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Should we lambast those who are overweight? (Photo by Gilles Mingasson/Liaison)
Only last month, Health Secretary Wes Streeting was warning us sternly against “killing the NHS with kindness”. This week, true to his principles, he announced an intention to start experimenting upon fat people in partnership with Big Pharma.
The five-year experiment is part of a £279 million deal struck with Lilly, the world’s biggest drug company, and aims to determine whether giving weight-loss injections to the obese will boost the economy. It will have two prongs. On one side, the NHS will identify potential participants for its trial on the basis of obesity, plus some combination of “hypertension, sleep apnea, cardiovascular disorders and unhealthy levels of … cholesterol”. It will then dose them with Mounjaro, Lilly’s competitor to Novo Nordisk’s Wegovy (better known as Ozempic). Meanwhile academics at the University of Manchester will be collecting data about the effects of the drug on “health-related quality of life and changes in participants’ employment status and sick days from work”.
Accustomed as we are to seeing the nation’s relatively poor health as a terrible financial burden, effectively Streeting is urging us to flip the script and see it as a possible goldmine. For ministers and managers desperate for cash injections to help get their most troublesome patient back on its feet, the implicit model must look deliciously appealing. At a price, it seems he is allowing one company exclusive access to a patient population: both to their bodies directly, via the use of a particular product, and apparently to some of their data afterwards. If public health does indeed improve as a result, the crippling financial burden on frontline resources, taxpayers, and employers will ease. Yet even if it doesn’t, sick people might continue to be a source of revenue in future, as companies like Lilly pay for access rights in the search for lucrative remedies and good publicity.
Later on, once voters have got used to thinking of national ill health as an economic resource to offset the drain on public finances, similar initiatives might be rolled out for other expensive UK-wide disorders. Mental health conditions like depression and anxiety appear prime candidates for future government interventions like this one. In Streeting’s imagination, perhaps, biotech companies will start flocking to our shores, lured by the juicy prospect of exclusive access to a centralised pool of patients. Lazarus-like, the NHS will eventually stagger out of the tomb, throwing off its bandages. The economy will boom, replete with newly svelte and mentally balanced workers. Government ministers will dance nimbly in celebration to the sounds of Taylor Swift .
But aside from such grand visions, there are several more mundane questions that might be posed about rolling out Mounjaro as a state-backed strategy. Some of these hinge straightforwardly on what is already suspected about side effects. Vomiting is commonly reported, as are other relatively minor but still unpleasant gastric issues. A bigger issue is that even where nausea is absent, such drugs seem to remove a major source of subjective pleasure in life — namely, delight in eating — for which the satisfaction of once again becoming an efficient source of productivity units may come as scant consolation.
Described as the “King Kong” of weight loss jabs, Mounjara’s key ingredient is terzepatide which, like semaglutide, works partly by causing appetite suppression. According to a former user of the latter “I didn’t even think of (food). … Looking at a bag of Doritos was kind of like looking at a pair of socks”. Another admitted: “Almost immediately I couldn’t eat at all. I couldn’t drink. I couldn’t do anything. Tea and toast in the morning is my go-to and I could not touch it from the very first day.”
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SubscribeExcellent clarifying post. In the book, “The Tomorrow File”, big pharma/big food was empowered to add addictive substances to foods so kong as they did not intoxicate or otherwise poison the victim, er consumer. And now here we are, for only $1000 per month…
With government bureaucrat$ all too happy to make sure it happens for the common good, of course.
I typically agree with Kathleen Stock’s articles, but maybe not so much this one. While obviously there’s a need for care in introducing new therapies or drug treatments for anything, on the face of it, if this drug enables people who don’t want to be fat, but have otherwise been unable to deal with it effectively to lose weight, then I don’t see much downside, provided of course it remains voluntary.
And it needn’t be forever either. Once they’re down to a decent weight, they can start exercising, being more active generally and finding enjoyment in ways other than eating junk food. Then hopefully they stop relying on the drug.
We give junkies methadone, smokers nicotine patches, and there are various interventions for all sorts of unhealthy lifestyle choices where people can’t break the spiral.
I find it hard to see the problem with giving another tool to medical professionals, or the individual, to take action to improve their health. If it gets to the stage where the State is mandating these kinds of interventions, our problems are way worse than an given treatment. While it’s voluntary, why not give it a go?
The difference is this isn’t medical practitioners impartially offering the most appropriate treatments to manage personal health conditions. This is an economic experiment. The government has done an exclusive deal with a pharmaceutical company offering them unfettered access to a market the state-controlled NHS almost monopolises to test the economic effects of a drug.
Patients who need this drug will be forced to share their medical data with the company. The state will use its near monopoly on primary healthcare employment to “incentivise” all medics to push only one product to patients identified using their medical records, privacy and access limitations waived. Other non-drug, potentially better alternative treatments will take a backseat irrespective of patient needs, demolishing the hippocratic oath.
