August 25, 2023 - 4:15pm
Ozempic is not a weight-loss drug — at least not officially. According to the company website, the product — based on semaglutide — is for adults with type-2 diabetes and is “not for weight loss”. However, there is the coy admission that “Ozempic may help you lose some weight” — hence the avid public interest, which will only be increased by reports today that the drug could reverse heart disease symptoms, according to a landmark global trial.
Unsurprisingly, the fat-acceptance movement is upset. There’s a prime example of this in an article for The Conversation by Fady Shanouda, an assistant professor of “critical disability studies” and Michael Orsini, a professor at the Institute of Feminist and Gender Studies in Ottawa.
For connoisseurs of progressive academic language the piece does not disappoint. For instance, we’re told that Ozempic has been “heralded by many to culminate in the elimination of fat bodies”, and that it can be understood as a form of “pre-emptive obesity biopolitics” (whatever that is). Then there’s the claim that talk of ending the obesity epidemic is “laced with the idea of eradicating fat people”.
Really? If a fat person gets thinner to the point of no longer being fat they haven’t been “eradicated”: they’ve just lost weight. One would think that the part of them which matters is the person, rather than their body shape. The authors decry “policy interventions that seek in the present to prevent fat futures”, but helping people to lose weight might just give them a longer future.
And yet, in the midst of the overwrought identity politics, Shanouda and Orsini do make a necessary point. This comes when the authors warn that we’re reaching a moment when “banal and commonplace fat-shaming” could be elevated to “an unprecedented level”. In my view, that moment will come if semaglutide, or something similar, is optimised and approved as a weight loss drug for the general population.
Over a quarter of adults in Britain are listed as obese, with a further 38% falling into the category of “overweight”. Given that obesity costs the NHS £6.5 billion a year, the Government has a clear economic incentive to tackle a fattening population. The more evidence there is of drugs like semaglutide working, the more likely health authorities are to encourage their uptake by the general population.
In free societies, healthcare is sometimes compelled on the unwilling — for instance, people with dangerously contagious diseases can be quarantined, the severely mentally ill can be sectioned and, as we saw in some EU countries during the Covid epidemic, vaccination can be made compulsory.
Of course, in all of those cases, the justification is one of public safety — which would not apply to obesity. However, given that being overweight is a risk factor for various medical conditions, there would be a huge financial motivation to systematically minimise those risks and hence the long-term costs of treatment. For instance, private health insurers could punish customers who won’t take their weight loss drugs by increasing their premiums, and employers could withdraw cover from uncooperative employees.
As for public healthcare systems, “difficult” patients could be deprioritised for the treatments that they do want. Here, the ground is arguably already being laid, with Health Secretary Steve Barclay claiming the drug could cut NHS waiting lists and trim benefits.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
Subscribe“Really? If a fat person gets thinner to the point of no longer being fat they haven’t been “eradicated”: they’ve just lost weight. ”
Exactly. Just as right-wingers who want to get rid of poor people can hardly be blamed if the means by which they achieve this is to make the poor people in question wealthy.
Hence why the definition of “poor” has been set as a percentage of national average income. Since that could in theory include those who might now be regarded as ‘comfortable’, the “poor” will always be with us.
But that’s the intention, so the term can continue to be exploited. This isn’t to disparage those who are genuinely poor through life circumstances.
We do the same thing in Canada. Low income is simply a percentage of median income. As a result, there are always low income people and the proportion really doesn’t change that much, up or down. The definition is almost meaningless. I bet 80% of the population has no idea how the govt determines low income.
Couple of comments here drifted this onto the perennial issue of why do we have measures of ‘relative’ poverty? We can argue about where one might draw the line, and inevitably that’ll be a bit arbitrary but there are v important societal reasons why we cannot ignore ‘relative’ poverty. It’s linked to social exclusion, the perpetuation of inherited advantage (and thus un-meritocratic and economically inefficient) and the wasting of a persons potential talents because they cannot escape it. Plus the obvious – where no concern about it would lead on violence, disorder, stability and the ability of those of us who’ve done well to actually enjoy the fruits from that.
So even those with a hard nosed view ‘it’s all about the person’ need to also grasp the implications if poverty left unchecked.
We should always strive for accuracy in all these measures. During periods of high inflation, relative low income numbers might actually understate the real scope of poverty out there.
None of the concerns you’ve mentioned here specifically defend the notion of relative poverty as opposed to absolute poverty.
Nor is this a “perennial” problem, the measure of relative poverty is actually a fairly new concept, having emerged in left wing think tanks a couple of decades ago as a tactic for maintaining the moral attack upon poverty in a world where free markets were in the process of eradicating real poverty at a rate approaching fifty million people per year. The relative poverty measure is therefore politically opportunist nonsense and is of use only to the Left’s desperation to remain relevant.
But you’re not talking about poverty there are you ? You’re actually talking about inequality. Why deliberately conflate two quite different things ?
Yes, there’s a discussion to be had about inherited wealth and the impact on opportunities and social mobility (and I probably largely agree with you there). But that’s not poverty.
I’ve seen richer countries and I’ve seen poorer countries where the typical standard of living is well below what we now label poverty.
Equally, by today’s standards most of our parents probably grew up in poverty …
It would be far more honest to talk about “relative wealth” than “relative poverty” in Western countries. Not least because the major problem you flagged was about wealth inequality – a side effect of national wealth, rather than a lack of it.
