The obesity epidemic has cast a long shadow over our health for decades: one in four residents of Poland suffers from this disease. We can take comfort in the fact that it is not 40 percent, as it is among Americans. However, trends had not previously offered reasons for optimism. Nevertheless, innovative discoveries in pharmacological treatment, particularly the advent of drugs like Ozempic, Wegovy, and Mounjaro, ignite a spark of hope for a future free from this disease epidemic. The active ingredient in these medications is GLP-1, specifically semaglutide. In addition to suppressing appetite—particularly cravings for fatty foods—which naturally leads to weight reduction and decreased body fat, semaglutide also has a beneficial effect on other aspects of health. They improve lipid profiles by lowering blood fat levels and also reduce blood pressure, which is a crucial element in the prevention of cardiovascular diseases. Additionally, semaglutide has anti-inflammatory effects, which are significant in preventing the consequences of atherosclerosis. Interestingly, animal studies suggest that this medication may even prevent the formation and development of atherosclerotic plaques, which gives hope for even more effective heart disease prevention.

Having examined public health in many projects and had the opportunity to work with a range of pharmaceutical companies— including a producer of one of these new semaglutide drugs—I try to keep abreast of the latest reports on this topic. In light of new statistics from the U.S., I would like to outline two possible scenarios: one painted in optimistic colours, the other less enthusiastic. I have been thinking about this for a few days, but yesterday at the Food and Agro Conference organised by BNP Paribas Bank Polska, Bartosz Urbaniak reminded me of the matter with his presentation.

If Everything Goes Well

We currently stand on the brink of a groundbreaking change in the perception and treatment of obesity. We see that the introduction of semaglutide in the U.S. has likely played a decisive role in the first-ever slowdown of the obesity trend in the population. New drugs, which bring impressive results in weight reduction (averaging 15-20%, and sometimes reaching even 30%), serve as a powerful weapon in the ongoing battle against this chronic disease. This success may result in a significant decrease in the number of individuals struggling with obesity, potentially paving the way for a future in which this condition ceases to be viewed as an epidemic.

Similar to the reduction in the number of smokers, which consequently led to a decline in lung cancer cases, the widespread use of these medications could have a similar effect on health issues associated with obesity, such as heart diseases, diabetes, and certain cancers. For cigarettes, economic mechanisms such as taxation and other regulations worked. In the case of obesity, the breakthrough source may lie in pharmaceuticals. But that is not the end of the story. Let’s consider the potential of these drugs in combating addictions, such as alcohol abuse or opioid overdoses—research shows that they weaken the neurological reward mechanism associated with substance use. Some may call them a panacea for modern plagues; I might not go that far, but I won’t deny their significant role in a social context. If a new generation of semaglutide becomes available in the form of long-acting tablets, it will make therapy more accessible and comfortable for patients, resulting in a very positive social impact.

If Everything Goes as Usual

While new drugs bring a glimmer of hope, we must not overlook the challenges. First and foremost, these drugs are not a “magic bullet” for obesity. They require lifelong use, and discontinuing them often leads to a return to previous body weight. We cannot underestimate the side effects of using GLP-1s, such as nausea, heartburn, constipation, or the rare but serious risk of pancreatitis. I have also encountered comments suggesting that these drugs “take away the joy of consumption”—I’m not sure this is such a drawback, given the positive consequences, but still. Such experiences can discourage patients from starting or continuing therapy. The high cost of these medications presents a significant barrier to access for many individuals, and the limited supply and high demand worldwide pose challenges to achieving broad access through mass reimbursement.

Current enthusiasm surrounding these pharmaceuticals may be premature, as their long-term effects remain unknown. Further research is necessary. While these drugs may bring significant weight reduction for some patients, they may prove less effective for others. Bariatric surgery will likely remain an essential tool in the fight against obesity, especially in severe cases where pharmacotherapy alone may not be sufficient. Here, we enter the realm of waiting lists for procedures, and it becomes a bit less rosy—much like in a science fiction story I read last year about a state lottery for access to a life-extending drug (if any of the readers can help me find the author and title of that story, I would be very grateful).

Furthermore, drugs treated as a miracle solution for obesity (and everything else) may foster a false sense of security and discourage the adoption of healthy eating habits and physical activity. Healthy nutrition and movement are crucial not only in treating diabetes, cardiovascular diseases, and obesity but are the foundation of health throughout a person’s life spectrum. Therefore, we could end up with a significant portion of the population becoming dependent on pharmaceuticals, and discontinuation would result in a return to previous body weight. This, in turn, would generate enormous costs for the healthcare system and be associated with the risk of long-term side effects from using these drugs—health-related, economic, and otherwise. Let’s note that currently, aside from various blood pressure medications with diverse mechanisms of action that are often used in combination, we have virtually no prescription drug taken permanently by tens of percent of the population.

What Does This Mean?

We await further reports on obesity therapies. We can expect the use of combined therapies focusing on multiple hormones responsible for appetite and satiety. As our understanding of obesity grows, we will likely see the emergence of personalised therapeutic strategies. But ultimately, effectively tackling obesity requires a social reevaluation—moving away from blaming individuals and recognizing obesity as a complex disease that necessitates holistic medical care, along with, as was the case with cigarettes, the use of all available regulatory means to ensure that future diets are healthier, food is safer, and our relationships with food are healthier. The emergence of new drugs was the first signal; changes in obesity statistics in the U.S. may already represent a turning point. We will continue to observe with bated breath (and not snack on chips).

Author: Kacper Nosarzewski, partner at 4CF, The Futures Literacy Company