Fighting addictives: Weight-loss drugs as health boosters

NEW DELHI: Throughout my life, I’ve been fat, thin and various sizes in between. Since I was a kid I’ve gained and lost weight repeatedly, putting on 20 pounds, taking it off, putting on 30 pounds and then losing it again. It has been a cycle of despair.

The fact that I’m a doctor, a former dean of two medical schools and ran the Food and Drug Administration for six and a half years was of no help to me. Like millions of others, I was caught between what the food industry has done to make the American diet unhealthy and addictive and what my metabolism could accommodate.

We may now be on the brink of reclaiming our health. New and highly effective anti-obesity medications known as GLP-1s have revolutionized our understanding of weight loss, and of obesity itself. These drugs alone are not a panacea for the obesity crisis that has engulfed the nation, and we should not mistake them for one. But their effectiveness underscores the fact that being overweight or obese was never the result of a lack of willpower.

It is the result of biology instead, and that is why these drugs work. They help people feel full after eating and reduce the cravings that are central to our addiction to the irresistible, highly processed, highly palatable foods that have glutted our shelves over the last five decades. For many of us, our biology makes the pull of these ultraformulated foods nearly impossible to resist.

These foods typically are called ultraprocessed, but I refer to them as ultraformulated because they have been engineered to manipulate the brain’s reward system. These foods have become the new cigarette, and similarly, have resulted in a health catastrophe.

Forty per cent of American adults are now obese. These foods have contributed to a rise in diseases characterized by visceral fat, or what I call toxic fat — fat that accumulates within our abdomens and surrounds the liver, heart and pancreas. These chronic illnesses include cardiovascular disease, stroke, diabetes, cancer and likely some forms of dementia. Visceral fat and obesity more generally are among the reasons that Americans have an average life expectancy that is four years shorter than that of people in other large, industrialized countries.

By the time many people reach old age, doctors are often treating multiple health complications that stem in large part from a lifetime buildup of visceral fat. Doctors typically treat these conditions piecemeal, with drugs that lower cholesterol, reduce high blood pressure and control diabetes. GLP-1s could be an alternative to this piecemeal treatment because they seem to improve so many markers of health.

The Trump administration recently rejected a plan by the Biden administration to expand access to these drugs by requiring Medicare and Medicaid to pay for them, a decision that will deny access to millions of people who otherwise cannot afford them.

This is a mistake. GLP-1s appear to modify addictive brain pathways that are activated by ultraformulated foods, helping people to change their body weight in a decisive way. Traditional dieting might result in a weight loss of 5 to 7 per cent. The new GLP-1 drugs more than double that.

Even so, these are not magic medications. Prescribing them without other interventions, like healthier eating, exercise and behavioural therapies aimed at developing other lasting lifestyle changes, isn’t good medical care. Unfortunately, most doctors are not trained in nutrition or weight management. Whether patients can safely and practically use these drugs over the long term is still largely unknown.

Numerous studies affirm a truth so many of us have experienced firsthand: Sooner or later, almost every weight-loss plan fails. Even GLP-1 medications have a high dropout rate. The data suggests that most people take these drugs for less than a year, and once they stop their lost weight is mostly regained.

One of the reasons people stop taking GLP-1s is that they are expensive and may not be covered by insurance. Another reason is the side effects. They work by causing us to eat less, in some cases much less, which can be dangerous. They keep food in the stomach longer, which can induce feelings of fullness, but can also generate feelings of nausea or distress.

Pharmaceutical companies must be more transparent about these reactions. What’s troubling is that the Food and Drug Administration approved GLP-1s for long-term use without requiring companies to conduct long-term studies on how these drugs are used in the real world. These drugs offer a chance for people to improve their health even as our national body is ill. Our health has been hijacked by the ultraformulated food bombs that GLP-1s offer the hope of defusing. If we truly want to make America healthy, as President Trump claims he wants to do, we are going to have to confront the metabolic damage these foods have caused and take steps to protect the public from them.