The most genuinely poverty-stricken person in 2023 has access to better health care than Queen Victoria.
Disagree, do they have access to quality food, safe place to exercise, time to cook healthy meals, etc
Disagree, do they have access to quality food, safe place to exercise, time to cook healthy meals, etc
We should always strive for accuracy in all these measures. During periods of high inflation, relative low income numbers might actually understate the real scope of poverty out there.
None of the concerns you’ve mentioned here specifically defend the notion of relative poverty as opposed to absolute poverty.
Nor is this a “perennial” problem, the measure of relative poverty is actually a fairly new concept, having emerged in left wing think tanks a couple of decades ago as a tactic for maintaining the moral attack upon poverty in a world where free markets were in the process of eradicating real poverty at a rate approaching fifty million people per year. The relative poverty measure is therefore politically opportunist nonsense and is of use only to the Left’s desperation to remain relevant.
But you’re not talking about poverty there are you ? You’re actually talking about inequality. Why deliberately conflate two quite different things ?
Yes, there’s a discussion to be had about inherited wealth and the impact on opportunities and social mobility (and I probably largely agree with you there). But that’s not poverty.
I’ve seen richer countries and I’ve seen poorer countries where the typical standard of living is well below what we now label poverty.
Equally, by today’s standards most of our parents probably grew up in poverty …
It would be far more honest to talk about “relative wealth” than “relative poverty” in Western countries. Not least because the major problem you flagged was about wealth inequality – a side effect of national wealth, rather than a lack of it.
The most genuinely poverty-stricken person in 2023 has access to better health care than Queen Victoria.
Couple of comments here drifted this onto the perennial issue of why do we have measures of ‘relative’ poverty? We can argue about where one might draw the line, and inevitably that’ll be a bit arbitrary but there are v important societal reasons why we cannot ignore ‘relative’ poverty. It’s linked to social exclusion, the perpetuation of inherited advantage (and thus un-meritocratic and economically inefficient) and the wasting of a persons potential talents because they cannot escape it. Plus the obvious – where no concern about it would lead on violence, disorder, stability and the ability of those of us who’ve done well to actually enjoy the fruits from that.
So even those with a hard nosed view ‘it’s all about the person’ need to also grasp the implications if poverty left unchecked.
You make the case well but things are not as bad as you say. Poor is defined by a percentage of the median income, not the average income.
Fair correction.
Fair correction.
We do the same thing in Canada. Low income is simply a percentage of median income. As a result, there are always low income people and the proportion really doesn’t change that much, up or down. The definition is almost meaningless. I bet 80% of the population has no idea how the govt determines low income.
You make the case well but things are not as bad as you say. Poor is defined by a percentage of the median income, not the average income.
There aren’t fewer of them, but there is less of them.
Hence why the definition of “poor” has been set as a percentage of national average income. Since that could in theory include those who might now be regarded as ‘comfortable’, the “poor” will always be with us.
But that’s the intention, so the term can continue to be exploited. This isn’t to disparage those who are genuinely poor through life circumstances.
There aren’t fewer of them, but there is less of them.
“Really? If a fat person gets thinner to the point of no longer being fat they haven’t been “eradicated”: they’ve just lost weight. ”
Exactly. Just as right-wingers who want to get rid of poor people can hardly be blamed if the means by which they achieve this is to make the poor people in question wealthy.
Why shouldn’t insurers adjust premiums accordingly? The whole industry is based on pricing a risk.
I’m fed up of being compulsorily taxed to pay for other peoples problems that they knowingly create. They can stay fat, smoke, get smashed or do what they like as far as I’m concerned so long as they don’t expect me to pay for the consequences.
Why shouldn’t insurers adjust premiums accordingly? The whole industry is based on pricing a risk.
I’m fed up of being compulsorily taxed to pay for other peoples problems that they knowingly create. They can stay fat, smoke, get smashed or do what they like as far as I’m concerned so long as they don’t expect me to pay for the consequences.
The Public Health Bolsheviks will make this into a circus, and the woke body-shaming worry warts will oppose them to the teeth. Ironic, isn’t it? Two busy-body, know-it-all progressivist groups going to war on behalf of the ideal of protecting average people?
( Who, by the way, have never asked for their help, and wish that they would just go away. )
Are the two approaches Progressive? I can see that the Public Health Bolsheviks that want to enforce conformity to the ideal body shape fall into the usual bullying progressive camp but surely those against fat shaming are extreme libertarians who believe the obese should have the right to shorten their lives if they so wish.
Should not the correct right wing response to obesity eschew forced or incentivised medication and simply rely on the traditional means by which the poor were spared from obesity by cutting welfare to a level that ensured that excess eating was not affordable and walking was promoted.
Of course no right wing government will introduce such a policy as it will be universally condemned as a cruel policy of starvation.
I probably fall into the libertarian camp. Let people behave the way they wish, as long as their lifestyle does not impose itself on others. People abuse themselves in many ways, through drugs, alcohol, gambling, video games, social media, even driving. We can’t regulate it all.
In the UK at least, those with self-inflicted morbid obesity (as opposed to a minority for whom it may be a genetic imposition) impact us all, through the increased costs of their disease profiles being dealt with by the NHS.
