17 February 2021

Should we worry about swapping semaglutide for self-restraint?


One of the many difficult things about lockdown is how tricky it has made looking after our health – especially now, when the weather is miserable and organised outdoor exercise is mostly illegal. Perhaps that’s why I’ve spent the last week looking forward to Lent, which starts today.

This feeling seldom survives the first few days, of course, and I’ve no doubt that after a week of sticking to just one meal a day – my personal challenge this year – I’ll be having fever dreams about Deliveroo. But it’s a good tee-up and, if you stick with it through the first couple of weeks, it tends to return.

I don’t think one needs to be religious to see the benefit of 40 days of abstinence. I’ve always found it easier to adopt a more stringent regimen than I normally manage if I know it’s for a defined amount of time. And by the time you reach Easter, you’ve given yourself enough time for at least some good habits to stick.

It is also well-timed to offer a chance of a reset after post-Christmas midwinter slump, which is more welcome than ever if you, like me, are not one of those people who has managed to turn lockdown into a dramatic lifestyle improvement. 

But viewed in this non-religious way, Lent is effectively serving as a focus for willpower. But what if there was actually an alternative to self-restraint? Step forward: semaglutide.

If you missed this story, semaglutide is a drug which is currently used to treat Type 2 Diabetes but has been submitted for consideration as an obesity treatment. Research suggests that subjects given a weekly injection of the appetite suppressant have seen dramatic weight loss. According to Sky News:

“The study into the effects of semaglutide on obesity by a University College London (UCL) team found that more than one third (35%) of people who took it lost more than one-fifth of their total body weight.

“Researchers say it means that for the first time it is possible to achieve through drugs what was previously only possible through weight loss surgery.”

Needless to say, this is hugely exciting if true. Weight loss on that scale can be genuinely transformative, not only to an individual’s physical health but many aspects of life. For example if I lost a fifth of my bodyweight (and maintained my current muscle mass) it would be the difference between being obese and being – try not to smirk – ‘ripped’.

But some are sceptical about whether or not we should go down this chemical rabbit-hole. Matthew Syed, writing in the Times, is wary of granting access to such a shortcut to those (again, like me) who “don’t have a medical condition; they lack resolve”. He asks:

“For what does it do to a person to subcontract a matter of volition to a pharmacological intervention, thus bypassing the will? What does it do to our sense of agency, perhaps our sense of self? These consequences may not show up in the side-effects listed in a clinical trial – but they are serious, nonetheless.”

These are certainly important questions, and they are likely only to continue to arise as pharmacology grows more sophisticated. It was only a few years ago that I crossed pens with Stephen Daisley over the ethics of using ‘Cognitalin’, a hypothetical performance-enhancing drug of the sort prophesied in PWC’s report, ‘The Future of Work’. Now, as then, my instincts lie with the alchemists.

In the case of semaglutide, I don’t think that it has quite the dire consequences for human agency that Syed ascribes to it. After all, the decision to enrol on a programme of injections – so long as it is voluntary – is itself an act of the will. It’s difficult to see how the moral implications are any different to those of getting gastric band surgery, an option which is already available and which has not, to my knowledge, kicked off any debates about free will.

I don’t shy away from the fact that I bear the bulk (no pun intended) of the responsibility for my weight. But so what? The health implications, both for me and ‘our NHS’, are unchanged by that. If Syed is suggesting that obesity be treated as a penance paid by the weak-willed, that’s a policy with a very high human cost indeed.

(And there are others who disagree, and point out that it perhaps an ‘obesity epidemic’ isn’t surprising, given that humans have not been evolutionarily prepared for the conjunction of super-abundant food and sedentary work that is such a feature of first-world societies.)

Where I am more sympathetic to Syed’s scepticism about semaglutide is his fear that it will have knock-on effects on the exercise of willpower and initiative in other areas. I think this is a credible concern, both because it matches my anecdotal experience and because of the hammering that the counter-concept of ‘ego depletion’ – “a hidden willpower gas tank in our heads” that runs out as we use it – has taken in recent years. 

But even if that’s true, it doesn’t mean that the costs outweigh the benefits. Not only do we need to weigh the hypothetical damage to willpower against the concrete health benefits of being slimmer, but against all the other benefits too. Interventions that protect our bodies against the negative impacts of vices undermines the authoritarian case for proscribing those vices – good news for libertines and indeed anyone concerned with ‘human agency’.

Nor should we discount the possibility that being healthier, happier, more attractive, and more confident will actually provide an overall boost to the willpower of millions of people who, by dint of getting the jab in the first place, are clearly not oversupplied with it.

It’s the same story with Syed’s final spectre: “people trying to wean themselves off the drug, their enfeebled willpower incapable of resisting renewed pangs of hunger”. What future are we comparing this to? Available evidence suggests one in which these people are simply still obese, or a long-shot alternative where better health outcomes have been brute-forced by an increasingly heavy-handed nanny state, the ‘social straightjacket’ I have written about previously.

If it’s the choice between those options or “a lifetime of self-medication”, is the latter really a bad thing? Especially if the real alternative is this easy option being available only to those with enough money or the right contacts, the way ‘study drugs’ such as Modafinil and Ritalin are today.

Yes, it feels weird to use a technological crutch for something we used to do ‘ourselves’. But it’s a transition humans have been making for as long as we’ve had technology. My distant ancestors would likely be horrified that I could scarcely survive a week, let alone a winter, out of doors.

But at some point, people started growing up who didn’t need to personally know how to start a fire or which berries were edible. As our collective capacity to work our will on the world increases, we rely less on our individual capacity. That’s progress.

To my mind, it’s not intrinsically less ridiculous to talk about whether our tech-enabled successors will be more or less human than us than whether we are more or less human than our palaeolithic forebears. As George Orwell put it: “What have you in common with the child of five whose photograph your mother keeps on the mantelpiece? Nothing, except that you happen to be the same person.”

As for Lent, there will always be something new to give up, or take up. The upside of human beings being imperfectible is there will never be a drug for everything.

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Henry Hill is News Editor of ConservativeHome.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.