The company is heavily insulated from future claims. The company’s own supervisory teams will partly control the parameters for offering the drug. The trial assessment criteria focus almost entirely on just weight and economic metrics, ignoring life satisfaction and long-term effects, which will make the “trial” meaningless. The success criteria of the trial are not improved while-life health outcomes (which isn’t being monitored), but increased economic participation and reduced dependency. (By that broad metric, a drug that turned people into mindless drones that die at 65 would constitute success.)
No government in history has ever resisted temptation to override personal liberty to fulfill the aims of the state. The state’s incentives are now completely misaligned with the needs of the individual at the most fundamental level. Most people in the UK are now financially dependent on the state and this deal illustrates how the state intends to turn those liabilities into new and lucrative market opportunities.
And (ignoring the commercial deal itself) consider how this huge change in public health strategy was developed: completely in secret without any public consultation. There has been zero scrutiny of the principles and safeguards before a massive contract was inked.
This is not just a healthcare car crash waiting to happen, it is an economic liberty and personal freedom car crash that has just happened. And it all just happened with all of us only made aware of it after the fact. That should should ring the loudest alarm bell of all.
Thank you for a thorough reply and I do agree. There are rotten private-public partnerships all over the place, and I can’t pretend the usual suspects won’t be lining their pockets here. COVID and the various reponses to it have already driven a truck through even the pretense that the medical establishment as a whole has your interests at heart (albeit individuals might).
But in terms of fighting the good fight, this particular drug is an odd hill to die on. I’ll happily have the odd cigarette and probably drink too much, but I would absolutely hate to be obese, and for people who are, something that can do them a favour in this regard would surely be welcome, regardless of the machinations going on elsewhere. It’s an ill-wind that blows nobody any good. There’s big silver lining on this one potentially.
The long term safety studies for this drug in this application are yet to report. From the approval safety studies it was found to increase the risk of pancreatitis, thyroid cancer, cholecystitis and kidney failure. There are no studies on its use of feotuses so should not be taken by those at risk of becoming pregnant.
The drug approval never mentioned mass prescribing. It was approved for targeted use for those with serious ill health arising from obesity where the balance of risk was clear. The deal between the Treasury and the vendor, and the illegal marketing of the drug across the internet, has completely removed the balance of risk equation. The Treasury, not doctors, is now massively increasing the usage of a drug with no long term safety studies.
Where do you get all this information from ?
There is no trial protocol indicated on ClinicalTrials.gov as yet and no detailed information on either the Health Innovations Manchester website, nor on the NICE or Eli Lilly websites
I think you should take some time to educate yourself some more about how drugs are approved in the UK. You could start with NICE’s draft guidance consultation “Tirzepatide for managing overweight and obesity” – only 43 pages long.
NICE don’t approve medicines. Tirzepatide use as a weight loss drug was fast track approved by the MHRA 2023. This came as a result of significant lobbying, yes lobbying, following EMA’s earlier fast track approval.
Yet its original safety approval was for managing type 2 diabetes. The increased risks associated with the drug were balanced by the life threatening nature of type 2 diabetes. It is now approved to treat BMI of 30 with no health conditions, which has barely any increased risk of premature mortality. Fast track and the nature of the original safety trials mean we have no significant data to demonstrate in healthy people with no morbidities (BMI of +30 is not itself a morbidity) that the drug does not introduce a net increase in the risk of health complications.
Fast track also means the safety of the drug will only be monitored by the yellow card system, which is not designed to track the overall risk / effectiveness of medicines.
“By that broad metric, a drug that turned people into mindless drones that die at 65 would constitute success.”
I’m sure they’re working on one…
This is a difficult one. I agree with you in that people need to take responsibility for themselves and not just live for food. I also agree that shops need to remove fat-free options because fat-free is usually bad and this will help to train people to eat well.
Where I don’t agree is that we now have a very corrupt government and every decision puts money in the politicians’ pockets – or their family and friends. It is difficult to take this idea seriously.
Governments don’t solve these kinds of problems. At best they replace them with something else – that’s usually worse.
Yes, let’s bring two of the most unethical bodies together in the name of public health, and I think I read right; in the name of the economy. So not about health but about boosting the economy. So what’s next about boosting the economy, who’s next? There are so many: the aged, the disabled, the low IQs, the unproductive, the unemployed, the chronically ill, the deniers, inappropriate cultural ideology, the opposition, Eventually we’ll all be a problem for the economy.
Especially when many of the economy’s biggest problems are not caused by the public.
Let’s just say we have no economy, just things that happen.
When all else fails they also have the assisted dying bill, a few extra tweaks should sort it!
And since the main side effect of these drugs is vomiting, I envision a new business opportunity in building portable vomit stations, so people have a place to vomit other than on the sidewalk and streets. And then a new cadre of government sanitation workers, covered head-to-toe in the mandatory, government-issued vomit protection suit, to empty the stations twice daily. Think about the special 100% electric vehicles that would need to be designed for this task, and the vomit processing plants to be built in order to purify the vomit for environmentally friendly disposal.