In some ways the biggest disease of modern Britain is not obesity, but the idea that you can have freedom (“rights”) without any sense of responsibility or civic duty.
You should of course be free to eat what you want. But not to push unlimited bills onto your fellow citizens.
Just before reading this, I heard a doctor claiming that obesity was a “disease”. I assume he meant a medical disease. Is this what they’re being trained to believe now ?
Yes, that is how they are being trained to think.
Yes, that is how they are being trained to think.
You can say that for smokers, drinkers, even drivers, and even those involved in adventure recreation.
In some ways the biggest disease of modern Britain is not obesity, but the idea that you can have freedom (“rights”) without any sense of responsibility or civic duty.
You should of course be free to eat what you want. But not to push unlimited bills onto your fellow citizens.
Just before reading this, I heard a doctor claiming that obesity was a “disease”. I assume he meant a medical disease. Is this what they’re being trained to believe now ?
You can say that for smokers, drinkers, even drivers, and even those involved in adventure recreation.
In the UK at least, those with self-inflicted morbid obesity (as opposed to a minority for whom it may be a genetic imposition) impact us all, through the increased costs of their disease profiles being dealt with by the NHS.
I probably fall into the libertarian camp. Let people behave the way they wish, as long as their lifestyle does not impose itself on others. People abuse themselves in many ways, through drugs, alcohol, gambling, video games, social media, even driving. We can’t regulate it all.
Are the two approaches Progressive? I can see that the Public Health Bolsheviks that want to enforce conformity to the ideal body shape fall into the usual bullying progressive camp but surely those against fat shaming are extreme libertarians who believe the obese should have the right to shorten their lives if they so wish.
Should not the correct right wing response to obesity eschew forced or incentivised medication and simply rely on the traditional means by which the poor were spared from obesity by cutting welfare to a level that ensured that excess eating was not affordable and walking was promoted.
Of course no right wing government will introduce such a policy as it will be universally condemned as a cruel policy of starvation.
The Public Health Bolsheviks will make this into a circus, and the woke body-shaming worry warts will oppose them to the teeth. Ironic, isn’t it? Two busy-body, know-it-all progressivist groups going to war on behalf of the ideal of protecting average people?
( Who, by the way, have never asked for their help, and wish that they would just go away. )
Critical Disability Studies (aka Crip studies ) is at least as dangerous as other critical social justice studies. I’ve seen an argument made in its name, saying that a pregnant woman who identifies as man should be allowed to continue taking testosterone during pregnancy even if it harms the baby, on the grounds that it is ableist to protect babies from severe birth defects.
Could you share that source?
https://www.sciencedirect.com/science/article/pii/S2667321523000811?via%3Dihub#bib38
https://www.sciencedirect.com/science/article/pii/S2667321523000811?via%3Dihub#bib38
You see arguments like this in the autism community, trying to cure severe ASD is ableist and literally genocide!!
Could you share that source?
You see arguments like this in the autism community, trying to cure severe ASD is ableist and literally genocide!!
Critical Disability Studies (aka Crip studies ) is at least as dangerous as other critical social justice studies. I’ve seen an argument made in its name, saying that a pregnant woman who identifies as man should be allowed to continue taking testosterone during pregnancy even if it harms the baby, on the grounds that it is ableist to protect babies from severe birth defects.
Ozempic may also reduce alcohol cravings (or so I just read). So a single pill to lose weight, conquer alcoholism and prevent heart attacks! We are approaching the Brave New World singularity. If they can combine with Ritalin and Viagra we will have achieved the best of all possible worlds.
Don’t forget Prozac!
Don’t forget Prozac!
Ozempic may also reduce alcohol cravings (or so I just read). So a single pill to lose weight, conquer alcoholism and prevent heart attacks! We are approaching the Brave New World singularity. If they can combine with Ritalin and Viagra we will have achieved the best of all possible worlds.
There’s only one sure-fire way to lose weight. It’s simple but difficult: eat less, exercise more.
I was so close, but I made the mistake of eating more and exercising less, school boy error
Thanks RWH
100% spot on. You can read so many complicated arguments about metabolism, macronutrients, genetics, etc. but the first principal component of weight loss/gain is about calorie deficit/surfeit. I challenge anyone to stop exercising or moving around and in addition to add an extra 1000 calories to their daily intake. Spoiler alert: you are going to get fat. And if you go on hunger strike then you tend to lose weight too, funnily enough.
Yes, we all know that, but the problem is that when you have lost the weight it affects the body in several ways and the brain tries very hard to get us to put it back on as it is perceived as a life-threatening famine. This means that it is easy to lose weight but very hard to keep it off.
Elaine Giedrys-Leeper’s post above.
I was so close, but I made the mistake of eating more and exercising less, school boy error
Thanks RWH
100% spot on. You can read so many complicated arguments about metabolism, macronutrients, genetics, etc. but the first principal component of weight loss/gain is about calorie deficit/surfeit. I challenge anyone to stop exercising or moving around and in addition to add an extra 1000 calories to their daily intake. Spoiler alert: you are going to get fat. And if you go on hunger strike then you tend to lose weight too, funnily enough.
Yes, we all know that, but the problem is that when you have lost the weight it affects the body in several ways and the brain tries very hard to get us to put it back on as it is perceived as a life-threatening famine. This means that it is easy to lose weight but very hard to keep it off.
