Humankind has been freed from the threat of disease by some wonderful, transformative inventions, from smallpox injections to the Covid vaccinations. With all due respect, I don’t think the so-called skinny jab is one of them.
A boom in injectable weight-loss drugs, such as Wegovy from the Danish pharmaceutical giant Novo Nordisk, a biological type 2 diabetes medication containing semaglutide, has promised to revolutionise obesity treatment in recent months. For some people with serious obesity-related health conditions, these appetite suppressants will indeed be a life-saver. Trials show Wegovy can help people lose 15% of their body weight, and the drug has been approved by the National Institute for Health and Care Excellence (Nice) for use in the NHS. That’s good news for people whose health is already suffering.
But the weekly injections, like Novo Nordisk’s earlier daily injectable, Saxenda, are being used to treat obesity, not prevent it. Meanwhile, rates of obesity-linked disease, such as type 2 diabetes, cancers, heart attacks and strokes, are increasing across the world. Diabetes UK has just published a sobering report, showing a rising impact on younger people. There are 4.3 million people in the UK with diabetes, of whom 90% have type 2. The numbers are growing fastest among the under-40s. There was a time when type 2 diabetes was almost unheard of in young people. Now it is no surprise.
Skinny jabs may look like an easy fix, and to pharma’s delight, they have been embraced by a Hollywood elite, as well as Elon Musk, who tweeted that he is using Wegovy. Novo Nordisk has been working to keep up with demand. It is expecting record operating profits this year. Novo Nordisk also has Ozempic, which is supposed to be only for patients with type 2 diabetes, but was hyped on TikTok last year, as people raved about its non-prescription use for losing weight. Other firms have similar drugs in the pipeline.
Obesity is most visibly driving type 2 diabetes, which can have terrible consequences, including blindness and foot amputations. But it is highly likely to be doing other damage too.
It should not be forgotten – although it has been – that obesity put people at higher risk of ending up in intensive care with Covid. Boris Johnson is living proof. Not long after his recovery, a chastened Boris launched into an offensive against the food companies, pledging to get rid of bogof (buy one, get one free) offers in supermarkets and ban junk food advertising before the TV watershed to protect children.
He later kicked the initiative into the long grass after backbench pressure, delaying the change on the spurious grounds that prices for junk food must not rise when the cost of living is hitting poor people hard, with no suggestion of subsidising better food instead, of course.
Yet, it is prevention efforts like these that are so sorely needed, rather than injections once illnesses develop. Curbing the marketing of junk food helps protect children from excess weight gain. And adults, though nobody will say so, since adults must make their own choices. Government foot-dragging is a result of pressure from the food and drink industry, which contributes substantially to the country’s GDP.
We are suffering from the rampant marketing of highly palatable sugary, salty, fatty foods by companies that have grown to mammoth size. The companies that dominate our eating habits with the cookies and pies they churn out from vast factories are hardly going to market bananas or broccoli to us. The best they’ve done is cut down a little on salt and reduce sugar in some of their soft drinks. That’s tinkering at the edges.
Governments want a quick fix, and these drugs seem to offer one. The health secretary, Steve Barclay, is delighted by the arrival of Wegovy on the scene. Government officials are said to be drawing up plans for the pharma companies to bid for multi-billion pound contracts to supply the drugs, and Barclay is hoping, according to the Times, to turn around the obesity epidemic without any “nanny state” measures.
But a miracle jab it isn’t. Those weekly injections have to be combined with a low-calorie diet and exercise – which people already find difficult. Diets are no fun and the body resists starvation, so weight loss slows as time goes on.
But, similarly, once people stop injecting these new drugs, the pounds can pile back on. People may have to stay on them for years, if not for life. We don’t yet know the consequences of that. Like bariatric surgery, which reduces stomach size, they should be reserved as treatment for people at high risk of diseases. They anyway take away much of the enjoyment of food because they suppress the appetite, as my restaurant critic colleague Jay Rayner points out.
The shift to the quick drug fix, away from tackling our junk food and sedentary living crisis is woefully shortsighted. The seminal Foresight report in 2007 told us the way, comparing obesity to the climate crisis in the extent of the shift we need to make, calling on governments to promote healthy diets, redesign our towns to get people walking and help shift societal values towards food.
Governments have tiptoed around it ever since. But without a full-frontal approach, encouraging healthy lifestyles and starting by taxing junk and subsidising real healthy food, global obesity will continue to rise. The jabs will not curb obesity. Preventing it in the first place is the only way.
Sarah Boseley is the Guardian’s former health editor