Terry Prone: Moral outrage won’t halt demand for new weight-loss drug of choice

Kim Kardashian reputedly used semaglutide to drop enough poundage to fit comfortably into this dress made famous by Marilyn Monroe.

Remember the heroic research that developed covid-19 vaccines, and the linked story of how major pharmaceutical companies upped their manufacturing capacity in order to churn out millions of doses of the stuff? 

That story’s going to be put in the ha’penny place by
semaglutide, the type 2 diabetes drug.

According to a substantial analysis in this paper on Saturday by Emma Court and Imasha Costa: “Analysts at Jefferies Financial Group predict that GLP-1s for diabetes and obesity could become the biggest blockbusters of all time, bringing in as much as $150bn a year globally.”

Wegovy is the branded weight-loss version which is upending healthcare more than any other drug in history, except perhaps for anaesthesia.

Before the development of the latter, when patients were awake and aware of the agonies inflicted upon them, surgeons tended to avoid invasive surgery except where there was no choice.

Novelist Fanny Burney, for example, had nothing to knock her out when a surgeon removed her cancerous right breast in Paris in 1811. 

Burney wrote to her sister that as the knife began its path through her skin and tissue, she “began a scream that lasted unintermittingly during the whole time of the incision”.

The 20-minute operation was borne by Burney “with all the courage I could exert, & never moved, nor stopt them, nor resisted, nor remonstrated, nor spoke”.

As a result of such horrific suffering, one of the priority skills for those surgeons willing to inflict it, was speed. 

Dr Richard Gordon, surgeon and writer, described a leg amputation completed in under five minutes, which, although technically successful, had a 300% mortality rate because the hurried surgeon slashed the hand of a bystander, who died some days later from infection, as did the patient, together with an assistant surgeon who dropped dead when he saw the injury to the bystander.

Anaesthesia radically changed how injuries, infections, and cancers could be treated.

Interestingly, though, what might have been seen as the inevitable, indeed patently desirable progress of anaesthesia was somewhat impeded by moral considerations. It was felt, for example, that ameliorating the pain of childbirth would remove from the new mother an ennobling experience.

(This may have been because gynaecologists at the time were male, and viewing labour pains as ennobling is greatly facilitated by the certainty that one will never have to experience them personally.) 

It wasn’t until Queen Victoria was anaesthetised for the birth of one of her many children and made no secret of the difference it had made that the moral objections reduced in volume.

England's Queen Victoria was anaesthetised for the birth of one of her many children.

The moral objectors to Wegovy use Kim Kardashian as their bogey-woman. Kardashian reputedly used the drug to drop enough poundage to fit comfortably in Marilyn Monroe’s dress. 

The moral position that immediately emerged was that, while it was OK for the morbidly obese to save their own lives by using the drug, it was not OK for anybody of normal weight to use it, least of all an international celebrity. 

That was doing things the easy way and using up medication that should be saved for the morbidly obese. 

The second half of that dual objection has merit: Australia and France have effectively instructed their doctors not to prescribe semaglitude for anyone other than diabetics and the morbidly obese until supply matches demand. How soon supply will match demand is anybody’s guess.

Novo Nordisk, the manufacturer of Ozempic, issued a statement stressing that it is not a weight-loss drug and is only for adults with type 2 diabetes. 

It could be argued that Novo Nordisk is not in a great place to be tut-tutting over the use of its drug, given its recent two year suspension from the Association of the British Pharmaceutical Industry over “serious breaches” of its code of practice.

Those breaches related to sponsoring weight-loss doctors without letting anybody know, other than the doctors trousering the cash. 

Novo Nordisk, the manufacturer of Ozempic, issued a statement stressing that it’s not a weight-loss drug and is only for adults with type 2 diabetes. Picture: Mario Tama/Getty Images

Cynics might suggest it would better suit the Danish drug maker to shut up and work on speedily and safely boosting its capacity to make Ozempic, because no amount of moral outrage is going to stop the non-obese from seeking out and paying through the nose for it.

The international impact is already obvious. Shares in Weight Watchers have slumped more than 15% in what appears to be the reaction all over the United States to the prospect of a medical solution making the traditional meetings/weigh-ins/eating right/star endorsements redundant. 

In similar vein, it can be expected that healthstore offerings including pills (Alli) claiming to prevent the absorption of fat calories will experience a similar decline. 

The impact on weight-loss surgery cannot be imagined. In the short term, before the patent runs out and cheap generic equivalents come on stream, health insurance companies are looking at coughing up a grand a month, ad infinitum, for policy-holders who want to use it the way Novo Nordisk piously suggest they should not use it.

The weight-loss industry has been kicked so hard, it is unlikely to recover in anything like its previous form. 

That’s going to be tough on authority figures like Dr Eva Orsmond, who has invested heavily in a hotel designed to welcome overweight guests wishing to be starved in a pampering kind of way. 

More seriously, it’s hopefully going to cause eating disorder specialists to re-examine the principles underpinning their difficult work.

The idea that the general public will, given half a chance, use any one of these drugs for what is pejoratively called “quick weight-loss” is to insult all the people, a majority of them women, who, over the past century, have had their lives shaped and skewed by yo-yo dieting, achievement, and shame. 

Body positivity has done little to this context other than persuade people to use “big” rather than “fat”. The wonderful Lizzo has created a personal brand worth millions but remains the exception that proves the rule.

It doesn’t take major unpicking of social media posts to register that when anybody reasonably famous gains weight, or gets to be famous while maintaining a high weight, they suffer an onslaught of ‘who-ate-all-the-pies’ abuse from the safely anonymous. 

Lizzo has embraced body positivity. Picture: Frazer Harrison/Getty Images

It doesn’t take much analysis to suggest that these trolls are not unrepresentative of society as a whole. 

Anyone who is or has been overweight knows that it attracts “support” of a kind nobody wants, and that losing weight or being thin attracts approval and envy from the cradle to the grave.

In that context, moral sniffing at the idea of people using Ozempic or Wegovy as a “quick weight-loss hack” driven by “culture” is ridiculous. 

Firstly, because everybody who’s considered taking the drugs knows the weight lost comes back like a tsunami when you stop taking them, so once in, you’re in for life. 

Secondly, because — as any overweight person will confirm — “cultural” opposition is not minor. It can be crippling.

Let’s have less of the moral posturing about what looks like a life-saver for more than the morbidly obese.