Don’t worry, we are developing the solution for the chronically ill – Assisted Suicide. The data from Canada is alarming and Trudeau has mooted extending the policy to include the mentally ill (delayed to 2027). Against a backdrop of transgenderism and transhumanism the treatment of the “meat suit” will become increasingly transactional and increasingly owned by external forces. We may be astonished what will be tolerated in the name of the singularity …. and I doubt “cultural Christianity” will be a bulwark against the forces of enlightenment!
Sugar is an addictive drug. Why is it treated so differently from any other?
It’s not a drug, it’s food — in fact, the human body will produce it (in the form of glucose) when it needs it. (Moreover, it’s both “natural” and “organic”, so surely it’s got to be good??? [Kidding, of course])
Not keen on yet more regulations and taxes imposed “for your own good”.
Sugar has addictive qualities, as do all Carbohydrates, of which sugar is one. In times gone by, Carbohydrates were helpful when, at the end of the vegetable/crop growing season, the resulting stored fat would help you survive during winter. Now, extreme athletes, like long distance cyclists, need extraordinary amounts of easily accessible Energy, so they do have controlled amounts in their diet.
Fat satisfies Energy needs, without any cravings. And, if your body isn’t swimming in blood sugars, Fat also leaves you satisfied, when you have eaten a sufficient amount, though Green vegetables (and sufficient Protein) are also very important.
It’s what the Keto Diet is all about, though medical advice should be sought, especially if you have existing medical conditions.
Another angle is that ultra processed food should be avoided. And there are plenty of books on that.
What makes you say sugar is an addictive drug? It’s nothing like one.
Cocaine and sugar both result in the release of dopamine in the brain, resulting in the feeling of pleasure.
I’m not sure what to say about that. It’s voodoo science. What we call sugar in diets is sucrose, a molecule with one glucose molecule and one fructose molecule attached together. During digestion the molecules are split. The brain cannot metabolize fructose but glucose is brain food –our brains thrive on it.
Cocaine is a drug, and glucose is not. The effects are nowhere near the same.
Those of us in middle age were told all our lives that eating fat is bad and eating carbs is good. We are still told this. You are only not told this when you are informed that you are pre-diabetic or diabetic and need to cut down the carbs. Furthermore, the processed seed-oil-filled rubbish we have been eating is now considered particularly to blame.
What is the health secretary going to do about what we consume? Nothing, because Labour’s energy policy relies on us eating more and more processed foods, and likely including in the future the Frankenfoods that the billionaires whom they suck up to want us to eat. The plan is to reduce the amount of healthy foods eaten in this country by covering our fields in solar panels instead of crops and cattle.
So, I read the government’s approach as inevitably impoverishing our diet and medicalising us to deal with the consequences. I will watch what happens to refuseniks with interest. I don’t doubt the nudge units are already on board. This government should learn the lessons of the last one about how a growing section of the public views pharmaceutical interventions whose long-term consequences are completely unknown.
Yes. Mass obesity was largely created by governments’ attempts to reduce heart disease by reducing the animal fat content of our diets. The idea that governments are going to fix the problem without creating another disaster in the process is laughable.
Good comment but I don’t have any hope that this present government wants to learn any lessons from “how a growing section of the public views pharmaceutical interventions whose long-term consequences are completely unknown.” Quite the contrary. If the evidence that has stared us in the face since around 2020 has not managed to convince us as to the grim direction the globalist agenda is herding us then Starmer’s open worship of figures such as Gates and Fink should. Last month the PM posted this: “Great to speak with Bill Gates this afternoon. We discussed our shared interests in driving economic growth through clean energy, international development and global health.” This week they were being entertained at Downing St.
The idea that the government can fix anything is clearly wrong. Governments almost always make the wrong decisions, bet on the wrong horse, and generally screw things up.
The previous Tory government made major mistakes. The current Labour government will make monumental mistakes.
Things are not going to get better (and no government ever taxed its way to prosperity).
Excellent piece again. The addiction is to dealing with symptoms not root causes. The toxic cheap food that is everywhere, full of addictive additives is killing us. If the motive was truly public health I think the government would tackle that issue and make sure nutritious non-toxic foods were affordable and available for everyone. No, instead they get the obese addicted to ozempic and hand big Pharma a fortune. This drug isn’t going to make these people healthier. It isn’t going to improve their outcomes. The body needs healthy food! This is so obviously a scam dreamt up by a cartel. But we know the government doesn’t really care about public health so this move shouldn’t surprise anyone.
Your reasoning is emotionally based and fallacious. It’s not an either/ or but part of an integrated solution that will involve these pharmacological tools alongside regulation of the food industry, and behaviour change.
Governments created the obesity problem in the first place. Now they’re going to fix it with drugs!? Do you seriously believe that’s a good idea? God help us.
Govers did not create the obesity problem except in the sense that they failed to regulste the food industry and intervene to support general well being so as to discourage addictive comfort eating. I am with the tech industry here and do think that pharmacological interventions can be part of the solution. Dinosaurs may neg to differ but the future does not need them.
I’m so glad that we have young, eager and brilliant comrades out there, so ready to solve other people’s problems with “integrated solutions” paid for with other people’s money.
