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Rude Health by Vir Sanghvi: It’s what we’ve weighted for
Around the world, drugs that suppress appetite are all the rage for weightloss. We’ve taken to them faster than any diet. Could the war on fat finally be over?
Have you been on a diet lately? Have you bought a diet book? Gone to see a “weightloss consultant”? Watched a diet video? Starved yourself for 18 hours because you are on an intermittent fasting diet? Looked longingly at a slice of toast that you are not allowed to eat because of your carb-free diet? Weighed yourself every day after coming back from the gym to check how much weight you have lost?
If you have, then enjoy it. Revel in the fasting. Make the most of the diet. Because, 10 years from now, when you tell your children that you used to diet or try and sweat off the kilos, they will look at you with wonder and astonishment. (And perhaps a little bit of pity too.)
It will be like how your own grandparents felt when they tried to explain the joys of an 18-inch, black-and-white television set, on which Doordarshan was the only network available. Your kids will find all your diet talk strange and will have no idea what you are going on about.
Because dieting is nearly dead.
It is a slow death, admittedly, but the stench of putrefaction has already filled the air. In the United States,the diet industry is crashing and burning. Diet books are selling in much lower numbers. Diet clinics are going bust. And gyms are becoming places you only go to if you are lonely and need to pick somebody up.
As you may have guessed, the assassin is the new generation of weightloss drugs. If you can make yourself thin without all the nonsense about food combining, carb-sacrificing and intermittent fasting, why wouldn’t you grab the opportunity?
The diet industry has watched the advent of the medically induced weightloss revolution like a deer caught in the headlights of an approaching Ferrari. The market valuation of Weight Watchers (which changed its name to WW) has fallen by 90% since 2021. Nobody is investing any longer in weightloss clinics or systems.
The diet-book industry has tried to cope with approaching obsolescence by repackaging itself as the wellness-book industry. A classic such as the Mayo Clinic Diet book (which, at least, is medically sound), first published in 1949 and a steady seller for decades, has faced such a huge decline in sales that it has now reinvented itself as a guide to “weightloss medication”. Other diet-book authors say that their advice is actually about longevity (Yeah, sure) and not about losing weight.
This is probably the fastest-moving of all eating revolutions. And America, where it started, has seen a lot of eating revolutions. For instance, the US government once pushed a grain-heavy Mediterranean diet, arguing that this would make Americans healthier. In fact, it legitimised excessive consumption of wheat and carbohydrates leading to the US epidemic of obesity.
Then, there was the campaign against cholesterol-rich food, which led Americans to shun red meat and eat lots of factory-bred chicken .Eventually, in 2016, the US government admitted that cholesterol from dietary sources was not a significant factor in human cholesterol levels.
Every eating revolution in America has taken years to penetrate public consciousness, but the craze for weightloss drugs has gripped the country almost instantly. The best known of these drugs, Ozempic, (Semaglutide) only hit the US market in 2021. It is manufactured by a Danish company called Novo Nordisk, which sold $876 million worth of the drug in 2022. A year later sales had reached $4.5 billion. I don’t have the figures for this year but some estimates say that they are around $8 billion.
These numbers are limited by Novo Nordisk’s production constraints. Otherwise they would be even higher.
I have written about how these drugs work (in January, in this column) so I won’t repeat myself. But basically it’s all about hitting the brain’s satiety centres. The new drugs make you feel full much more quickly and therefore stop you from eating as much as you would normally.
The oldest of them is Semaglutide. It was originally created as a diabetes medication but normal oral doses of Semaglutide don’t do much for weightloss. It was only when Nova Nordisk reformulated it as an injection (under two brand names Ozempic and Wegovy) that it set off the weightloss revolution and led to the development of other drugs.
Interestingly, all the new weightloss drugs rely on the old-fashioned approach: Eat fewer calories and you will lose weight. This is in direct contrast to the basic principles of today’s trendy diets, which claim that calories don’t matter. It’s all about how you combine foods; or how if you just give up carbs you’ll be fine; or you can eat as much as you want as long as you do it within an eight-hour window; and so on.
There is lots of scientific data about the efficacy of the new drugs and of course there is anecdotal evidence. But they do have side-effects. Semaglutide can cause nausea and there are allegations that it affects your mood. But if you don’t like Semaglutide, you can use Tirzepatide, a newer generation drug that does not cause mood changes and may be even more effective in causing weightloss.
The Semaglutide side-effects have to be measured against the benefits, which are also scientifically proven. These include control of diabetes, lower rates of heart disease and more. In such countries as the UK, there have been calls to give people Semaglutide free of charge, because it would make society healthier and lower the country’s overall medical bill.
So far at least, all weightloss drugs require one injection a week, but new drugs are coming which will work if you take a shot just once a month. And easy-to-take new oral tablets will soon be available.
There are 300 new weightloss drugs in the works. Not all of them will be approved for sale, but by 2026, Novo Nordisk and Eli Lilly (which are the biggest manufacturers of such drugs) will launch three new medications, which are expected to be approved.These will include oral tablets of one of the new drugs.
Because demand is so high, weightloss drugs are expensive and can be hard to get. In many Western countries there is already a black market for Ozempic. But, by the end of next year, supply will increase and as new drugs hit the market, prices will come down.
At the moment, all this seems distant to us in India. The drugs are not legally imported or manufactured here. They will have to go through the usual process of satisfying local regulators before that can happen. But it is only a matter of time. There are already unconfirmed reports that both Ozempic and Mounjaro (Tirzepatide) will be available (and probably manufactured) in India as early as next year.
So, for all the ‘diet consultants’ and quacks out there, the bell is already tolling. Gyms will be less affected because many people exercise not just for weightloss but also for personal vanity. And anyway, exercise is good for the system even if you don’t need to lose weight.
But if you’re struggling to lose the kilos and starving yourself, relax. Help may be only a few months away.
From HT Brunch, November 30, 2024
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