Ozempic, the brand name drug for a medication called semaglutide, is one of the most popular drugs on the market right now. Originally developed to treat type 2 diabetes, the injectable drug has recently boomed in popularity for its off-label use to help people lose weight... fast. Celebrities and public figures have admitted they're taking it. Instagram influencers are showing off remarkable before and after photos. It's been called "TikTok's favorite weight loss drug." As one doctor said, "we haven't seen a prescription drug with this much cocktail and dinner chatter since Viagra came to the market."
But alongside the rise in Ozempic prescriptions come many questions still unknown: Who should be taking it? Is it safe for longterm use? Who is it safe for? Should children be prescribed it to treat childhood obesity, as the American Academy of Pediatrics recently advised? Is Ozempic a permanent solution to the obesity epidemic? Or is it more like a bandaid, a quick fix that does little to address the root causes of obesity? And, to that end, what is the root cause of obesity? Is it a "brain disease," as one Harvard doctor recently declared on 60 Minutes that warrants medication? Or do diet, exercise, willpower and other behavioral lifestyle choices still matter?
These are questions that my guests do not agree on. Dr. Chika Anekwe is an obesity medicine physician at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School. Dr. Vinay Prasad is a hematologist-oncologist and a professor at the University of California San Francisco. His most recent book is Malignant: How Bad Policy and Bad Evidence Harm People with Cancer. And Calley Means is a former consultant for food and Pharma companies who now works to expose their practices and instead incentive healthy food as the foundation of health policy.
Today, Dr. Anekwe, Dr. Prasad, and Means debate: will Ozempic solve obesity in America?
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I enjoyed this podcast. As a primary care physician who has practiced medicine for 25 years and who has raised 3 children, I've had a good overview on this issue. I actually did appreciate Calley's point that the medical "establishment", particularly some of the highly respected and influential medical centers and individual physicians, need to speak more loudly about this public health crisis. I think the 2 key changes that have occurred starting in the early 80s is the overwhelm of our food system with sugar and processed carbs (HIGHLY PALATABLE FOODS) AND the whole concept of SNACKING. As I was growing up in the 60's/70's, snacking was not the mainstay and commonplace daily habit that it is now. I always appreciate VP's point of view, but I don't think our more sedentary lifestyle has nearly as much impact as the bad food choices American culture currently encourages. (exercise is fantastic, a cornerstone of good health - but doesn't drive weight to the same extent that types of food and the schedule on which we eat them does.)
Most preschools and early elementary schools mandate that mother's help provide "snacks" for the kids' classes - because no way should young kids survive from breakfast all the way to lunch without a "snack". Most Americans feel no hesitation to eat whenever they feel hungry - and often eat/snack without fully realizing it. The lure of highly palatable foods is greater than most of us can fully resist. "Big food" companies have teams of researchers who understand the "bliss point" and the exact balance of salty/cheesy/melt-in-your mouth taste that hooks the human brain. Our "drive through" culture only fuels this fire - drive through fast food whenever we want it. I am frequently shocked by the family's that allow their children to develop "Starbucks habits" - besides the calories easily hidden in these drinks, how do they afford it. Why allow your child to develop this expensive habit? Youth sports even focuses around food - so easy for parents to drive through fast food on the way to or following practice; games are celebrated with eating out at high-calorie restaurants, team travel has a total focus on eating out/snacks/etc. Even these kids who are moving quite a bit are having these bad food practices cemented in their brain as an OK way to live.
Probably our best societal move would be to look at highly palatable and processed food choices in the same way that we evaluate what sorts of things have helped decrease smoking - clear public warnings by health officials on a constant basis about how bad these things are for you; tax/pricing these foods to a level it becomes uncomfortable, etc. Much of our focus should be on early childhood - we need strong messaging to families with young children that snacking and sugar/processed foods are not healthy.
I think we need to use Ozempic (or Wegovy) as a "tool" to help some people who have significant health issues due to weight. it doesn't work for everyone and it is certainly NOT the "answer" to childhood obesity. And sure, genetics has some part in this, but not to the extent that exactly what and when we eat does. For medical doctors to tell anyone that this is not directly related to what and when you eat, is irresponsible and disempowering. Obesity certainly is a "brain thing" - but it is our human brains reacting to diets high in sugar/processed foods and too much of it throughout the day. And yes, the longer you are overweight/obese, the more your brain chemistry becomes focused on keeping you there, but it is not insurmountable and Ozempic is not the national "answer".
The obesity epidemic is most of all an epidemic brought on by highly processed, unhealthy food that is more available and cheaper than healthy food - and it is food engineered to be addictive. So now we're going to provide expensive big pharma medicines to counteract the obesity caused by corporate control of food abetted by government subsidies.