Science names GLP-1 RAs with their "Breakthrough of the Year" moniker for 2023

Adding to the growing ideological shift in the fight against obesity.

Following the ever-growing popularity of GLP-1 receptor agonists Science has considered these drugs as their “Breakthrough of the Year” for 2023:

From Science

This class of drugs has garnered attention in all avenues of life including the social/cultural sphere as well as medical and financial, with Novo Nordisk, the producer of Semaglutide, becoming the largest company in Europe’s stock market in September and unseating a position initially held by LVMH.

It’s also been brought up by many celebrities through initial speculations on Ozempic users, with recent revelations suggesting that Oprah has taken her own “GLP-1 Journey” as Weight Watchers begins launching their own program for GLP-1 users:

Of all drugs to hit the market GLP-1 RAs are likely to be the next big move for pharmaceutical manufacturers given how big of a money maker these drugs have turned out to be, with the unfortunate consequence being that social commentary surrounding obesity has been altered in favor of these drugs over traditional lifestyle changes.

This follows a new era of social justice ideology which seems to obfuscate the real health and financial consequences of being obese with absurd ideas such as fat activism, Healthy at Every Size, and notions such as “fat shaming”. Like with everything, it seems to be a manner of feelings over biological reality over the perils of being overweight.

Unfortunately, Science starts off their article with this ideological spin (emphasis mine):

Obesity plays out as a private struggle and a public health crisis. In the United States, about 70% of adults are affected by excess weight, and in Europe that number is more than half. The stigma against fat can be crushing; its risks, life-threatening. Defined as a body mass index of at least 30, obesity is thought to power type 2 diabetes, heart disease, arthritis, fatty liver disease, and certain cancers.

It’s a strange pairing when social commentary is intermingled with reality in such a way. It doesn’t help much that stigma here is a nebulous term, because what exactly would be the sort of stigma that Science is alluding to.

The Science article also goes further to include this following excerpt, almost as if it was some sort of requirement to garner some social points (emphasis mine):

In honoring these therapies, we also acknowledge the uncertainties, even anxieties, this sea change brings. We recognize, too, that obesity comes with medical and social complexities, and that many deemed overweight by others are healthy, and have little desire or pressing need to lose weight.

Great- rather than argue the complexities or nuances that may be related to obesity we may just consider it to be highly subjective, because how exactly would one person be considered overweight while also be considered healthy?

In wanting to look into this alleged stigma more I looked up “fat stigma” I came across articles such as these:

From the APA

From Harvard Health Publishing

From WebMD

The Harvard Health article seems to provide the only definition of weight stigma which isn’t nothing more than a reference to discriminatory behavior and practices against overweight people:

Weight stigma, as defined in a recent BioMed Central article, is the "social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape." Put simply, weight stigma is a form of discrimination based on a person's body weight.

Here, again, social commentary is provided in the use of “social norms”- nebulous terms and phrases beget one another.

The American Psychological Association is even more tainted with the social justice language that we have all come to know and love:

“Simply put, weight stigma is damaging to both emotional and physical health, and it decreases quality of life,” said psychologist Rebecca Puhl, PhD, a professor at the University of Connecticut and deputy director of the university’s Rudd Center for Food Policy and Health. “This tells us that we need to address weight stigma not only as a social justice issue but also as a public health issue.”

Effects of sizeism

Sizeism is one of the most deeply entrenched stigmas in today’s society, partly because of sociocultural ideals tying thinness to core American values such as hard work and individualism, said Puhl. The implication is that people in larger bodies lack willpower and discipline.

“People can’t change the color of their skin, but there’s this perception that people can diet their way out of obesity—that if somebody has a larger body, it’s 100% their fault,” said Janet Tomiyama, PhD, a professor of health and social psychology at the University of California, Los Angeles.

As the young kids say- there’s quite a lot to unpack here. It should be made clear that outright targeting people for being obese shouldn’t be accepted, and yet at the same time this isn’t quite the same form of discrimination or shame that people refer to, but rather the biological imperative that comes with being obese, such as requiring two seats because, well, these people may require two seats:

From The Guardian.

Funnily enough, Southwest has recently been in the news for giving overweight individuals free seats:

From Time

Again, this is an intersection of ideology with biological and physical imperative where ideology seems to overtake and reality related to the fact that people who are larger will inherently take up more space, or will be additional weight that would need to be considered into various factors such as weight distribution on planes and roller coasters- things that wouldn’t have been necessary decades prior and would cost hundreds of thousands (if not millions) of dollars to accommodate and ever-growingly obese globe.