Elaine Giedrys-Leeper’s post above.
There’s only one sure-fire way to lose weight. It’s simple but difficult: eat less, exercise more.
“Unsurprisingly, the fat-acceptance movement is upset. There’s a prime example of this in an article for The Conversation by Fady Shanouda, an assistant professor of “critical disability studies” and Michael Orsini, a professor at the Institute of Feminist and Gender Studies in Ottawa.”
If you go to that article, you will find that the Mickey Mouse credentials of these two idiots are hidden, and must be accessed by expanding a tab.
I’m calling you out on your musophobia. Mickey Mouse was quite smart and somewhat entertaining.
Shouldn’t it be anthropomorphicrodentphobia?
Shouldn’t it be anthropomorphicrodentphobia?
I’m calling you out on your musophobia. Mickey Mouse was quite smart and somewhat entertaining.
“Unsurprisingly, the fat-acceptance movement is upset. There’s a prime example of this in an article for The Conversation by Fady Shanouda, an assistant professor of “critical disability studies” and Michael Orsini, a professor at the Institute of Feminist and Gender Studies in Ottawa.”
If you go to that article, you will find that the Mickey Mouse credentials of these two idiots are hidden, and must be accessed by expanding a tab.
I think this is a serious point. There is a lot of bias against fat people – and some of the claims about health risks aren’t actually statistically correct. I think Covid highlighted how quickly go to the ‘if you don’t do X – you should be denied health care.’ Well it is a slippery slope – what if you drink? Smoke? Don’t get enough exercise? Engage in risky sports that elites don’t like such MMA? The Biden administration is now pushing a report that says you should only have two alcoholic drinks a week. I don’t think it is far fetched at all that the people who want have digital money will also want to track everything we do and punish us for what they deem to be inappropriate lifestyles.
You can have health care for self-inflicted harm, just pay for it yourself.
If you’re a person who smokes, drinks, etc. then my declining to pay for your bad habits isn’t punishment, you do that to yourself.
That isn’t how public health care works – nor should it be. The problem is that self inflicted harm could include AIDS or other diseases people who don’t play safe are much more likely to get. Downhill skiing costs the healthcare system insane amounts of money for knee surgeries and worse. People who work too many hours at the office and suffer stress induced ailments. People who drive too fast. The CDC just announced that people who are vaccinated are MORE likely to get the new COVID strain. Maybe we should deny them healthcare too – like they wanted to do for the unvaccinated – for being such gullible dupes.
Please provide some evidence for your claim about skiing injuries. And also that these are not covered by insurance.
My evidence is anecdotal but compelling to me. I did an advanced first aid course taught by a ski patroller from British Columbia and she had a recent anecdote from the ski hill about every type of injury – no matter how serious. Compound fractures, life threatening blood loss, broken necks, broken spines, it really opened my eyes. She would say “… two weeks ago we moved an injured man who we thought only twisted his knee and found a two foot column of blood under him – you really need to do this bleeding body check thoroughly …. “. If you live in ski country you hear about people getting seriously injured all the time and about deaths not infrequently. My wife strained both her knees when hit by a snowboarder. After that we quit skiing due to the risk. My young daughter tore a knee ligament. This year a co-worker tore a ligament in a knee. At the same time his spouse broke her leg in three places. Another coworker is still recovering this year from surgery to repair a knee from last year. It is a very risky activity that puts costs on the public health care system. Injuries are underreported in the press because ski hills are big advertisers. A report on press bias in British Columbia listed two clear examples of press bias due to advertising – the leaky condo crisis being under reported (due to property developer advertising) and deaths on ski hills (due to ski industry advertising). As to private insurance I am not an expert but I have never heard of supplemental private health insurance being denied due to the activity.
My evidence is anecdotal but compelling to me. I did an advanced first aid course taught by a ski patroller from British Columbia and she had a recent anecdote from the ski hill about every type of injury – no matter how serious. Compound fractures, life threatening blood loss, broken necks, broken spines, it really opened my eyes. She would say “… two weeks ago we moved an injured man who we thought only twisted his knee and found a two foot column of blood under him – you really need to do this bleeding body check thoroughly …. “. If you live in ski country you hear about people getting seriously injured all the time and about deaths not infrequently. My wife strained both her knees when hit by a snowboarder. After that we quit skiing due to the risk. My young daughter tore a knee ligament. This year a co-worker tore a ligament in a knee. At the same time his spouse broke her leg in three places. Another coworker is still recovering this year from surgery to repair a knee from last year. It is a very risky activity that puts costs on the public health care system. Injuries are underreported in the press because ski hills are big advertisers. A report on press bias in British Columbia listed two clear examples of press bias due to advertising – the leaky condo crisis being under reported (due to property developer advertising) and deaths on ski hills (due to ski industry advertising). As to private insurance I am not an expert but I have never heard of supplemental private health insurance being denied due to the activity.
Please provide some evidence for your claim about skiing injuries. And also that these are not covered by insurance.
That isn’t how public health care works – nor should it be. The problem is that self inflicted harm could include AIDS or other diseases people who don’t play safe are much more likely to get. Downhill skiing costs the healthcare system insane amounts of money for knee surgeries and worse. People who work too many hours at the office and suffer stress induced ailments. People who drive too fast. The CDC just announced that people who are vaccinated are MORE likely to get the new COVID strain. Maybe we should deny them healthcare too – like they wanted to do for the unvaccinated – for being such gullible dupes.
