A Bioethicist Weighs In On Obesity Drugs
By Ben Comer, Chief Editor, Life Science Leader
By now, it’s likely that you know someone, a friend, family member, or associate who has been prescribed a GLP-1 inhibitor like Wegovy/Ozempic or Zepbound/Mounjaro for weight loss. Maybe you have taken it yourself. The most obvious outcome that I have noticed personally, based on conversations with people taking those drugs, is that they work. People are successfully losing weight, just as clinical trial data suggested that they would.
No drug is free from risks, and no two human anatomies are completely identical (meaning different individuals can face different risks), but from a real-world patient perspective — anecdotally — the drugs appear safe and effective. The biggest problem at this moment seems to be the price and insurance coverage of these medications (Medicare doesn’t cover the weight loss indication, for example, and most state Medicaid plans won’t either), and the ability to produce enough supply to meet demand. Being on the drug shortage list, however, unlocks new avenues for unregulated supplies produced by compounding pharmacies, and telehealth weight loss programs, some of which operate in a legal grey area.
I spoke with Zimmerman to learn more about her position; our call touched on topics including electronic health record pop-up ads and AI, to DTC advertising, functional foods, and to the American College of Lifestyle Medicine. There is a through line connecting these diverse topics, which is the medicalization of American life, a cycle that leads to overuse of medication, says Zimmerman. But what’s wrong with using weight loss drugs, if you can’t lose weight with diet and exercise?
Zimmerman’s concerns include the potential for longer term side effects emerging. “I think we might see safety and health implications down the road, and one of them could have to do with brain health and the way in which healthy fats are necessary to brain health,” says Zimmerman. “Some of the stomach and intestinal side effects, in some patients, were quite serious,” but those seem to have been swept under the rug, she says. “I am also uncomfortable with taking a medicine that changes the way your brain thinks about food, and changes how people absorb the food they eat.” Zimmerman also notes as a concern the paucity of weight loss specialists, the massive advertising effort supporting weight loss drugs, and the quick-fix demand it creates between patients and their general practitioners (or weight loss clinical healthcare providers).
Because the American diet has been so politicized, with various industries lobbying for influence in nutritional guidelines, it has become harder over time for Americans to get good information about a healthy diet, notes Zimmerman. Also, the U.S. “subsidizes low quality foods” and has a lower minimum wage compared with many other developed countries, making healthier, more expensive foods less easily obtainable. “A huge soda is less expensive than a huge, flavored seltzer water,” for example, says Zimmerman.
In 23 U.S. states, more than one in three adults is obese, according to recent CDC population data. Denmark, which is “making a lot of money in taxes” from Novo Nordisk’s products, has a lower obesity prevalence, says Zimmerman. “Sometimes I feel they’re laughing all the way to the bank … Denmark doesn’t need people in their country to gain weight and be on these drugs, but it’s in their financial interest for Americans to stay unhealthy, and to continue needing them.”