It doesn’t help that there is also a reality that many foods in grocery stores are formulated to be inherently addictive. There can be a reality in which we can acknowledge that junk food is designed to be addictive and difficult to give up, while also acknowledging that obesity is a serious issue that shouldn’t become commonplace or seen as being healthy. We can empathize with those struggling to lose weight due to these challenges without being complacent in believing that obesity can be considered healthy. We can learn more about biological factors that may contribute to increased risk of obesity without excusing poor habits or lifestyle choices because of “muh genetics”.

There’s a seriously growing concern that obesity will lead to great healthcare strains. Consider the difficulty in managing someone who is several hundred pounds, or the instruments needed in order to image these individuals.

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The problem with this new reimagining of obesity is that it strays further from autonomy or the strength of the individual, making people believe that they have no control over their own lives and relying on Big Pharma to step in to help them on their “GLP-1 journey”- all at a steep price.

As a thought, consider what world we would live in if these drugs are eventually found to be efficacious in curving addictions? What if these drugs came out decades prior, with the main conclusion pressed by the media that you can’t forego your addiction through your own hard work, therapy, and help from others but can do so by taking a medication? And in order to not go back to your prior addictive behaviors you would need to stay on these drugs for life? It seems rather insulting to people who have battled with addiction and have remained sober if they were told that there was no way they could do so without medications.

To that, also consider that most remarks on GLP-1 RAs have suggested that these drugs should be used long-term. This comes with the idea that those who stop taking these drugs tend to gain back their weight based on limited clinical data, suggesting that people should keep taking these drugs if they want to keep their weight in management as commented in a Business Insider article rebutting companies who are pushing to forego GLP-1 RAs:

A giant question is looming over the rise of Ozempic, Wegovy, and the other drugs that caught fire for helping people lose dramatic amounts of weight: Once you go on them, do you really have to take them forever?

The FDA, the drugmakers, and obesity-medicine doctors argue that these drugs should be taken long term, maybe for life.

But a growing number of healthcare companies are rejecting that consensus. They're turning their efforts toward helping people quit GLP-1 drugs like Ozempic, Wegovy, and Mounjaro and suggesting they can maintain a lower weight and the health benefits that come with it. In doing so, these companies are at the forefront of an informal medical experiment that evidence suggests is likely to fail and risks harming patients in the process.

[…]

There's just one problem. At least for now, there's no evidence that most people can stop taking medication and keep the weight off, obesity experts say. There is, however, a growing pile of research suggesting the opposite — that once people stop taking them, their weight creeps back up.

Again, the language of dependency is rather blatant in this excerpt, and it’s becoming part of a growing trend where these drugs are now seen as the norm for weight-loss and is the only way we can deal with the obesity epidemic.

Some of these studies looking at weight gain post-Ozempic also don’t take into account if participants return to their previous bad eating habits. More importantly it doesn’t take into consideration whether any sort of GLP-1 dysfunction may be underlying the issues that people have in dealing with their obesity. For instance, there seems to be a relationship between gut microbes and GLP-1 production/signaling, and so one would have to wonder if bad diets and gut dysbiosis may lead to poor GLP-1 production in obese individuals.¹,²

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There’s a ton of uncertanties when it comes to these medications, but rather than take a precautionary approach it seems as if society has dove head-first into acceptance of these drugs as the only move forward. Paired these pharmaceuticals with social justice ideology and you can trick the masses into thinking that their weight is outside of their control; that they shouldn’t be shamed for their weight; and more important to investors, that they should remove the stigma associated with these medications thus helping line the pockets of pharmaceutical giants as more and more high-profile individuals endorse the grandness of these drugs.

It’s a push for further complacency, less autonomy, and more dependency.

But congrats to these GLP-1 RA producers. A win for you guys is likely a loss for the rest of us.

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1. Greiner, T. U., & Bäckhed, F. (2016). Microbial regulation of GLP-1 and L-cell biology. Molecular metabolism, 5(9), 753–758. https://doi.org/10.1016/j.molmet.2016.05.012

2. Wachsmuth, H.R., Weninger, S.N. & Duca, F.A. Role of the gut–brain axis in energy and glucose metabolism. Exp Mol Med 54, 377–392 (2022).