You can have health care for self-inflicted harm, just pay for it yourself.
If you’re a person who smokes, drinks, etc. then my declining to pay for your bad habits isn’t punishment, you do that to yourself.
I think this is a serious point. There is a lot of bias against fat people – and some of the claims about health risks aren’t actually statistically correct. I think Covid highlighted how quickly go to the ‘if you don’t do X – you should be denied health care.’ Well it is a slippery slope – what if you drink? Smoke? Don’t get enough exercise? Engage in risky sports that elites don’t like such MMA? The Biden administration is now pushing a report that says you should only have two alcoholic drinks a week. I don’t think it is far fetched at all that the people who want have digital money will also want to track everything we do and punish us for what they deem to be inappropriate lifestyles.
And diabetics in Europe have struggled to access Ozempic supplies for a year now because the bourgeois press publicises them for weight loss (see The Times of London) and all the supplies flood over to Harley Street if not Los Angeles.
And diabetics in Europe have struggled to access Ozempic supplies for a year now because the bourgeois press publicises them for weight loss (see The Times of London) and all the supplies flood over to Harley Street if not Los Angeles.
It’s often said that we have never been so healthy as during the period of rationing. There is nothing so threatening to bodily autonomy as that of severe morbid obesity where the person is so fat they cannot reach parts of their own body and any tiny infection becomes life-threatening. Losers, misanthropes, terrorists and all sorts of nutters have also latched onto the language of rights and identity championed here by people who like the larger person – I do too – but that should never get in the way of what is right, which is being alive.
It’s often said that we have never been so healthy as during the period of rationing. There is nothing so threatening to bodily autonomy as that of severe morbid obesity where the person is so fat they cannot reach parts of their own body and any tiny infection becomes life-threatening. Losers, misanthropes, terrorists and all sorts of nutters have also latched onto the language of rights and identity championed here by people who like the larger person – I do too – but that should never get in the way of what is right, which is being alive.
Don’t know if this drug is good or bad news, but I often wonder, is fat shaming really *so* bad?
Don’t know if this drug is good or bad news, but I often wonder, is fat shaming really *so* bad?
Eliminating obesity? Really? This article is an exercise in seeing how big a cart we can put in front of this particular horse. I’m skeptical that any drug or even some combination of drugs, will reduce obesity. The drug companies tested this drug on a bunch of people who had diabetes and a lot of them lost weight. That’s all that’s happened. Of course, there are a whole lot of people who complain about the ‘obesity epidemic’, from bureaucrats who see people in terms of costs to the healthcare system to health nuts who just don’t like looking at fat people to ordinary folk who have had the unfortunate luck to be seated next to a morbidly obese person on the train/bus/plane. There’s a lot of hopes and politics being piled onto this particular pill. Color me skeptical it holds up.
Eliminating obesity? Really? This article is an exercise in seeing how big a cart we can put in front of this particular horse. I’m skeptical that any drug or even some combination of drugs, will reduce obesity. The drug companies tested this drug on a bunch of people who had diabetes and a lot of them lost weight. That’s all that’s happened. Of course, there are a whole lot of people who complain about the ‘obesity epidemic’, from bureaucrats who see people in terms of costs to the healthcare system to health nuts who just don’t like looking at fat people to ordinary folk who have had the unfortunate luck to be seated next to a morbidly obese person on the train/bus/plane. There’s a lot of hopes and politics being piled onto this particular pill. Color me skeptical it holds up.
“In my view, that moment will come if semaglutide, or something similar, is optimised and approved as a weight loss drug for the general population.”
Like Wegovy? https://www.wegovy.com/
It seems that “moment” has already arrived, at least here in the US.
“In my view, that moment will come if semaglutide, or something similar, is optimised and approved as a weight loss drug for the general population.”
Like Wegovy? https://www.wegovy.com/
It seems that “moment” has already arrived, at least here in the US.
Bring back SHAME, all is forgiven.
It worked for smoking and drink-driving, so why not for obesity?
It worked for smoking and drink-driving, so why not for obesity?
Bring back SHAME, all is forgiven.
A pill isn’t going to sort the problems of obesity. Another quick fix with its own problems that won’t have been discussed. And forcing people to take a drug, regardless of any potential benefit, is unethical. If the government is serious about addressing all the costly health issues associated with obesity, they are going to have to look at how we eat and how the food industry keeps us eating badly.
A pill isn’t going to sort the problems of obesity. Another quick fix with its own problems that won’t have been discussed. And forcing people to take a drug, regardless of any potential benefit, is unethical. If the government is serious about addressing all the costly health issues associated with obesity, they are going to have to look at how we eat and how the food industry keeps us eating badly.
It’ll be interesting to watch what free market health insurance does with this in the US.
In the UK it’s £5.5k for 2yrs, and limited to 2 yrs I think. Chances are some doctors already prescribing with weight loss in mind, but NICE yet to rule specifically on that.
