Ozempic, Wegovy and Mounjaro are claimed to be wonder drugs that will solve the problems of modern living, like obesity, diabetes and dementia. But there are better ways to do that, like going for a walk and stopping eating ultra-processed food. So are they really just mechanisms to perpetuate the profits of Big Pharma, at cost to us all?
This is the audio version of this video:
This is the transcript
I don't believe in Ozempic, I don't believe in Wegovy, and I don't believe in Mounjaro.
What on earth am I talking about? These three are the so-called wonder drugs that the Economist is talking about. They are singing their praises because they believe that these three drugs will solve the problems of diabetes, of obesity, and potentially of dementia, which some doctors are now calling diabetes type 3.
I don't believe that they're right.
I don't believe that these are wonder drugs.
I don't believe they are what the world needs now.
I do believe that they are another mechanism for Big Pharma to capture the income streams of the world's governments that are supposedly dedicated towards healthcare, but which are actually being used to maintain the unhealthy lifestyles of a world that has lost touch with food reality.
Forty years ago, we did not have crises of obesity and diabetes or of dementia on the scale that we have it now. We obviously had all three conditions, I'm not pretending that they have been created over that period, but their growth has been extraordinary. And to suggest that there has been some mutation in the human genome that has created this outcome over such an extraordinarily short period of time would be absurd, because clearly that has not happened.
Of course, the genome does develop, and change, and so do drugs, and so do diseases. But, in this case, I got the order of drugs and diseases right. Because, what I mean is, that we have taken a great many drugs over that 40 years, and they have caused us untold harm. The drug in question is ultra-processed food.
Ultra-processed food is fundamentally not a food. I know that because a food should satisfy our craving to be fed. But ultra-processed food doesn't do that. It is chemically engineered to make sure that very soon after we've eaten a dose of it, we want another dose of it.
And then another dose of it.
And then some more.
In fact, there is a report that I read recently that suggested that the average American has eleven feeding events a day. That's only a bit over an hour between the occasions when they want something to eat. Why? Because they are chemically induced to want more and more by the ultra-processed food that they eat.
And that as a consequence is of course fueling the crises that we have. Obesity is caused by overeating. Let's not beat around the bush. It doesn't need a drug to solve it, it needs a mechanism to break the addiction to that overeating.
And the same is true with regard to diabetes, which is a consequence of that obesity.
And let's be clear, that would also eventually be true of dementia if that is caused by the same problem.
So, what do we really do? Do we produce these drugs in vast quantities at enormous expense and get people hooked on them for life because they don't work unless they are basically used for life with massive side effects and consequences for those who take them, including a loss of muscle mass, which will make life in old age much harder for many people because longevity is dependent upon the retention of muscle mass? Or do we go back and say we've got the whole of this wrong?
Now, I ask that not as a medical practitioner, because I'm clearly not, although, I was advised on this video by a medical practitioner, who I happen to be married to. But, the point about this is that there is a fundamental economic argument here.
What we have are very few companies in the world who control most of our food supply. In fact, the vast majority of the world's food supply is controlled by just four companies. They are, for all practical purposes, monopolies, each with some degree of speciality in a certain area, making sure that basically they can set prices. Now I know there's some variation here and there in the futures markets and so on, but these companies are dominant, and they want us to buy more of their product.
Unsurprisingly, they do not want any solution to the obesity and diabetes and dementia problems that we face that might reduce the consumption of ultra-processed food because their profits depend upon us being hooked on them. And as a consequence, they love the fact that Big Pharma has now come up for us with a solution for these so called problems, which don't exist if only we changed our diets, and that those solutions can be prescribed by the world's national health services or equivalents and, as a result, will let people carry on consuming foodstuffs as if it didn't matter.
But it does matter, because we could solve this problem by first of all cracking down on the monopolies that are controlling our foodstuffs.
Secondly, by cracking down on the content of those foodstuffs so they are not addictive. Which does, in essence, require a considerable reduction in the amount of harmful sugar that is included within them.
