“Weight-loss jabs could help us finally defeat obesity,” Health Wes Streeting told the Labour Party conference earlier this week. “The wealthy talk about how they’ve transformed their health, their confidence, their quality of life,” he said. “But […] what about the millions who can’t afford them?” The Streeting “war on obesity” subsequently produced headlines: obesity is the enemy, and the new generation of GLP-1 drugs (such as Wegovy and Ozempic) are our foot soldiers.

Streeting’s point on health inequalities is well made. Numbers of people whose weight is categorised as overweight and obese are steadily rising in the UK, with over a third of 35 to 74-year-olds technically “obese”. The risk is higher for people who are disabled, or who live in areas of deprivation. There are also a massive number of online pharmacies and clinics which have been offering these drugs on a paid-for basis over the last couple of years, costing a couple of hundred pounds a month all while the NHS has been highly restrictive in prescribing them.

Taken together, this means that the people most likely to benefit from this new group of drugs have been the least able to access them. And given that it’s difficult for most people who have lost weight to keep it off in the long term, an effective intervention should be welcome. Medicine has a long history of offering dodgy diet pills from even dodgier clinics, but these new drugs have been through high-quality trials and the NICE approvals process.

Except there is something that bothers me: not simply the echo of the “war on cancer” that Richard Nixon announced in 1971, but the aim at obesity as though it is a lone ranger, appearing unexpectedly over the horizon as if from nowhere. The risk factors for obesity are complex, but it is enmeshed with poverty, advertising and food insecurity. Children in reception year, for example, are twice as likely to be obese if they live in the most deprived areas of the UK, compared with those living in more affluent areas. Are we really going to wait for children to become old enough to be prescribed these drugs to “finally defeat” their obesity? Isn’t it better to try and create an environment which means that people who are already worse off don’t carry the excess risks from obesity as well?

To be fair to Streeting, he did also talk about free school meals; but on a public policy basis, the risk is that politicians develop an overreliance on these drugs, handing over the obesity problem to clinics and pharma, while neglecting the need to deal with the socio-political causes in the first place.

Although effective, these drugs are not a panacea; many stop using them due to gastric side effects. After stopping, most people regain two-thirds of the weight they lost, meaning that some will likely elect to keep taking them in the long term, or end up in a yo-yo pattern. Naturally, for a relatively new drug, we don’t yet have data about very long-term side effects. None of this is to diminish the fact that these drugs work, and reduce many of the risks of obesity. But they are not a simple solution that can replace true prevention.

That would mean disrupting the somewhat symbiotic relationship between the drug industry (weight loss) and the food industry (weight gain). In post-Brexit Britain, it’s clear the pharmaceutical industry is seen as key to future economic health. But an effective obesity prevention strategy would aim to reduce the need for weight-loss drugs over the coming decades. Let’s hope this particular battleground prioritises prevention, not just prescriptions.

---

Margaret McCartney is a GP and broadcaster.

mgtmccartney

---