Putting aside the clashing ‘moralities’ on this, I’d be inquisitive about some of the health economics. Economically what we want is people to live a life that’s healthy and mobile until v near the end and then have a v short period of ill health before the end. The economic problem is we have generations having 2-3 decades of poor declining health and the consequences of that for them and society, before life ends. If when NICE more fully assesses this it genuinely can move us to the more optimal trend then recommending it’s use has a strong argument. But at £5.5k and c250,000 obese now, not sure the economics stack, and this assumes 2 years enough to get folks in a position to cease medication and manage a better equilibrium.
Think we should be open minded but needs more assessment.
Spoken like an NHS apparatchik watson – with more than a hint of the actuary.
Your tendency to ‘play the man not the ball’ fairly standard now Sats. Shame.
Your tendency to ‘play the man not the ball’ fairly standard now Sats. Shame.
What evidence is there that the drugs are only needed for 2 years and that the obesity is sorted after that ? Do we even know yet ?
Any self-respecting pharma company would surely design their drugs to require indefinite use and not actually solve the problem after 2 years. That’s how most pharma drugs seem to work (work from a commercial standpoint that is).
Everything you never wanted to know about medications for obesity :
Pharmacotherapy of obesity: an update on the available medications and drugs under investigation March 2023
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00059-7/fulltext
There are currently 5 medications approved for the management of non syndromic obesity. They all have side effects and have variable results (Semaglutide less variable results than some of the others in terms of achieving “useful” weight loss).
The two sections in this paper that have probably the most interest for non medics are “Suggested algorithm” and the “Discussion”.
The Phase 3 trial durations for one of these drugs extended for 4 years and a couple of them were designed to look specifically at appropriate “maintenance” regimes.
There is a potential problem (weight regain) with all weight loss progrmmes and this is bound up with the hormonal changes that occur, around the gut – brain axis, consequent on the reduction in food intake and increase in exercise and possibly psychological changes as well.
The hormones involved are several and various – leptin, peptide YY, cholesystokinin, insulin, amylin and grehlin (and maybe others).
The result is that appetitie increases and the resting energy expenditure drops (people need less food to maintain basic biochemical processes) – a double whammy for people trying to maintain a reduced weight.
There are successful losers (lost >30lb in weight and maintained for > 10 years). In the US these individuals are part of the National Weight Control Registry, apparently. It carries details of successful strategies for achieving amd maintaining weight loss.
Whether people like it or not, NICE in the UK exists to do cost benefit analyses on behalf of tax payers.
We don’t PB, that’s just the course provided currently related to diabetes type 2. We’ll have to wait and see what NICE conclude on ‘weight loss’ I guess, but in theory once you’ve lost the weight perhaps you can manage without it? A big problem for many obese is exercise is not easy so a helpful kick-start to that, putting aside other moral judgments, perhaps has good sense.
Good point about the exercise, but EGL above has given an account of the research which shows that, as we know, there is a major problem with weight regain. ‘[Weight loss affects the hormones] The result is that appetite increases and the resting energy expenditure drops (people need less food to maintain basic biochemical processes) – a double whammy for people trying to maintain a reduced weight.’
Good point about the exercise, but EGL above has given an account of the research which shows that, as we know, there is a major problem with weight regain. ‘[Weight loss affects the hormones] The result is that appetite increases and the resting energy expenditure drops (people need less food to maintain basic biochemical processes) – a double whammy for people trying to maintain a reduced weight.’
Everything you never wanted to know about medications for obesity :
Pharmacotherapy of obesity: an update on the available medications and drugs under investigation March 2023
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00059-7/fulltext
There are currently 5 medications approved for the management of non syndromic obesity. They all have side effects and have variable results (Semaglutide less variable results than some of the others in terms of achieving “useful” weight loss).
The two sections in this paper that have probably the most interest for non medics are “Suggested algorithm” and the “Discussion”.
The Phase 3 trial durations for one of these drugs extended for 4 years and a couple of them were designed to look specifically at appropriate “maintenance” regimes.
There is a potential problem (weight regain) with all weight loss progrmmes and this is bound up with the hormonal changes that occur, around the gut – brain axis, consequent on the reduction in food intake and increase in exercise and possibly psychological changes as well.
The hormones involved are several and various – leptin, peptide YY, cholesystokinin, insulin, amylin and grehlin (and maybe others).
The result is that appetitie increases and the resting energy expenditure drops (people need less food to maintain basic biochemical processes) – a double whammy for people trying to maintain a reduced weight.
There are successful losers (lost >30lb in weight and maintained for > 10 years). In the US these individuals are part of the National Weight Control Registry, apparently. It carries details of successful strategies for achieving amd maintaining weight loss.
Whether people like it or not, NICE in the UK exists to do cost benefit analyses on behalf of tax payers.
We don’t PB, that’s just the course provided currently related to diabetes type 2. We’ll have to wait and see what NICE conclude on ‘weight loss’ I guess, but in theory once you’ve lost the weight perhaps you can manage without it? A big problem for many obese is exercise is not easy so a helpful kick-start to that, putting aside other moral judgments, perhaps has good sense.
Spoken like an NHS apparatchik watson – with more than a hint of the actuary.
What evidence is there that the drugs are only needed for 2 years and that the obesity is sorted after that ? Do we even know yet ?
Any self-respecting pharma company would surely design their drugs to require indefinite use and not actually solve the problem after 2 years. That’s how most pharma drugs seem to work (work from a commercial standpoint that is).
It’ll be interesting to watch what free market health insurance does with this in the US.
