Are the long-term (>20 years) effects of taking GLP-1s really all that well understood? Because that's kind of what you're suggesting here.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
Why not? We have an overweight and obesity epidemic that has persisted through everything else we've gotten enough political capital to try thus far. The "miracle" drug is the most promising direction we've had in a long time. Whatever possible adverse long term effects have to be (plausibility they actually happen) x (harm they cause) > known harms of being overweight.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Well, don't say you weren't warned when it turns out the miracle is not such a miracle after all and it all massively backfires in a few decades, at which point you're still going to have to actually fix the real underlying causes.
The class of drugs having a 2+ decade negative health effect greater than the negative health effect of obesity over the same period, without any obvious short-to-medium health effect, is likely to be small.
For obese people: probably. The overall health benefits for overweight people are a lot less clear. Being merely overweight (rather than obese) is not that strongly associated with negative health effects.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available
- Better nutrition education
- And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
I agree with every word of your analysis and I agree that we've tried basically nothing. But this is why I talked about political capital—every one of your suggestions has been available for the last twenty years and nothing has come of it and the problem continues to get worse. When you say something like, "healthy food should be more affordable and readily available" you'll get a lot of nods of agreement but when it comes time to turn that idea into actual policy everyone gets cold feet. Proposals like price caps for whole foods, subsidies for meals that meet some threshold of healthy, sin taxes for unhealthy foods, outright bans of certain ingredients the votes dry right up.
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
> healthy food should be more affordable and readily available
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
Of the measures you suggested, the one I've seen has worked was taxing soda and a direct correlation on less consumption.
The thing with healthy food is not that they are expensive, because they aren't, raw veggies, whole grains, raw chicken, raw pork are not that expensive, especially if you buy in bulk. The problem is that it takes time to cook them, which people may not have, and in general (at least the USA), I feel like people suck at cooking, and don't really have a good food culture of enjoying cooking, like italians do for example.
I believe something similar happened to cigarettes, they are super taxed as well as all the health campaigning around them.
Funnily enough, GLP1 might fix this food production issue as well.
Since urges for junk food and stuff are lowered as well, it would be interesting to map how GLP1 spreads through the population vs junk food consumption.
Matt Levine in his column actually addressed that GLP1 could cause the junk food/alcohol/other addictive stuff industries to lose a lot of money due to less consumption.
It's possible that junk food becomes a niche thing given enough time and GLP1.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.