Governments sponsored the research that led to the replacement of animal fats with sugar as the dietary mainstay of most Americans. Ignorant and/or brainwashed people may, of course, beg to differ. Governments don’t solve social problems, they just replace them with new ones.
Where is the evidence that ‘behavioural change’ and the education that involves, is being considered at all?
Just say no to excess, and get moving to counteract the effects of Labour saving technology.
I can only remember one fat girl at secondary school, and she had a glandular problem.
I think a lot of this is anecdotal. Let me add my experience. I have been taking ozempic and now an alternative for less than a year and have not lost the joy of food. I have, however, lost the joy of overeating, of eating junk, and that can only be good. I have had some nausea, which can be annoying, but I chew a ginger lolly and it goes. The outcome is worth it as I feel more confident and don’t obsess. Our experiences are different. I have no desire to be skinny like I did when I was younger, but I just want to be able to climb some stairs without dying.
I agree completely. I have had no side effects and my mental health is better than it has been in forever. My productivity has soared and I really feel wonderful. I understand why people are suspicious of “big pharma”, and some is justified, but I can honestly say that this medication (not ozempic but similar) has changed my life
Interesting do you have any concerns that you may never be able to come off the drug and if you do you would return to how you were?
Are you still on the drug? If so, you will only be in a position to comment on it after you stop taking it.
Ginger lollies? How delicious! Where do I get them?
In modern western socities, fatness has never been more socially acceptable than it is now.
Unfortunately it doesn’t work like that. Demand for healthcare will remain effectively infinite until such time as we all live forever in perfect physical and mental health.
If we could cure obesity for everyone with a single injection tomorrow, some other “crisis of healthcare” will emerge to spend the money on.
Any large-scale free at point of delivery healthcare system will always spend as much money as is made available to it.
So reduce the amount of money available. It’s the obvious corollary to what you explained and the only way to reduce demand (most of the demand here being spurious, since we have several thousand years of human experience in which obesity was a solved problem).
The NHS budget goes up every year for political reasons. Even under the “austerity” of the coalition government, the budget went up 1.1% in real terms.
Labour politicians are inherently in favour of big state spending anyway, while Conservatives know that the public affords the NHS “sacred cow” status which prevents any meaningful reform or consideration that we might reduce costs by asking it to do less.
The irony is that the best performing healthcare services in the world, of which the Dutch system is a good example, typically operate a mixed health economy of public, private and non-profit. The state sets the rules and funds the tax-funded minimum level, but most provision is via private or non-profit suppliers, typically funded by mandatory insurance.
More removal of agency. You’re obese because you eat too much. You’re a child in fact, that can’t control themselves from eating all the cake pies crisps ice cream and drinking all the Coke. Why should anyone else take responsibility for your gluttony? Always everyone else’s fault, but yours.
Harsh but true.
You can eat as much as you like (as i do) as long as you expend sufficient calories to balance the equation. If you can’t burn the calories, don’t consume them.
In the 1950s the average Texan, fed on steak and eggs, consumed twice as many calories as (s)he does now. (S)he wasn’t fat.
Obesity, like most things that are wrong, is a consequence of government action.
Why should anyone else take responsibility for your gluttony?
Sadly I guess the answer is obvious. People who behave like children need something equivalent to a parent to provide control.
One more thing to add to the long list of things that I can’t believe anyone thinks is a good idea.
“…it is thought that people will need to become lifelong Mounjaro users…” that’s all you need to know, right there.
It doesn’t cost anything to eat sensibly or go out for adequate exercise. Absolutely no need to be paying drug companies to [not] fix already solved problems. Even if these latest wonder drugs worked and without side effects, it would still be the wrong way to go.
How did this ever become the government’s responsibility ? Fundamental mistake to allow that to happen and for government/NHS to take ownership of something that’s the responsibility of the individual. All susbsidising and incentivising poor behaviour ever does is create more problems. It’s just the same with overseas aid and state funding of charities.
“On January 17, 1961, div > p > a”>Dwight D. Eisenhower ends his presidential term by warning the nation about the increasing power of the military-industrial complex.”
And now we have a Big Pharma-Industrial complex. Why on earth would a Government cosy up to such a complex when it is antithetical to individual citizens’ interests? Unless the Government has been bought off with promises of a more thankful electorate.
Great article which helps us see straight through the government plan, it is grim.
I find it quite concerning that Robert Jenrick takes Ozempic, do we really want a potential PM who is incapable of going on a diet and sticking to it ?
Assisted killing, compulsory obesity jabs, and increasing ageism are part of a pattern of Labour policy ‘thinking’ reminiscent of the early Fabian belief in finding ‘scientific’ (i.e sociological) solutions to social problems and the government always knowing best. The Starmer government with an agenda of ‘change’ seems wedded to this authoritarian mindset, and naive belief in the efficacy of state intrusion over private liberty.