In the UK it’s £5.5k for 2yrs, and limited to 2 yrs I think. Chances are some doctors already prescribing with weight loss in mind, but NICE yet to rule specifically on that.
Putting aside the clashing ‘moralities’ on this, I’d be inquisitive about some of the health economics. Economically what we want is people to live a life that’s healthy and mobile until v near the end and then have a v short period of ill health before the end. The economic problem is we have generations having 2-3 decades of poor declining health and the consequences of that for them and society, before life ends. If when NICE more fully assesses this it genuinely can move us to the more optimal trend then recommending it’s use has a strong argument. But at £5.5k and c250,000 obese now, not sure the economics stack, and this assumes 2 years enough to get folks in a position to cease medication and manage a better equilibrium.
Think we should be open minded but needs more assessment.
I’m not convinced that fat shaming is all that bad… assuming it works of course.
But it doesn’t, or so I keep hearing from research. Apparently, it makes the situation worse, for instance fat people are ashamed to go to the gym, they get depressed and eat more. It’s almost a catch 22.
But it doesn’t, or so I keep hearing from research. Apparently, it makes the situation worse, for instance fat people are ashamed to go to the gym, they get depressed and eat more. It’s almost a catch 22.
I’m not convinced that fat shaming is all that bad… assuming it works of course.
This drug is incredible if it can cause so much loss of weight that you are “eradicated”. I know a few thin people I’d like to try it on.
Me too. Where can I get some free samples?
Me too. Where can I get some free samples?
This drug is incredible if it can cause so much loss of weight that you are “eradicated”. I know a few thin people I’d like to try it on.
As usual, it’s Americans pushing drugs as the solution to every problem. Even those who like to think of themselves as rational:
https://astralcodexten.substack.com/p/semaglutidonomics
If we’re concerned about the cost of obesity to the NHS, we don’t need widespread drug prescription or “sin taxes” on fat and sugar.
We should address the problem directly: mandate annual check-ups, and financially penalise people who are obese (or incentivise those who maintain a healthy weight, through tax rebates).
Internalise the externality, and let people find their own solutions (eat less, move more, buy pills of choice at market rates).
While practical, your solution has about as much chance of being approved by voters as I have being elected King of the Moon.
While we’re at it let’s put cameras in their bedrooms too, eh?
Not if they are obese, no. That really is a niche thing.
Not if they are obese, no. That really is a niche thing.
So which is it: mandate annual check ups and penalize people who are overweight or let people find their own solutions? How about you mind your own d*mn business?
Maybe yes, maybe no. But there are also people who are unhealthily thin. Do we expect them to eat more and move less and buy pills for the sake of the socialised costs of their care?
Let the market work it out, perhaps with a system of body mass permit trading such as those used for carbon emissions or fishing quotas. Fatties could offset their excess blubber with permits that the chronically underweight trade with them, thus exempting them from compelled interventions or the denial of health care. On paper, everyone is a healthy weight and still dies of a heart attack or starvation at 55.
Let the market work it out, perhaps with a system of body mass permit trading such as those used for carbon emissions or fishing quotas. Fatties could offset their excess blubber with permits that the chronically underweight trade with them, thus exempting them from compelled interventions or the denial of health care. On paper, everyone is a healthy weight and still dies of a heart attack or starvation at 55.
Yes we Americans are to blame for everything.
While practical, your solution has about as much chance of being approved by voters as I have being elected King of the Moon.
While we’re at it let’s put cameras in their bedrooms too, eh?
So which is it: mandate annual check ups and penalize people who are overweight or let people find their own solutions? How about you mind your own d*mn business?
Maybe yes, maybe no. But there are also people who are unhealthily thin. Do we expect them to eat more and move less and buy pills for the sake of the socialised costs of their care?
Yes we Americans are to blame for everything.
As usual, it’s Americans pushing drugs as the solution to every problem. Even those who like to think of themselves as rational:
https://astralcodexten.substack.com/p/semaglutidonomics
If we’re concerned about the cost of obesity to the NHS, we don’t need widespread drug prescription or “sin taxes” on fat and sugar.
We should address the problem directly: mandate annual check-ups, and financially penalise people who are obese (or incentivise those who maintain a healthy weight, through tax rebates).
Internalise the externality, and let people find their own solutions (eat less, move more, buy pills of choice at market rates).
I recently attended a reunion of people from my secondary school where participation in sport was compulsory three days a week. I didn’t encounter anyone who was overweight, let alone obese.
I recently attended a reunion of people from my secondary school where participation in sport was compulsory three days a week. I didn’t encounter anyone who was overweight, let alone obese.
As ever, the old “burden on the health services” argument is wheeled out. Beside that we also have the word “epidemic”, as though gluttony were some sort of contagion to which fat people have fallen victim and to criticise their self-indulgence is just cruel and unfair.
Disappointing to find there is such an entity as a fat acceptance movement. Unsurprising though as we live in an era when protecting the self-esteem of any group defined as vulnerable has become a major social priority. The knock-on effect is to subvert the idea that people should strive to live up to any standard that might take them out of their comfort zone.
The burden on health services is real, even if you don’t like the idea.
Oh, it’s real enough Murray – but perhaps I should explain a little further. That “burden on the health services” trope is used by the state to justify the attempted regulation of our private lives in many health related areas. As though our health and wellbeing are gifted to us by the state and it is up to us as individuals keep them in good order (the state would like to define “good order”). But perhaps you are happy with that situation.
