The US Food and Drugs Association (FDA) has this week approved a Wegovy weight-loss pill, a more convenient version of the widely available semaglutide injections. It taps into a familiar belief that technology can solve complex human problems. A tablet that reduces hunger and delivers weight loss without much effort feels like progress, and given the scale of harm associated with obesity, the appeal is obvious.

But we have been here many times before. Weight loss pills have a long and unhappy history, and each generation has a similar naive confidence that this time it will be different.

The first widely used weight-loss pills were amphetamine-based and appeared in the Forties. They suppressed appetite by increasing energy and were prescribed liberally, particularly to women, often framed as lifestyle aids rather than serious drugs. It was not long before speed pills moved into the recreational drug scene. By the Seventies, high rates of dependency had emerged, alongside anxiety, psychosis, insomnia, and cardiovascular problems, prompting tighter regulation as the risk of addiction became undeniable.

Fen-phen came in the Nineties, when fenfluramine and phentermine were prescribed together and marketed as a breakthrough, producing dramatic weight loss. By the time it was withdrawn in 1997, legal damages exceeded $13 billion, following reports of serious heart-valve damage and pulmonary hypertension linked to the drug.

Later weight loss drugs were marketed as safer refinements. Sibutramine increased feelings of fullness via serotonin and noradrenaline pathways, but was withdrawn by 2010 after being linked to higher risks of heart attacks and strokes. Orlistat took a different approach, but it was only modestly successful and the side effects were again off-putting. Rimonabant, approved in Europe in 2006, initially looked promising before being withdrawn within two years after links to depression, anxiety, and suicidality. It was a reminder that interfering with reward and appetite systems can destabilise mood and mental health.

Overall, weight loss drugs tend to take time to fail. They are initially celebrated as successes, only for unforeseen consequences to emerge later.

Wegovy is different in a variety of ways. It mimics a naturally occurring hormone involved in appetite regulation rather than stimulating or speeding the body up. Perhaps more importantly, it quietens what many describe as “food noise,” significantly reducing cravings. For some, this brings a welcome liberation from a constant mental preoccupation with eating.

But enthusiasm should not blind us to risk. The most obvious dangers are medical. Nausea, vomiting, and gastrointestinal problems are already well-documented, and the long-term consequences remain unknown, particularly for those who remain on the drug for years. There are also emerging concerns about muscle loss and metabolic adaptation once the drug is stopped.

The second danger is psychological. If hunger is pharmacologically muted, what else is muted? Appetite is not just biological. It is social and emotional, and likely bound up with our zest for life. A pill that silences hunger may also silence signals that deserve attention.

Today, distress of all kinds is quickly medicalised, with suffering framed as something to be eliminated rather than endured. That shift raises questions about the kind of society we are creating, and whether it leaves us with less understanding about the challenges of being human.

Wegovy may well help many people, and it appears more effective than its predecessors. But pharmaceutical solutions to social and psychological problems rarely stay within their original remit. Wegovy may free many people from the prison of food dependency, but it will also create consequences we do not yet understand. If history is any guide, optimism will once again be undone by the evidence.

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Stella O’Malley is a psychotherapist and bestselling author. She is Founder-Director of Genspect, an international organisation that advocates for a healthy approach to sex and gender.

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