If it has no side effects ( or side effects that aren’t as bad as the condition) and it improves health and lowers public spend in tne long run then it has a benefit cost ratio above 1 and shpuld be done. Policy makers will, thankfully, ignore the murmurings about ” personal responsibility” and commence implementation. In the pipeline there are radical new treatments for depression and anxiety involving neuro feedback which alters patterns of brain activity using a headset that receives and tranmits signal from and to the brain. Once this matures nobody will be ble to stop it without looking like a mean spirited Ayatollah.
One of the advantages of the popular social media site, Twitter, is the ability to reply with an animated gif. In this case, Malcolm McDowell being reconditioned in Kubrick’s “A Clockwork Orange” would do very well.
William Blake observed somewhere, “Man was made for joy and woe.” Like it or not, depression and anxiety are appropriate and normal responses to certain conditions and will not disappear with fancy sci-fi headsets. If I were less certain that these headsets will remain in the pipeline in the way that personal jetpacks have, I’d consider this the most chilling vision of the future since Anthony Burgess’s 1959 novel.
Of course there are side effects of substituting drugs for normal healthy diet and exercise. You might be able to maintain the same weight, but without adequate exercise you’ll be far less healthy and resilient. You’ll also lack the mental health benefits of exercise – which might be part of the reason people are over-eating in the first place.
Those are the non-medical side effects. Before you add in any that the drugs might create.
This is misinformation. You should delete it. Nobody has any idea what the consequences are of prolonged use of these drugs.
No, for two reasons. The first one is that obesity does not cost the Exchequer more money. It increases healthcare costs in midlife, but saves pension and adult social care costs over the whole lifetime. The financial arguments don’t add up.
The second reason is that even if the financial argument is correct, which it isn’t, it is still wrong to regard human beings as pieces on a board in a utilitarian game of chess. By all means the government should facilitate healthy choices as part of public policy, but once it goes into something like this, such a fundamental interference in personal liberty, it becomes authoritarian.
Interesting article. Obesity is a big problem, and a puzzling one. No one really knows its cause. There are plenty of theories, but they all fail verification. The proof is in the pudding, except in the case of obesity, it’s not. The proof of a cause cannot be found.
We humans have trouble with complexity. We always seek a pat solution to any problem, and many people think the cause of the increasing obesity problem in countries like the US is eating too much and exercising too little. But causal inference principles say no — statistics rule that out.
Myself, I like to see people do experiments in nutrition and exercise, and often perform them on myself (to my wife’s dismay). I like to see governments doing experiments too. But I do share the concern that this kind of experimental program can be abused.
Duh! What are you talking about? Everyone knows the causes of obesity.
Do you have any evidence to back up your statement?
Here’s a hint, it doesnt involve eating too little.
Thousands of years of human history. Obesity is not the natural state of affairs.
These are solved problems (the solutions are good diet and adequate exercise). More research and experiments are a waste of time and money better directed to actual unsolved problems.
I’ve studied this issue for more than a decade. This is not a solved problem. Scientists that study obesity and weight loss diets and exercise find puzzling and contradictory results. Those who study population statistics have been able to disprove all theories as to why obesity has spiked in some countries.
An example of a book for the general public is Secrets from the Eating Lab, by Traci Mann. There are also articles in the medical literature. Debates on diet really started back in the 1940s with Ancel Keys and his famous experiments that would be unethical today. Then Robert Atkins got involved with his diet. The debates still rage, the latest target being “ultraprocessed food”, a term no one can even define.
Now doctors like Peter Attia with his book Outlive and Casey Means with her book Good Energy attract eager readers, but they have no evidence to back up their claims. Then we also have charlatans like Chris van Tulleken with his book Ultra-Processed People who have gone off into the deep end of the pool.
If good diet and adequate exercise were proven solutions it would be wise to shift to implementing them. In fact they have been disproven as solutions. They certainly help with health, and are good things to do, but poor diet and lack of exercise are not the cause of the obesity epidemic.
When I stopped working in an office I was quite seriously overweight. I fixed it with exercise and without really changing my diet at all.. People should at least try the obvious time-honoured solutions before stuffing themselves with drugs that may have all kinds of unforeseen consequences.
Good to hear that you found a way to lose weight and keep it off. Some people do, and even if they can’t, exercise and/or a good diet are good for health. You are right that they are better than largely untested drugs.
People should try diet and exercise if they are fat. They might work. The problem is that most people that lose weight from diet and/or exercise can’t maintain a healthy weight. In fact, within a year or two they regain the lost weight, and more.
So the big question is, what has caused the obesity epidemic? Why are so many people in the population of some countries today overweight and obese when there weren’t nearly so many fat people even a few decades ago? What changed?
There are lots of theories, but none of them have survived close scrutiny. There have not been changes in the average diet or exercise habits during that time that would account for the epidemic.
It’s an epidemiological puzzle. If we could solve the puzzle, we might be able to address the root causes of the obesity epidemic without resorting to drugs like Ozempic. That would be a much better solution.
Better to promote exercise than addiction to these drugs.
