, GIP, and glucokinase regulator gene, CGCR) with potential loss of up to 25%!
Ozempic, Wegovy, and Mounjaro were initially targeted for type 2 diabetes. However, pharmaceuticals with different modulating properties have been FDA-approved or are on the shortlist for future approval for long-term weight loss. These include:
- Bupropion-naltrexone (Contrave) (an anti-depressant, anti-addictive)
- Orlistat (Xenical, Alli) (reduces fat-absorption)
- Phentermine-topiramate (Qsymia) (an anti-convulsant)
- Setmelanotide (Imcivree)
There are still other drugs now available or in the research pipeline, some of which come in pill or capsule formulations facilitating usage rather than injectable form, as are the ZOW group.
Reports indicate that these drugs are effective in combatting weight gain years after bariatric surgery. (Who knew there was still weight gain after such a drastic, invasive intervention?) But once these pharmaceuticals are all on the druggist counter, what a svelte world this will be! Sunny days, right?
Well, maybe not so fast.
The unintended result of the ZOW revolution and the newer drugs may be the demise of our favorite treats and other now-desired products.
On November 8, Reuters reported that American manufacturers are facing investor questions regarding risk to future sales occasioned by the popularity of these drugs.
On the pro-market side, Conagra may consider limiting the portion size of its snacks. Hershey’s and Dr. Pepper denied any effects, but J&J reported a slowdown in demand for devices used in bariatric and other abdominal surgeries as patients turn to GPI-1 medications. Similarly, surgical robotic maker Intuitive Surgical said demand was down for surgical robots due to decreased growth in weight loss surgery. (Intuitive does not expect patients to be on these drugs longer than a year or two, which seems to fall into the hopeful thinking category, as once drug use begins, the patient must be on them for life - or the weight comes back, and rather quickly) On a brighter side, at least for surgical suppliers, J&J’s CFO said patients previously ineligible for hip or knee surgery due to obesity may now be candidates – creating a potentially larger market.
But the most horrific outcome was issued by Stock Analyst Bill Chappel, who downgraded Krispy Kreme Inc’s stock from “Buy” to “Hold.” worrying the impact of the drugs would decrease consumption.
“Our call is based on the belief that the current GLP-1 overhang on packaged food stocks will not dissipate for six to 12 months if not longer… with strong potential for additional multipole contraction as the initial impact of GLP-1 use becomes more apparent.”
Stock analysts are concerned about a decreased demand for snacks and the pocket of the (now thinner) investor. But the situation might open other markets – with more emphasis on fashion (but less on liposuction) or a greater need for wrinkle creams and facelifts (as skin sags from “Ozempic face”) [1]
But once investor confidence in Krispy Kreme wanes and/or there is little consumer demand, will the company abandon the market and shut down or decrease production? Will the customer revolution do by indirection that which all the good nanny-gate legislators couldn’t achieve directly?
Will our thinner population be happier?
Are Oreos next?
[1] Significant weight loss with drugs like Ozempic and Wegovy… can lead to changes in facial appearance, as weight reduction makes their face look too thin.
