It’s been nearly a decade since the American Medical Association first classified obesity as a chronic disease, which may require medical interventions beyond diet and exercise.

Now, as blockbuster drugs Wegovy and Ozempic gain popularity, attract more attention and add complexity to cultural and medical conversations about weight and weight loss.

Both drugs are brand names for semaglutide, a drug that can lower blood sugar levels and suppress appetite. Ozempic is approved to treat type 2 diabetes in adults, while Wegovy is approved for weight loss in two groups: those 12 and older with obesity, and adults who are overweight and also have at least one obesity-related health condition. weight, such as high blood pressure or cholesterol.

Patients and doctors say the results they are seeing with the drugs further underscore the consensus that lifestyle changes alone are often insufficient for people trying to lose excess weight.

«Two-thirds of Americans did not wake up one morning and choose to be overweight or obese. This is not a behavioral choice or a behavioral disease. This is a chronic disease, a treatable chronic disease, and we must treat it like we treat any other disease, with drugs and with interventions that target disease mechanisms,» said Dr. Ania Jastreboff, an associate professor at Yale School of Medicine. She is a member of the scientific advisory board for Novo Nordisk, which makes both drugs.

Stacey Bollinger, Account Director in Maryland, said that when he started taking Wegovy last January, he had exhausted most other options for improving his physical health. She was prediabetic, her joints ached, and her asthma was flaring up. But she had been working with a nutritionist, eating a healthy diet, and doing regular strength and cardio exercises for about a year.

«I went in for my physical and it’s one of those things where I know the doctor will tell me I’m overweight. It’s not shocking,» she said. «I see it. I feel it physically. But also, I feel miserable. Let’s have a conversation about what options I have.»

Stacey Bollinger in the fall of 2021, prior to starting Wegovy.Courtesy Stacey Bollinger

At Wegovy, Bollinger said, he has lost more than 50 pounds, down from 266. He said he feels more energetic, his asthma is better controlled and his feet, ankles and knees don’t hurt at the end of the day. At a recent checkup, his blood work showed that she was no longer prediabetic.

«I really don’t think I would have had this loss without Wegovy,» he said.

Novo Nordisk describes Wegovy as a long-term treatment, noting that just as a patient with high blood pressure sees an increase after stopping the medication, people taking Wegovy may regain weight if they stop the medication.

«Obesity is a chronic, progressive and misunderstood disease that requires long-term medical treatment,» he said in a statement.

«A key misconception is that it is a disease of willpower, when in reality there is an underlying biology that prevents people from losing weight and keeping it off,» the company added. «Like any other chronic disease, such as high blood pressure or high cholesterol, obesity should be treated as such.»

Why has obesity become more common?

Semaglutide is part of a class of drugs called GLP-1 agonists, which mimic a hormone that sends signals to the brain when a person is full.

«This particular drug stimulates the pathway in your brain that tells you to eat less and store less, and then downregulates the pathway in your brain that tells you to eat more and store more,» said Dr. Fatima Cody Stanford. , an assistant professor of medicine at Massachusetts General Hospital.

More information about Ozempic and Wegovy

More important than inducing weight loss, he said, the drugs can reduce the risk of health problems associated with obesity, such as diabetes, heart disease, stroke and some types of cancer.

«Many people assume we’re going for a size» when prescribing the drugs, Stanford added. «I never look at a size with a patient. I’m looking at their health.»

Obesity rates have been increasing in the United States since the 1980s. In the four years prior to 1980, the obesity rate was 15% for adults and 5% for children and adolescents. Those numbers jumped to 42% and 20%, respectively, over the period between 2017 and early 2020, according to the report. Centers for Disease Control and Prevention.

The reasons for that increase are complex, but medical experts generally attribute it to interactions between genetics and social and environmental changes.

One of the main explanations for obesity is that bodies try to maintain a particular baseline, or set point, of fat. At the population level, changes in the environment and behaviors have increased fat set points over time, Jastreboff said.

On average, people are now less physically active, eating more processed foods or larger portions, getting less sleep, and experiencing more stress than past generations, which can cause bodies to maintain a higher fat base.

That could explain why some people struggle to lose weight through lifestyle changes, or why others gain weight back through dieting.

Individual genes can determine how the body responds to external factors, so they can trigger obesity in some, but not in others. A theory known as «thrifty genotype hypothesisfor example, it suggests that some people store more energy as fat thanks to genes inherited from ancestors who needed that storage to survive famines.

Ozempic and Wegovy can help reduce a person’s fat set point, Jastreboff said. Semaglutide was shown in trials to reduce body weight by about 15%. On the contrary, a 2018 study found that, at best, diet, exercise, and behavioral counseling help people lose an average of 5% to 10% of their body weight.

«Some people can lose weight with behavior changes alone, but others can’t. Why do we have a problem with that?» said James Zervios, vice president of the nonprofit advocacy organization Obesity Action Coalition. «Why do we keep leaning to the side and say, ‘Well, we’re just going to tell someone to journal their food. We’re just going to tell someone to go for a walk at night after dinner.'» . If that works, you wouldn’t be dealing with the number of people experiencing obesity or severe obesity right now.»

Debates continue over obesity drugs

However, the notion that obesity should be addressed with diet and exercise alone remains widespread.

«Unfortunately, the public view is that if a person is on medication, they’ve taken the easy path to losing weight,» said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut.

Even some doctors are still not comfortable prescribing the new obesity drugs. Stigma can influence those decisions: Investigation has shown that physicians harbor similar levels of weight bias as the general population, and medical school training rarely addresses weight stigma, Puhl said.

Stacey Bollinger during the summer of 2022, in the middle of year 1 of wegovy.
Stacey Bollinger last summer, halfway through her first year on Wegovy.Courtesy Stacey Bollinger

On the other side of the coin, some people active in the obesity acceptance movement say that many of those considered «overweight» by medical definitions are healthy and do not need interventions.

TO study 2017 of 3.5 million UK health records found that although obesity increased people’s risk of diabetes, high blood pressure or high cholesterol, around 15% of people with obesity did not have those conditions.

In a BuzzFeed editorial last monthEvette Dionne, a cultural journalist and columnist for MSNBC, suggested that the medical establishment is now more focused on weight-loss drugs than fixing systemic problems related to obesity risk, such as food deserts.

«Objectively, it’s a good move to decouple the idea of ​​moral virtue from being fat. Yet in these attempts to complicate our cultural understanding of fat, the remedy remains the same: lose weight rather than change the ways we our society interacts with and treats fat people,» she wrote.

Puhl said that while discussions about obesity treatment are important, decisions about drug use should be between a patient and a doctor.

«We don’t want drugs to be used as a default strategy, and we want the risks and side effects to be considered,» he said. «But we also have to respect that, for some people, medications can be very helpful.»