There’s a heart-tugging movie to be made about the miraculous new weight-loss injectable drugs – though a few versions of it have already been made.
Remember Flowers for Algernon, about the downtrodden low-IQ janitor whose intellect was boosted to far above average by a groundbreaking new surgical technique? His once-miserable life blossomed – until the cerebral transformation unexpectedly regressed, leaving him bereft.
Or Awakenings, the true story of coma patients given a revolutionary new dopamine treatment that restored their consciousness – only for the effects to wear off, sending them back to bleak oblivion.
Euphoria is understandably rampant about the new drugs, which take the vice and virtue, nagging and guilt out of weight loss for most patients, causing them to shed life-changing amounts of fat. It’s estimated one in eight Americans have used them and the US’s obesity rate may already be in decline.
Now, US drug company Eli Lilly is committing £279 million (NZ$600m) to a collaboration with the UK government, initially trialling its brand of tirzepatide, the hero drug so far, on extremely obese patients in Manchester. Indications are the patients will lose, on average, a fifth of their weight in eight months.
But this could easily devolve into a mass re-enactment of Cinderella – the bit where the golden carriage turns back into a pumpkin. Unless the jabbed develop radically improved food and activity habits while they’re on the injectables, they’ll regain an average of two-thirds of the weight they’ve lost once off the drug, studies have shown. This statistic is getting less attention than the ones touting the weight-loss impact while on the drug.
Given the mammoth cost, it’s unlikely many public health services will provide the treatment indefinitely. It’s not clear if Britain can afford a nationwide programme, even if the pilot is a raging success.
Even if the drug were free, there are still risks to the long-term use of any drug. The hope is this treatment will be a deft, rapid fix, and relief from the terrible burden of obesity will motivate patients to keep the weight off afterwards. Bluntly, they won’t unless they can be persuaded, nagged or motivated to change their habits – and that, too, takes time and most especially money to provide the right level of counselling.
So are we, heaven forfend, back to nagging, guilt, vice and virtue? Or worse, the fatuous and scientifically bankrupt old orthodoxy of calories in/calories out? Or worse still, the repressive warnings from health experts that exercise and increased activity are largely irrelevant to weight loss?
As is often smugly parroted, you can’t out-exercise a bad diet. But the benefits of physical activity are numerous – a healthier metabolism and boosted mood are advantages highly relevant to people struggling with their weight. Unless people get help in changing their food preferences and becoming more active – both extremely steep habit mountains to conquer – they’re being set up for Algernon and Awakenings sorrow.
Let’s not downplay the wonder of these drugs. Appetite regulation is a holy grail in the fight against obesity. It brings people with disordered eating rapidly to a point where, for the first time sometimes in decades, they simply do not want to over-eat.
The least-worst outcome to drug-only treatment is still better than the status quo. If people lose a fifth of their body weight and regain two-thirds of it, they’re still better off. There’s also strong evidence the drugs can quench drug and alcohol addiction – a rare side effect to cherish.
Perhaps the most telling side effect will be that projected for economies. Any overall reduction in obesity carries fiscal and productivity benefits, so economists are generally keener on the drugs than doctors. The desirability of slimming countries’ deficits may be more persuasive than health and even vanity.
