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Dieting has become an American pastime. At any given moment, 45 percent of women and 30 percent of men are trying to shed extra pounds. Maybe diets and weight-loss drugs are so popular because the sheer number of obese individuals since 1975 has risen an eye-popping 610 percent—from 105 million to 641 million according to a study in The Lancet, one of the world’s premier medical journals.
Sustaining weight loss over the long term has always been a challenge. But exactly what is obesity beyond its cosmetic and social aspects? Medically defined as having a Body Mass Index greater than 40, obesity is both a challenge to live with and has proven itself resistant to treatment. Sustaining even modest weight losses is difficult for both patients and the physicians who care for them.
You can calculate your own BMI here to see how you measure up.
The psychological aspects of being obese are myriad, starting with Western society’s idealization of thinness. Self-esteem, confidence, body image, and acceptance among peers and coworkers can all suffer. Ridicule of obese individuals may be one of the last socially acceptable forms of disparagement. Prejudice begins in childhood.
The earlier people become obese the more likely they are to be dissatisfied with their bodies. Six-year-old children characterize overweight peers as “lazy,” “dirty,” “stupid,” and “ugly.” College students rate obese individuals as less suitable marriage partners than embezzlers, cocaine users, or shoplifters. The corpulent—especially women—suffer at virtually all stages of employment: from selection, placement, and compensation to promotion, discipline, and firing.
Talk of willpower is irrelevant. Nor is obesity a moral issue. As James Cordon, the overweight host of The Late Late Show, says in his plea to end fat-shaming, “If making fun of fat people made them lose weight, there’d be no fat kids in schools.” Obesity isn’t a choice, and making people feel ashamed of their heft only makes them feel worse about themselves.
It’s no surprise, then, that emotional issues make maintaining a healthy weight hard: anger, loneliness, depression, boredom, anxiety, and unwillingness to confront others, especially family.
Along with the fit and firm, the medical establishment has long insisted that the formula for weight loss isn’t rocket science: Eat less and exercise more. But failed dieters know that it is nowhere near that simple.
In one sense, health boosters are right: Anyone can lose weight. The tricky part is keeping it off. Other than committing to sustained lifestyle changes—meaning food restriction and consistent exercise—only two options exist for overweight individuals: bariatric surgery that either blocks off or cuts away part of the stomach, or weight-loss medications. Surgery helps people lose 25 to 30 percent of their body weight, but it is an invasive solution that permanently alters the digestive system.
Numerous medications have promised to tackle the problem over the years, and all have failed. Side effects of five currently available anti-obesity drugs limit their use. The most effective, phentermine, brings about an average of 7.5 percent weight loss but can be taken only for a short time. Once stopped, patients regain even that small amount of weight. It is therefore natural to question whether the latest candidate, semaglutide, will be any different.
Initial reports in the New England Journal of Medicine suggest that it definitely will. "No other drug has come close to producing this level of weight loss — this really is a game-changer," says obesity researcher Rachel Batterham at University College London. Normally, weekly semaglutide injections of 0.5 to 1.0 mg are a secondary treatment for diabetes. In a weight-loss study, however, weekly injection of 2.4 mg over 68 weeks—a dose 2 1/2 to 5 times greater than that used to treat diabetes—caused a 15 percent drop in body weight in nearly 2,000 individuals who had a BMI greater than 27 (and at least one coexisting condition).
Those receiving a placebo lost a small but clinically insignificant number of pounds. Given that more than 90 percent of Type II diabetics are overweight, shedding those extra pounds is an important aim of treatment. Reducing body weight by even 5 percent improves sugar control, lipid levels, and blood pressure.
Semaglutide is a manufactured analog of the naturally occurring hormone glucagon, which suppresses appetite and promotes a sense of fullness via its action on the brain. Study participants lost 15 percent of their initial body weight on average, and more than a third lost over 20 percent. Glucagon analogs are a second-line therapy added to oral diabetes medications such as metformin. All existing analogs such as Victoza, Adlyxin, and Trulicity cause some weight loss, but in a study reported by the American Diabetes Association, semaglutide has proven twice as effective and approaches the efficacy level of surgical interventions.
Left unchecked, obesity leads to insulin resistance, hypertension, type-2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, and ultimately a shortened life span. The economic cost is staggering to say nothing of the societal one. Obesity is second only to smoking as a preventable cause of death.
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References
Ingelfinger, J. R., & Rosen, C. J. (2021). STEP 1 for Effective Weight Control—Another First Step?.
