Slimming drugs have changed the way we talk about obesity. For decades, this was presented as a personal failure. But Ozempic, Wegovy, Mounjaro and the like helped millions of people lose weight and changed the narrative. If obesity could be corrected with medication, it was logical to think that it was a disease. It seems like a nice change, but the underside of this statement has its shadows. And it is a huge business.
An editorial published this week in the journal Science warns of the risks of entering “the Ozempic era,” a cultural moment in which this family of medications conditions the way we understand food. Your concern is not that the medications don't work. They do it. “The problem is that they can end up becoming an individual health patch for a complex disease with an important social aspect,” explains Luc Hagenaars, a health policy researcher at the University of Amsterdam and co-author of the writing, in a video call.
“The pharmaceutical industry tends to present obesity almost as an epidemic fallen from the sky that requires medical treatment,” denounces Hagenaars. But there are specific culprits and nothing is being done to stop them. Ultra-processed foods are not food, they are edible industrial preparations that artificially stimulate appetite. They are cheap, hyperpalatable and quick to prepare. A commercially perfect and health-disastrous product. A series of scientific reviews published in The Lancet last year pointed out how they are colonizing traditional diets around the world and eroding public health. Scientists called on governments to take action. “Food and health must be prioritized over corporate profit,” they warned.
But these products continue to increase their presence in supermarkets. From 2007 to 2022, annual per capita sales of ultra-processed foods increased by almost 20% (from 104 kilos to 121.6) in upper-middle-income countries. Not enough is being done to reverse this trend. But if a person gains a lot of weight (and can afford it), they can take a slimming drug to return to a healthy weight. For this new population segment, large conglomerates are creating functional meals, meal replacement shakes, nutritionally balanced and very practical, since they do not have to be cooked. It is a new business opportunity.
“The use of these drugs can be beneficial to help those patients who have more difficulties losing weight,” says Maira Bes Rastrollo, professor of Preventive Medicine and Public Health at the University of Navarra. "But it is very dangerous that in a hedonistic society like the current one, it is thought that one can gorge on ultra-processed foods without any consequences for one's health, thinking that later there will be a drug available that will solve the problem." It is a problematic model, but it is the one that seems to be consolidating.
The Ozempic era is here. And to understand its consequences, it is best to pay attention to what is happening in the United States. The percentage of Americans with obesity has fallen from 39.9% to 37% in the last two years, coinciding with the expansion of these treatments. It seems like good news, but it must be put into context. In Spain, where its use is much lower, obesity affects just over 15% of the population. The solution does not go through the pharmacy, but through the supermarket.
But health policies and medical decisions do not seem to be going in that direction, Hagenaars laments. In his editorial (also signed by public health expert Laura A. Schmidt) he criticizes certain recent medical trends. For example, the concept of “clinical preobesity” proposed a year ago by a committee of experts in The Lancet magazine. Hagenaars and Schmidt don't think it's so much a medical debate as a marketing strategy. “This is what is known as expansion of the diagnosis,” they denounce. “The more people who fall into obesity-related medical categories, the greater the potential market for new treatments.” Hagenaars is not only opposed to the idea of medicalizing overweight. It also points out the conditions under which that conclusion was reached. "The conflict of interest section in that article took up two full pages in two columns with small print. This illustrates the magnitude of what we are talking about," he says.
Pharmaceutical companies subsidize many of the research works of scientists in this field, something that must be reflected in the papers. It does not mean that the studies are flawed, but Hagenaars believes that it conditions them. “The scientific ecosystem has lost the ability to think critically,” says the expert. “It focuses on analysis at the cellular and health level, rather than looking at the broader picture of lifestyle, power and financial interests.” So has the press, which he accuses of having been too complimentary of these medications. Hagenaars recalls cases such as those that have occurred in his country, Holland, where the justice system has fined several media outlets for promoting Ozempic and similar articles with excessively flattering articles.
The trend is global, but there are countries that are better prepared to face it. Spain is one of them, says Cecilia Díaz Méndez, professor of Sociology at the University of Oviedo and director of the Sociology of Food Research Group Socialimen. “Food cultures are a way of resistance against these homogenizing trends in the business world,” he explains in a telephone conversation. And in Mediterranean countries, this culture is more deeply rooted than in the Anglo-Saxons. With the term culture, the expert does not refer to the diet itself, but to family recipes, which are transmitted as a legacy and inheritance. To the idea of cooking for others and doing it in company. To the culture of food markets, where you ask the fishmonger for the freshest fish or the butcher for which piece is good for a roast. There are words, such as gulusmear, tapaar or sobremesa, that have no translation into other languages, because they name concepts that are foreign to them. The Mediterranean diet is that too.
GLP1 agonists eliminate all these social and recreational aspects related to eating. They suppress not only hunger, but the pleasure associated with food. And this can be a lifeline for those who have been trying to lose weight for years without success; It is an effective solution at an individual level, but the signatories of the Science editorial consider what social effects it could have if it is extended as the only method to end the obesity pandemic.