Where does this stop? Fatness can’t be cured by medicine, but it can be cured by exercise and healthy eating. Just look at me. I used to be fat(ish). I really hate big pharmaceutical companies, and food companies putting suger in everything. Destroying our health, and charging us for the privilege. Rant over. For now. Just as well I’m leaving, this kind of idea would start a revolution in France.
as long as people think there are shortcuts – like the latest fad drug – it will never stop. Look what has happened in the space of a couple of generations: society has gone from obesity being a rarity to being seen as a lifestyle choice and anyone saying otherwise is guilty of shaming.
Sorry, typo. It seemingly can be cured by medicine, I meant to say shouldn’t
‘adolescent girls are seamlessly incorporating the drug into their already vast repertoire of ways to mortify the flesh; plastic surgeons are busy informing those with “Ozempic face” about which fillers and surgeries are best to purchase, in order to disguise the sag.’
How long before people just start melting at forty odd as the fillers slide and the drugs they just keep adding into their systems, one on top of the other, dissolve their insides.
Obesity is a lifestyle disease … but it is a disease. Across the ocean, new treatments show fantastic results that result in very significant improvements for some patients.
Why should brittons be deprived of this medical breakthrough ?
Who is saying they will or should be deprived of it ?
The proposal appears to be about whether the NHS should provide this free. Nothing I see suggests people couldn’t pay for this themselves if it’s important to them.
Thank you so much for addressing the makeup of our food as part of the cause. We’re already eating garbage in the same food we purchased 60 years ago because costs are cut to offer the worst of everything healthwise to make the same product. That’s where they should start, especially in the US. Our food is an addictive embarrassment. Anything good and healthy is triple the price. Maybe start there to see how society reacts.
…. while his parliamentary colleagues have published this: https://collegeofmedicine.org.uk/beyondpills/
Imagine that the only food available in the shops was unadulterated meat, fish, cheese, natural yoghurt, milk, butter, grains and flour (including white), vegetables, fruit, honey and sugar. People would have to prepare meals from scratch like they used to (some of us still do). I doubt whether the obesity problem would hang around for long under such conditions.
All that food is available in the shops today. Nor is it unaffordable. No one is forced to buy and eat ultra-processed foods.
Drugs can’t solve problems created by lack of individual responsibility and self-discipline and lax cultural norms. Politicians peddling such illusions are a waste of space.
No one is being forced to eat ultra-processed foods… but they are the ones designed to be cheap, quick, and easy with immediate satisfaction from eating them. They typically have longer shelf lives and come in attractive packaging.
Yes, cooking from scratch is actually cheaper, a basket of food from aldi that includes most of the stuff in that post, is cheaper than buying decent ready meals for everyone for every night of the week. By quite a long way.
I don’t think cost or what is available in the shops is the problem. The problem is people eating too much. It seems relatively simple to me.
It’s cheap, if you’ve got the money to buy all the prep gear needed. Many do not.
What do you mean by “all the prep gear needed”?
A couple of knives, pots, and perhaps a frying pan?
Do you have any evidence that even a significant minority – let alone “many” – do not have the money for such basic items…?
No, you don’t, because your claim is blatant nonsense!
(For one thing, it’s easy to find people giving away such items online every day…)
So how do you think people have managed for the last century?
What prep gear needed. You have been watching too many cooking shows.
What expensive prep gear do you need to make a lasagne or a shepherds pie, or a quiche or to cook some chicken and pasta, curry, risotto, potatoes only need a peeler and a knife and you’ve got chips or roasties or mash.
What planet do you live on.
I have an electric mixer for cakes. Apart from that I don’t have anything snazzy to cook meals with.
If only we had a lifetime of data and strategies on how to deal with weight. Forty years ago, no one was talking about obesity in “epidemic” terms or absolving the individual of responsibility and suggesting drugs instead. Noticing that someone is overweight is not ‘shaming’ them; it’s noticing that they are overweight and that it’s a condition that bodes poorly unless it is addressed. And it can be addressed. Usually without big pharma.
The normally excellent Kathleen Stock has misfired today. If an obese person wants to find a way to curb their out of control craving, and if the anti-obesity drug can be shown to be acceptably safe, what’s the problem? Obesity is ruining and shortening the lives of the obese. Armed with full understanding of side effects, why should they not make the choice to take the drug? If it works, they win. If more people can lead fuller healthier lives, everybody wins.
Yeah, it’s comfortably her worst article that I can recall.
I think you’ve missed the point of the article, which isn’t about individuals making health decisions for themselves but the role played by government and pharma in a scheme which isn’t ostensibly about health at all, and its potential downsides.
Don’t worry, I’m sure we’ll soon have drugs for all of those – and for the further side effects those drugs cause. Ultimately I guess we’ll have a drug that makes the most awful drudge work so enjoyable you’d actually pay to do it.
While not suggesting that we should return to the rationing of the 1940s, I think that our population was healthier in those days. There was less sugar; fewer fast foods; more home grown vegetables. Other comments have also suggested that overeating is the consumption of more energy than the body spends, and it seems to me that fastfooditis as advertised on the telly encourages this way of life. But of course we cannot control McDonalds or KFC etc; and therefore we need yet another American company in Lilley to control the outcome of overeating. Truly, Britain has become the 51st state of the union; and one way or the other, the consequent profit will wing its way to the other side of the Atlantic.
