In 1903, H G Wells penned the humorous short story called The Truth About Pyecraft, a fantasy tale about a morbidly obese member of a London club who undertakes an ancient Hindu weight-loss recipe, only to be found floating like a balloon in the air. He had reduced his weight, but not his fatness. Such stories are as absurd as intended, and the realm of fad dieting, though avoiding levitation, has also created a strange dysphoria amongst medical practitioners.
As with so many inventions, what was once absurd has now become reality with drugs like Ozempic, Wegovy (both semaglutide) and Mounjaro (tirzepatide), which give patients the sensation of feeling full for longer, extended digestion periods, and higher rates of insulin release paired with reduced glucagon production. By simply injecting a replicant of the hormone peptide-1 (glp-1), patients can rapidly decrease their consumption of food (and thus calories), and see significant and rapid improvements in their body-mass index (BMI).
That could be where the story ends, as NICE have rapidly approved the drug for people with a BMI of between 30 and 34.9, and have one weight-related comorbidity. However, it is important to address obesity at large and why it continues to perturb policymakers.
Obesity has come to epitomise a certain view of the ‘decadent West’ (even if it is more prevalent in poorer regions). Here in Britain, NHS figures suggest that 26% of men and 25% of women are morbidly obese (albeit according to the rather imperfect yardstick of having a BMI over 30).
A glance at the geographical correlations between location and obesity also raises concern: It seems the New Elite Islington wokerati’s tofu and avocado on rye bread is doing wonders for their health, while areas that require serious Levelling Up in investment also need Levelling Down in waist size.
Obesity also brings social stigma. In Japan, where the state is much more concerned with obesity than their global counterparts, companies can receive fines for having too many obese workers. Social stigma abounds, too, with obese Westerners being subjected to immense social stigma, particularly in crowded Tokyo subway cars. In the UK, NICE found that the failure of weight-loss methods and related social stigma around obesity contribute heavily towards severe psychological strain and illness. That mental health crisis, to which obesity contributes significantly, has huge costs for the UK: indeed, pre-Covid figures placing the cost to employers of £56bn due to sick leave induced by mental health problems.
Policymakers have turned to various nanny-state measures to combat obesity in the public, citing the £6bn in annual costs and forecast a rise to £9.7bn each year by 2050. Sugar taxes, which the IEA’s Chris Snowdon has shown to have been a total failure, remain at the top of public health’s arsenal in the war against both obesity and choice. Failing that, we have proposals to ban the advertising of junk food before the watershed, even though the supposed ‘success’ of bans on fast-food advertising on Transport for London services was shown to be based on flimsy statistics. However much they try, the Public Health State can’t seem to get to grips with this issue.
Perhaps it’s frustration with those failed efforts that leads some commentators, such as health journalist Sarah Boseley, to take arms against pharmaceutical solutions to the obesity crisis. ‘The shift to the quick drug fix, away from tackling our junk food and sedentary living crisis is woefully shortsighted,’ she writes, though in truth the objection seems to be as much to nasty Big Pharma companies making money as to problems with the actual treatment on offer.
Because the unpalatable truth for the Guardian doomsters is that in so many areas, science really is the answer. This is particularly true when it comes to tobacco harm reduction, where the embrace of tobacco alternatives such as vaping has contributed to a big drop-off in smoking (not least in newly ‘smoke free’ Sweden). The arrival of weight loss drugs like Wegovy should be seen in that context, as a triumph of human ingenuity to be celebrated, rather than scoffed at.
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