If you have watched any daytime television or YouTube videos over the past few years, you have no doubt seen advertisements for medications like Ozempic, Wegovy, and Mounjaro. The ads are ubiquitous, and so are the medications – 5 million Americans were prescribed semaglutide (the major ingredient in many of these medications) in 2023, a 40-fold increase from the past five years. Researchers for JPMorgan estimate that by 2030, nearly 10% of the U.S. population may be taking weight-loss drugs. Headlines often refer to the obesity “epidemic”, but with the prevalence of these medications, are we finally approaching a solution to a problem that has seemed intractable?
Perhaps. But caution is needed, say some experts. Dr. Na Shen, an endocrinologist at UCLA Health, says that weight-loss medications “are not the silver bullets we hoped they’d be, especially for the patient populations most at need.”
Dr. Shen notes that holistic treatments, not just pharmaceuticals, are necessary to combat the obesity epidemic. “For a lot of people, even those on new life-changing weight-loss medications like Ozempic and Wegovy, it takes a combination of intensive lifestyle intervention, anti-obesity medications and even surgical interventions to optimally treat obesity.”
Just how bad is the problem of obesity? Fifty years ago, around 15% of U.S. adults were considered obese. Today that number is 42%. Obesity is a specific term referring to a high body mass index; a person is overweight, but not obese, if their BMI is between 25 and 30. Around 30% of Americans are overweight, meaning that a startling three quarters of the United States adult population are at an unhealthy weight. Years of public health campaigns have made little impact on rising obesity rates. Michelle Obama’s “Let’s Move” campaign, perhaps the most well-known of these public health initiatives, sought to reduce childhood obesity in the U.S. to 5%, but today, nearly 20% of U.S. children are obese.
Yet the rate of increase in BMI appears, for the first time, to be slowing, or even leveling off, in the United States. This trend comes as, or as a result of, medications that aid weight loss are more available and accessible than ever. Semaglutide, the main medication being prescribed, was approved for medical use in the United States in 2017. Initially a diabetes-management medication, semaglutide is now also prescribed as a long-term weight-management medication. Hollywood stars and social media influencers have sung its praises. Oprah Winfrey left the board of WeightWatchers after revealing that she was using a weight-loss medication, telling media that she no longer believed the kinds of methods advocated for by programs like WeightWatchers were sufficient to lose weight.
Semaglutide works in a few ways – it decreases blood sugar levels, lowers appetite, and slows down digestion in the stomach. It can be administered through an injection or taken orally, and is sold under the brand names Ozempic, Wegovy, and Rybelsus. The drug tirzepatide is another popular medication that works in similar ways to semaglutide and is also prescribed for both type 2 diabetes and weight loss; it is sold under the brand names Mounjaro and Zepbound and according to some studies may be superior to semaglutide for obesity reduction. Semaglutide is still the most prescribed of the two – indeed, it is the 48th most prescribed medication in the United States.
The way we view obesity is slowly changing as a result of these medications. Now that semaglutide and tirzepatide are specifically prescribed for weight loss in addition to diabetes, it is easier for people to see obesity as a medical condition in need of pharmaceutical intervention, rather than, say, a problem of will-power.
It’s also worth noting that as with many health conditions, obesity also impacts certain populations disproportionately, points out Dr. Shen.
Obesity prevalence is highest among Black and Latino adults, people living in rural communities, and low-income communities, and these are also the populations that may struggle with access to healthcare, including access to medications like semaglutide. And the medications themselves are mixed blessings. They can cause gastrointestinal distress among other unpleasant side effects, and perhaps most notably, people who lose weight with these drugs typically have to stay on them indefinitely, as they generally gain the weight they lost back very quickly if they stop taking them. We don’t know everything about the long-term impacts of semaglutide, nor about the effects of long-term use of semaglutide, so more research will be necessary. It is too early to declare that semaglutide heralds the end of obesity in America.