And thirdly, we can actually attach conditions - which the government is now saying might be applied to those who want work that they take these drugs - might attach conditions instead, like, go for a walk, because that will be a lot better for you.
My point is there's an economic issue here that we need to address properly.
Treating the symptom, which is obesity or diabetes, is the wrong way to deal with this problem.
Treating it in a way that maximises the profits of the pharmaceutical industry, which, to be candid, is desperate for us to remain ill, because that is the basis for its future prosperity, has to be wrong.
Treating it by making sure that we can eat decent foodstuff is the right way to go.
And for all those who tell me, “But people won't be able to afford to buy decent foodstuff”, Let me be clear; the cost of Ozempic and these other drugs will be enormous. If we instead diverted those resources into providing people with a sufficient income and a sufficient time availability so that they could eat properly, we'd solve this problem.
We could afford to do this.
In fact, it is estimated that we could cut the cost of the NHS by one third if only we tackled the problem of ultra-processed food. Think about that. That would be £60 to £70 billion a year that could be released to pay people a much better minimum wage, for example. That would help.
It would also mean that our productivity would rise, so our economy would grow.
And we would all feel better, which would mean we would be happier.
This is the answer to the problem.
The answer to the problem is not super drugs that actually simply compound the fact that neoliberal big business wants to exploit our unhappiness to pursue its own goal of profit maximization.
We have to rethink the way we look at these problems.
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Some good points. I assume that a lot of the ready meals are included in the ultra-processed category – sold on the basis that you save time by not having to prepare food. They are also very tasty. I minimise the use of these and try to cook from scratch using the ingredients I need! Also regarding walking I try to do as much as possible – for example rather than take the car, last week I walked 1.8 miles to buy fish and chips and walked back – 3.6 miles in total!!!
Walking is key to my well-being
And I admit I avoid ultra-processed food, almost entirely.
Very good points Richard. I’m typing this on a short break in the midst of an 11 mile weekend walk. To do a decent walk at least once a week is now an established habit even if a slightly arthritic knee makes that a bit harder.
I find country walking very therapeutic. And we try to do our own cooking rather than buy much processed food.
I bet that’s the best thing you can do for that knee
I have also been walking – not as long as you though
I need that exercise
I suggest taking a further step back and asking why people are eating Ultra Processed Foods – Poverty, not knowing how to cook, Food Desserts etc and not walking or cycling, either because its too far to get where they want to go – see the 15 minute city or too dangerous either because of traffic or other people.
These issues need tackling as well
Much to agree with. I agree with you that our obesity crisis is caused by the way we manufacture and distribute food. Clearly these problems have got a lot worse over the decades. And, no, the human genome has not changed significantly over that time. So environmental factors are clearly to blame.
There is a role for government to play in regulation. For example to reduce sugar, as was done for soft drinks. We definitely need government action not a so called free market. We do very much need new solutions to the problem of obesity, not just drugs.
Clearly pharmaceutical companies are delighted with these new drugs. I think that highlights that the way we developed drugs, in the private sector is highly problematic. For example big pharma is not interested in developing new antibiotics, because if they did they would be kept as antibiotics of last resort, the wouldn’t sell, so they wouldn’t make a profit. We need to change the way drugs are developed with more public R&D.
But there are aspects of what you say that I disagree with.
I don’t think that food manufacturers are delighted with these new drugs. If widely used they would cause less food to be bought and reduced their profits. They would need to change their business model.
Yes, weight loss drugs do cause loss of muscle mass. Estimates vary from 60:40, fat to muscle loss, to 75:25. And this is a problem. But the same thing happens with any form of weight loss.,not just these new drugs. Muscle loss is a particular problem with conventional yoyo dieting where muscle mass decreases with each cycle. It needs to be addressed with lifestyle changes. And these lifestyle changes are easier after weight loss. The dangers of obesity are greater than the risk of muscle loss.