In the 1940s we walked to school, ate food our mothers had packed in a paper bag for us (no school canteens selling lollies etc), there was no tv (in Australia anyway). Actually where I lived in the early 1940s there were no private cars on the road (fuel needed for the war effort) so we walked, either the whole way or to the bus stop. I recall that in each school class there might have been one overweight child. The rest of us were skinny.
Next headline: “Crisis in the Hospitality Industry”.
A very thoughtful analysis.
Like the good French Queen once said: ‘Let them eat insects!’
Nye Bevan hoped that paying for drugs now to improve health will reduce costs later. This never happened. Mounjaro will help obese people to lose weight but it make Lilly fat.
“…practically the one daily pleasure in life you can reliably count on”
Gracious me, has Doc Stock not ever heard of masturbation?
Side effects may include depression and anxiety? Fantastic. Pass them over to the antidepressant trial.
For those of us who struggle to fit in to a job which involves sitting down all day in front of a computer screen, the ADHD medication ( AKA speed) transformed us from distracted clock watchers into highly productive economic units.
For the NHS the patients are again the problem. Pesky people! The NHS would run so much better with less people bothering them. The idea that the solution is giving a large swathe of them a chemically induced eating disorder ( for as long as they keep taking the drug) is terrible.
Certainly the long term outcomes of Ozempic are unknown. The outcomes of obesity are known. Eating and appetite are complex; we eat for many reasons. Certainly there is a genetic component. Obviously it is best never to become overweight in the first place (set a weight number you want to maintain and eat less if you exceed it). As a former dietitian, I spent years counselling obese people on how to lose weight, and as we all know, it is impossible for many to lose weight and maintain the loss. The misery of being obese and the misery of constant dieting are unknown to those who are slim. I have several friends on Ozempic and they are so happy with it, not with standing the side effects which they consider worth it. They feel better, they look better, their insulin and other medication requirements have decreased significantly, and they are not constantly miserable both physically and mentally. Yes, they may have to take Ozempic for the rest of their lives but how many of you are on other life long drugs such as drugs for diabetes, hypertension, high cholesterol, thyroid conditions, other hormonal diseases, and the list goes on and on. Yes, “Big Pharma” has downsides, but many of you complainers would be dead without the drugs we all expect to have access to.
Instead of mass-medicating a large section of the population at taxpayers’ expense, why not make us all fund our healthcare through insurance? The insurers would soon ensure that we were all aware of the risk factors that were driving our premiums.
As an admirer of KS I wld say that this is a moronic article. These drugs have massive benefits for a disease which leads to so many co-morbidities , the cost , and suffering from which , is immense. Of course it is better if people eat more healthy food , take exercise. But where thet can’t or won’t, why not use the benefits of modern medicine to help? By the way this class of drugs is a standard for T2D, and has fantastic effects re heart failure/adverse incidents, joints , possibly sleep apnea, kidney disease etc.
Actually, seeing foods such as Doritos as appealing as eating socks, is probably a good thing. Agreed that emphasis should be put on the tendency of processed, planned addictive foods to add to obesity, and not necessarily over eating. My daughter’s a Monjaro guinea pig, I wish she could just change her diet on her own. Sad!
As usual Stock writes a very interesting and clear article. The problem of obesity seems a difficult one. Having a liking for beer and crisps, I carry a few too many pounds and while I think I’m saved (perhaps) with a reasonable amount of exercise and being well fed by my wife, I find myself deeply confused.
Should we eat fat? How much sugar? What cards are good and what bad? Should I eat steak or chicken? Fish or lentils? Is beer so bad given the delight of a goodly company at the pub?
Do these health articles I avoid reading help anyone or make them terrified of unknown symptoms?
I don’t much trust the medical profession. I’ve seen the sort of young person who want to follow that career path. I’ve also seen the catastrophic failure of their hubris. They are, however, sometimes right.
Celebrities have the luxury to have their ozempic face fixed, although one plastic surgeon said their skin resembles a dry rubber band rather than a stretchy one. That means that some women—and it’s mainly women—will have problems. About a week ago I saw an ozempic face—Meghan Markle, Prince Harry’s wife. She has lost a lot of weight in a very short time, and she looks like she is 50 years older. A comparison to what she looked like last year is shocking. She was a beautiful woman. What’s weird is that she wasn’t remotely overweight. But she has the shoulders of an anorexic, so I guess that’s what she wanted. Two other things. Does the NHS and Wes realize that seriously obese people who lose a lot of weight are left with huge flaps of skin? That skin has to be surgically removed, as it can breed dangerous bacteria and fungi. That costs a lot of money. Finally, unless obese people are taught healthy behaviors—like cooking healthy meals and exercise—the entire scheme will backfire. (Finally, finally, who wants to lose life’s small pleasures, as many people have reported that they can’t seem to enjoy anything .)
