GLP-1s May Be Taking Our Eyes Off the Real Obesity Problem

GLP-1 receptor agonists may be powerful tools for treating obesity and cardiometabolic disease, but relying on medications alone risks overlooking the forces helping drive the obesity epidemic, according to Laura Schmidt, PhD, of the University of California San Francisco.

In a new Science perspective, Schmidt and co-author Luc Hagenaars, PhD, of Amsterdam University Medical Center, argue that the “Ozempic era” should be accompanied by policies aimed at the food environment, including restrictions on marketing, warning labels, taxation, and other measures modeled on tobacco regulation.

In this exclusive MedPage Today interview, Schmidt explains why treatment and prevention can coexist, and why GLP-1 drugs shouldn’t be viewed as a “magic bullet” for what she sees as a systemic problem.

The following is a transcript of her remarks:

They’re not a magic bullet. And we have a history of kind of looking to medications as the magic bullet for problems that are really systemic.

Medicalizing Obesity Can Miss the Underlying Problem

Trying to solve the problem by defining obesity as a medical condition that needs treatment with these medications means that we’re taking our eyes off the ball when it comes to really thinking about the food environment as the driver of the problem. And it sets us up for a situation where if we repeat history where pharmaceutical companies put a lot of pressure on WHO [World Health Organization] and we wind up delivering those medications first and foremost to high-income countries, we’re really looking at a situation where we’re exacerbating health disparities.

At Amsterdam University, Luc Hagenaars and I conducted prior to this a systems analysis. The primary finding of that was that the biggest impediment to solving the obesity epidemic is the belief that it’s the individual’s responsibility to solve the problem.

We know from clinical trials that ultraprocessed foods cause obesity. They make people overeat and they make people eat more calories than an unprocessed diet. So if that’s the driver of the problem, anything we do to medicalize obesity is kind of moving us in the wrong direction.

Treatment and Prevention Can Coexist

I think WHO got the memo because they are saying at the same time, they’re saying we need to think about equitable distribution of these medications. And that is, we can have it all. We can have GLP-1s for people who already have cardiometabolic disease and they seem very effective. So we can have that for the people who are already suffering and then we can be preventing at the same time the emergence of more obesity, especially in kids through these food environment reforms. So I think that is the agenda that WHO is saying, we’re on that train.

The question is how do we get there in a commercial milieu where everyone is jumping on the bandwagon, whether it’s food companies, pharmaceutical companies, supplement companies, everybody’s trying to make money off of these drugs and they’re driving these medications exclusively towards higher-income populations.

Guardrails for the GLP-1 Era

WHO has a real challenging job ahead of itself. It’s been a real leader for many, many decades in thinking about chronic diseases from the standpoint of regulatory reforms, tobacco-style regulations, taxation, warning labels, school-based interventions that keep these products out of children’s environments, curbs on commercial marketing, especially targeted children.

It should come as no surprise to anyone that tobacco-style regulations — warning labels, taxation, curbs on marketing — work really well when it comes to ultraprocessed foods. They use a lot of the same product development approaches.