No, obesity is not caused by overeating, that is the mechanism of weight gain not its cause. The cause is a malfunction in the appetite control mechanism, which these new drugs help to regulate. People are indeed overweight because they eat too much. But they eat too much because of appetite problems, that is the cause. Too many people victim blame by saying things like “why don’t you just eat less”, overweight people cannot do this.
These new drugs are well tolerated by many people particularly in low doses. The problem with low doses is that weight loss is slow, and many people want a quick magic solution, and perhaps use too high a dose. And, of course, as with any drugs, some people have adverse reactions. By and large these adverse reactions are unpleasant but not dangerous.
These new drugs do seem to have other beneficial effects. They seem to reduce craving and so may help with other addictions. There’s even suggestions they may help with dementia. I don’t have a financial interest in big pharma. These drugs are not magic, like any other drug they have drawbacks. But they are useful
The reality is that there are many, far too many, obese people in our society. They are victims of our current system which needs to change. But what are we going to do? Conventional dieting has clearly failed over decades. Are they to be abandoned to diabetes, heart disease, dementia, joint replacements, and the host of other diseases of obesity, and ultimately an early uncomfortable death? In my opinion these new drugs are an important way to help these people who are sick and suffering now. We do need them.
I disagree with just about everything you say Tim
The reasons are explained in the video
And these drugs will make everything worse – most especially bacuse of permanet loss of muscle mass
In my opinion, we do not need these drugs
What we need is proper regulation of food
Reasonable people may differ 🙂
🙂
It has been said that the NHS is in fact the NIS (National Illness Service). It’s just not very good at preventative medicine.
But to my mind, the problem with over-consumption comes down to capitalism itself. It is the ultimate paradox. In a capitalist system, there is permanent pressure on shareholder-owned businesses to grow. There is little incentive to invest in a business if there is no return, so shareholders are looking for increasing share prices, resulting from increasing business valuation, which comes from increasing sales. This leads to relentless advertising to get us to buy things we don’t need etc.
But in the food industry, taken as a whole, the market is already saturated, in that we all have enough to eat (apart from those who can’t afford enough, but that’s a whole different topic). The only way the food industry can grow is by getting us to eat more, more than we need. It also wants to maximise profit, so it concocts products engineered to be almost addictive but cheap to produce.
The only way this can stop is if the food industry accepts that its business model should be roughly steady-state, but given our ideas of a “healthy economy” embody a relentlessly rising FTSE, it appears to be a circle that’s impossible to square.
This is of course the fundamental problem with building a sustainable economy in all areas.
Can I plug “Free for all” ( why the NHS is worth saving) a book by Dr Gavin Francis.
Written from a GPs view he looks at these subjects, it was an interesting read for me as I sit here throwing 3 grands worth of enzalutamide down my neck each month, hopefully only for a few months more though.
What few doctors tell cancer patients is that glucose is a major issue in canver, inclduing its recurence
They know the association – becvause glucose is used in cancer scans
What they don’t say is that people post cancer need to change their diets to increase life chances (and my wife, a former GP and a cancer victim has read extensively on this)
An excellent report Richard.
Re obesity, yes, ultra-processed food (UPF) is a major cause of overweight and obesity , but UPF consumption is associated with more adverse health outcomes as well including cardio-metabolic risks, cancer, type-2 diabetes, all-cause mortality, and, as you suggest, dementia (‘type 3 diabetes’). It’s an area I know a little about and let me assure you, no study has ever reported a single positive association between UPF consumption and beneficial health outcomes.
One small point though, if I may: The horrendous increase in obesity is for some people an endocrine (hormone) issue and whereas UPF is certainly an major factor, so also is lifestyle and pharmaceutical over-use.
I’m delighted you see these matters as economic issues andthank you for your insights.
Point noted and accepted
Good advice on ultra processed food.
I have felt for some time that what we have is an awful accommodation with market operators whereby they will make us unwell to make money, rot our teeth etc., and then send us into the arms of more exploiters to be ‘cured’ in order maintain our consumption of bad stuff and even go back for more.