I have noticed a definite tendency to downplay personal responsibility for obesity. Rarely do we hear the term gluttony. Far more politic to blame the fast food / processed food producers than those who recklessly guzzle the stuff. The implication of a term such as epidemic is that obesity is something which happens to you.
Anyway, the point I was really trying to make is in the last sentence of my original comment about the fat acceptance movement.
Please desist from using schoolboy tropes such as surnames in your comments. I’ve told you before about this.
My last name or surname, if you prefer, is Walker. Was called that for 24 years in the USAF, and since it was my name it never bothered me. Must be a UK thing.
It’s a public school thing, as well as an armed forces thing, here in the UK. Those are the only places where one is addressed by one’s surname alone. It therefore has odd connotations.
It’s a public school thing, as well as an armed forces thing, here in the UK. Those are the only places where one is addressed by one’s surname alone. It therefore has odd connotations.
My last name or surname, if you prefer, is Walker. Was called that for 24 years in the USAF, and since it was my name it never bothered me. Must be a UK thing.
Please desist from using schoolboy tropes such as surnames in your comments. I’ve told you before about this.
Oh, it’s real enough Murray – but perhaps I should explain a little further. That “burden on the health services” trope is used by the state to justify the attempted regulation of our private lives in many health related areas. As though our health and wellbeing are gifted to us by the state and it is up to us as individuals keep them in good order (the state would like to define “good order”). But perhaps you are happy with that situation.
I have noticed a definite tendency to downplay personal responsibility for obesity. Rarely do we hear the term gluttony. Far more politic to blame the fast food / processed food producers than those who recklessly guzzle the stuff. The implication of a term such as epidemic is that obesity is something which happens to you.
Anyway, the point I was really trying to make is in the last sentence of my original comment about the fat acceptance movement.
Or take responsibility for their own health. If anyone wants to eat crap food and not exercise hey, go for it, but no whining allowed. Underlying all this ‘acceptance’ crap is a defeatist, negative denial of human potential
The infantilization of the populace continues. Now they actually look like babies.
Who needs human potential when you’ve got Ben & Jerry’s?
The burden on health services is real, even if you don’t like the idea.
Or take responsibility for their own health. If anyone wants to eat crap food and not exercise hey, go for it, but no whining allowed. Underlying all this ‘acceptance’ crap is a defeatist, negative denial of human potential
The infantilization of the populace continues. Now they actually look like babies.
Who needs human potential when you’ve got Ben & Jerry’s?
As ever, the old “burden on the health services” argument is wheeled out. Beside that we also have the word “epidemic”, as though gluttony were some sort of contagion to which fat people have fallen victim and to criticise their self-indulgence is just cruel and unfair.
Disappointing to find there is such an entity as a fat acceptance movement. Unsurprising though as we live in an era when protecting the self-esteem of any group defined as vulnerable has become a major social priority. The knock-on effect is to subvert the idea that people should strive to live up to any standard that might take them out of their comfort zone.
“No fat people came out of Belsen”, as the saying goes.
“No fat people came out of Belsen”, as the saying goes.
It would be fine if, having lost some weight with Ozempic, one was then able to keep the weight off, but, as with dieting, experience shows it is easy(ish) to lose the weight but nigh impossible to keep it off.
The same public health, cost and personal choice arguments could apply to smoking – even more so. The glacial decline of smoking in the ‘developed’ world and its deliberate promotion in the ‘developing’ world would seem to justify aggressive measures. Canada (recently featured in these pages in relation to euthanasia) will require every individual cigarette to bear a printed warning from 2024. Not much help in other countries where literacy may not be so widespread. An argument that polluting public air with toxic, or just addictive, chemicals in a radius of 10 metres or so is a matter of ‘personal choice’ cannot stand. That seems to me to set a paradigm that is not borderline.
More borderline is owning dogs (and to a lesser degree other animals) especially in towns and cities, where they urinate and defaecate all over public spaces and generate a huge amount of waste that is not subject to processing like human waste. The habit varies between countries, likely in the opposite direction to smoking because it requires surplus cash and space. In some countries, the practice of keeping a dog as a companion and towing it around elicits wonderment and disbelief. It has the same effect on me when I see people, usually women, cradling dogs or pushing them in babies’ push-chairs. There’s something unnatural going on, not to forget promotion for profit by the ‘dog industry’.
Obesity may be the most borderline or society-dependent ‘habit’. Fat is a natural part of the human body and some amount of it may be an adaptation to surviving in cold climates and maritime environments. In cities it may reduce the need for heating in winter, but increase the demand for air conditioning in summer. What’s the balance? It’s a pathology when it limits mobility and everyday activities, but what should those be?
We could all become obese and immobile and expend fossil fuel or renewable energy running machines to perform activities for us, or become so thin that in northern climates we need several layers of microplastic-shedding fleece. Fat also does not cause pollution or, by and large, directly affect other people’s health or wealth. Where once body shape may have directly reflected income, today there will be a spectrum of body shape preference, with involuntary outliers. If anything can narrow down that spectrum, apart from drugs with unknown environmental and health side effects, it will be reformation of human attitudes towards our impact on the biosphere, both locally and globally.