Very good article. However these drugs are not quite so effective as you may think. They have a significant failure rate in addition to complications of the treatment
Just for the record, Kathleen, Lilly is not the “the world’s biggest drug company”.
In fact, according to the latest (2024) rankings by annual revenue, it’s not even in the top ten!
As US residents who have traveled extensively in Europe, my wife and I frequently discuss the unhealthy US diet – everything is made by massive corporations, all “bread” is filled with preservatives, fast food is consumed by many families nightly. Result? obesity through the population, fat children, fat teens. If you compare pictures on beaches from 1970 and 2024, you will be horrified – so many fat people, and so many of the fat people are girls. You don’t see this fat issue in France or Italy. Of course, there are fat people, but not as many as in the US.
When does it become Killer Mounjaro?
I think to make sense of any of this, you need to operate in the world of meta-virtue. Virtue would consist in being tough on welfare (or obesity leading to it), to encourage personal responsibility. But that would appear unkind. So the meta-virtue is to offer drugs, in order to reduce, not the demand for welfare, but the unkindness of refusing it.
In the same way, we grieve about migrant deaths in the channel, but not about their deaths in Libya on the way. We say that unemployment is a waste of human potential, when it is very largely (not always, of course) a life choice. The greater the supply of welfare, the greater the demand.
“It seems to me you can’t chemically neuter a huge part of the population’s taste buds and not see swingeing social effects elsewhere.”
The article is excellent as usual from Prof Stock, however I’ve decided to go off on a tangent related to this paragraph, and it relates to the war on the motorist. In the supposedly-ideal future where the car has been relegated to irrelevance by a combination of walking and bicycles for local travel and a fully-funded public transport infrastructure that is going to be even better than the car (just go with the scenario and ignore for the moment what a stupid idea it is), I have a pet theory that there would be some unexpected and unwelcome consequences for wider society.
My conjecture is this: presently, the responsibility of gaining the skills to drive a car (not just passing the driving test, but the years of experience that come afterwards) combined with the expense of owning and running a car, the avoidance of fines and licence endorsements, and the constant low-level concern for one’s own safety and that of other road users that comes with controlling two tons of speeding metal – this is a responsibility that develops into a shared and generalised unspoken code of conduct towards other people that would not necessarily otherwise exist, and it affects how we treat each other all the time, not just when we’re on the road.
Even small mistakes on the road can come with expensive and even life-threatening consequences: driving a car is an act that demands exceptional care, attention, self-preservation and skill. What would society look like if no such discipline had ever developed amongst the majority of people? What will it look like in the event the government succeeds in foisting its long-desired communitarian transport “solution” upon us all or, more likely, that self-driving cars make obsolete the skills of driving and we’re all moving about in driverless taxicabs? My guess – and I realise it’s a bit of a stretch – is that there could be a generalised increase in the sort of fecklessness we presently see in people possessing no shared stake in any part of society. We may lose something irreplaceable about our collective selves in the event that this happens.
I do admit though, to return to the article, that this is probably a good deal less serious than destroying – by state edict – the satisfaction from food experienced by the fattest members of society without considering the likely psychological reaction from those people. Fat people do not eat too much just because they’re hungry, they do it to suppress emotional pain. Destroy that coping mechanism and we’ll likely have half of them on heroin in no time. So far, willing Ozempic users are motivated by priorities that amount to preferring being thin to enjoying food. The government’s plan is not the same as this: it’s making people surrender an appetite they enjoy in order to make them do something else that they presently don’t do and don’t want to do, so how is that supposed to work?
What stands out most for me is that this is possibly just another attempt to stop people from hanging out together, talking to one another and exchanging unwanted opinions about our rulers. Companionship is sharing bread together. Shared meals will be a thing of the past if a large proportion of the population are medicated out of having an appetite, and as Kathleen says, we are already headed that way. And then the idea of us becoming dependent on the state for a healthy weight and doing even less to take responsibility for this ourselves… What a nightmare. We’ve already been persuaded that a government can medicate us out of infectious disease. And I’m now seeing advice from the UK Chief Medical Officer on cans of low alcohol cider… I really don’t understand why so many citizens believe the government knows how best to keep us healthy…
Starting with Pudding Face II Streeting?
I don’t fully agree with Ms Stock on this subject, nor the prior on Voluntary Euthanasia, but she always elucidates interesting perspectives. P.S> The order of comments as most popular allows the most activist and tunnel-visioned to dominate the btl discourse…. then again – few will see this comment 😉
Wise words.
I usually agree with Kathleen Stock- but not on this issue! Personal responsibility and restraint have failed to stem the obesity epidemic – these drugs are the first thing that has worked. It’s a miracle to those of us who have struggled for decades to tame our appetites. I needed a slight reduction in pleasure around food! You sybaritic types don’t understand. I still get plenty of joy in eating.
Also, the collaboration between big Pharma and NHS doesn’t seem so sinister. It’s a study, they happen all the time! The potential upsides in health and quality of life for people is huge – and if there are also positive economic effects? Win-win in my mind.