I call it the ‘Popeye’ economy after the film the French Connection where the hero ends up becoming the prisoner of his drug dealing quarry and who is then made into a heroin addict and is cruelly exploited and degraded.
Just one thing Richard, while I agree with the main thrust of your article in regard to the damage done to us by ultra processed foods, it’s worth noting that not all diabetes is caused by this. I was diagnosed in my early 30’s and have been on insulin for almost 30 years now. At the time of my diagnosis I led a healthy lifestyle, walked pretty much everywhere, was very aware of the food I was consuming and cooked fresh ingredients for myself and my kids.
I recognise this has nothing to do with type 1 diabetes
That is a wholly different issue
In fact not all type 2 diabetes is obesity related, although the modern epidemic levels are.
I know
A huge puff for ‘pro biotics’ etc – fermented foods from Danone.
https://www.ft.com/partnercontent/danone/why-biotics-are-vital-for-the-future-of-health.html?twclid=2-2ldeeyld5t1htibn9xb4ae54g
The message seems to be ‘ eat more natural fermented foods – we have been doing for centuries’ but, surprise surprise we also need massive investment by food companeis and pharmaceuticals to produce new wonder foods.
Dubious.
I am not convinced fermented foods are much of an answer
I do like pickled foods though…
Mostly agree Richard. Shop-baught fermented foods are a waste of money. They are neither strong enough nor sufficiently molecularly diverse to deliver the reported health benefits. Make your own yogurt (high fat and 24 hour fermentation time), sauerkraut, kefir etc. and your end product will not need to be hygeinised and neutered to have a 3-month shelf life.
Yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea – get fermenting at home. Your gut microbiome, vitality and health will thank you!
Ultra Processed Food is not just a cause of obesity, study after study shows its consumption correlates with increased cardio-metabolic risk, cancer, type-2 diabetes, dementia (‘type 3 diabetes’?), and more.
Thing is, if the health system just conceded this and tried to deploy a meaningful system of evidence-based medicine, the NHS might not just save/or spend differently/ up to a third of its budget, the general health-awareness of the population would improve considerably and ” our productivity would rise, so our economy would grow”.
Small point, ever since Streeting’s “jab-for-jobs” tirzepatide Eli Lilley “deal” hit the press, there has been a perceptible increase in an anti-fat-people reporting in the MSM . Point is, overeating (bad) UPF is not the only cause of obesity. Endocrine (hormone) issues feature too. It might be that endocrine-disruption is yet another effect of ubiquitous UPF, but so too might it result from over-use of pharmaceutics (aided and abetted by neoliberal charlatans like of Wes Streeting)
Your championing of the ‘economic issue’ that we need to raise coincides with and supports another priority issue to fixi the harm our food and medicines produce: uncorrupting Evidence based Medicine. https://www.bmj.com/content/376/bmj.o702.long. Thanks sincerely Richard.
Thanks
I don’t know what the definition of “wonder drug” is but the GLP-1 agonists really are a significant medical advance, and will become more important if oral forms (rather than injectable) are developed.
Of course you are right that the rising level of obesity has a strong origin in the changing choices of diet most people make, and find easy to make due to the way it is encouraged by food companies. But that doesn’t make being able to deal with it any less significant given its negative impact on most other medical problems. I would hail an effective cure for lung cancer as a medical breakthrough regardless of the way most lung cancer cases only exist because of tobacco products, or an effective cure for melanoma despite it being avoidable by protecting against sun exposure.
It is interesting that GLP-1 agonists seem on rather early evidence to have a protective effect against dementia, though you have to assume those findings were well publicised purely because it is in the interest of manufacturers who are benefiting from profits on their sale. It underlines the central role of metabolism in a lot of illness. But for reduction of future risk it is likely they that a good diet and adequate exercise will achieve the same benefit. It might be possible to argue that because of the enormous impact of dementia – on the individuals, their families, and health and care systems – it would be worth maximising risk reduction by protective medication but you would start with the less publicised but apparently similar benefits of metformin (otherwise used for type 2 diabetes) and statins (lowering blood cholesterol), both cheap drugs with a well established safety profile.
I agree though that GLP-1 agonists are essentially sticking plaster to help a problem that has already happened, their use needs to be secondary to reducing the incidence of obesity using dietary and exercise means – which means governments being prepared to act on food producers in the interests of the public.
GLP-1 drugs woirk by destroying muscle mass, which is a massive cause of infirmity in old age, and is excepotionally hard for post menopausal women to ever reverse, I am told. I see them a the biggest potential class action ever invented. But time will tell.
I think these drugs do remove more fat than muscle, but there must be a lot of patients where it will be difficult to maintain strength after any muscle loss. As you say, losing strength is a major cause of frailty in old age – one we are facing second hand with a couple of elderly female relatives.
Muscle is clearly an important issue and should not be diminished.
Readers may be interested in this article in The Lancet.
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00272-9
Richar Boulton, GLP-1 receptor agonists (GLP-1RAs) are a promising therapy for modern lifestyle diseases such as diabetes and obesity, yes. However, there are concerns about their long-term use and potential effects on the thyroid gland and pancreas. Recent studies have shown that prolonged use of GLP-1RAs may increase the risk of thyroid tumors and acute inflammatory conditions such as pancreatitis. Physicians should advise patients on the need for more frequent and detailed follow-ups.
FWIW, the use of natural GLP-1 antagonists (Psyllium, berberine, curcumin, ginseng, etc.) can be v effective and avoid the dangers of synthetic GLP-1 antagonists. As you say, we need better and more health education.
I have no problem with all that
And remember, my concern is economic – that we can address this issue better in a different way, which is why these are not miracle drugs as a result, as the Economist saud they were
It’s interesting that long term problems of taking these drugs have been recorded, given that once you’ve lost the weight and stop taking the drugs, you will start eating as you did before and gain weight.
Or is this just going to be a cycle of yo-yo weight loss for the 21st century whereby you are on the drugs on and off for the rest of your life?
Kerching!!
Hello Richard,
it occurs to me that we have hit the ultimate crisis in human autonomy. In fact this dates back to the start of the capitalist industrial revolution and the upsurge in Enclosure acts. From that point on, we have been denied access to food production. It was then what it is now – very effective enslavement (waged, yes – but no one ever chose to work for a wage after all).
This imposition has now been so perfected that young people today see no alternative – nor wish to, as far as I can see.
So, what is the solution – not that it will be welcomed with open arms by millions, but it’s this- we have to demand back common land – demand control of what was known as The Commons – and learn to take responsibility as communities, to grow and prepare our own food, take collective decisions about self sustainability, and so, what we are willing to ‘consume’ from capitalism. More than in over 200 years, it’s now about survival. Of course this is a big ‘IF’, but nontheless, it is the crucial step to independance.
At 80 years old my wife and I gave each other a birthday present of twice-weekly sessions with a personal trainer aimed at building muscle strength. Within weeks we both felt physically transformed – diminished and then banished joint pain (especially knee joints), renewed energy and vigour. Use it or lose it… still true into old age.
On diet it is increasingly obvious that processing natural foods beyond mechanical milling, grinding, fermenting and so on transforms their nutritious effects in uncertain ways. As has been said here, UPFs extract and then reconstitute constituents of natural foods to enhance their appeal. The complex hormone systems which we have evolved to signal satiety are overwhelmed by the desire to eat more that is induced by the enhanced taste and appeal of manufactured foods and overeating with all its consequences is induced. Read the label… the warnings are there. Anything listed that you can’t buy as a separate ingredient in a well stocked supermarket is immediately suspect, And, Richard, fermented foods, which include cheese by the way, are important for the health of your biome. It all sounds very woke to people of a certain age, but I learned the basics of what I know about this from my mother and she learned it from her father who was a healthy eating fanatic.
Yes indeed you don’t need an expensive drug to deal with obesity and its consequences but we do need some legislation about processed food products and some more effective health education.
I love your story
Thanks
And as my wife says “Motion is lotion”.