The Ozempic craze

Emile Zola’s 1873 novel “The Belly of Paris” is centred around the capital’s once large food market of Les Halles which sadly moved to the suburbs in 1969.

The book explores themes of inequality at a time when France was gripped by another wave of revolutionary fervour; the Paris Commune had flared brightly, if briefly, only two years earlier. Zola depicts many of the bourgeois characters as well fed, gorging on the delights of the market while the thin, poor characters scrounge around for scraps. It is why the alternate name for the book is “The Fat and the Thin”.

In the century that followed this depiction of the rich and poor has slowly flipped so that now in the 21st century it is the working classes who are more likely to be fat. Being too tired or too busy to exercise or to cook healthy meals they often resort to junk food - burgers, fried chicken or pizza.

The kale eating rich, on the other hand, are slimmer and healthier, and have plenty of leisure time to exercise regularly.

These are not lazy stereotypes. The United States National Center for Health Statistics reported in 2018, that 42.4% of adults with an income below $25,000 were obese, compared to 24.9% of adults with an income over $75,000 (This is according to Gemini, formerly Bard’s Artificial Intelligence app as are all the statistics cited here). And not only do the rich live healthier lifestyles they live longer. The richest 1% of American men live on average 14.6 years longer than the poorest 1%.

Being thin is now seen as a virtue, a symbol of discipline while being fat is a vice suggesting lassitude.

The problem is that keeping slim can be hard work. Modern humans are conditioned to crave fatty foods and thanks to advertising we tend to overeat. Exercise too is often monotonous and time consuming. That is why most people who start diets end up putting on back the weight they lost.

If only there was a magic drug that could help you lose and keep off the pounds with none of the effort….

In 1984 Dr. Daniel Drucker, a Canadian endocrinologist identified a gut hormone called glucagon-like peptide-1 (GLP-1) which helps regulate blood sugar. This had the potential to be a source for a breakthrough treatment for diabetes, a disease affecting some 500 million people worldwide. The other role of GLP-1 is that it regulates appetite.

It would be many years later and involve many clever scientists before a stable, deliverable form of GLP-1 was developed by the Norwegian pharmaceutical company Novo Nordisk.

The drug Ozempic was finally approved in

2017 for patients with Type 2 diabetes and it has transformed many of their lives. By 2021 further trials had also established its effectiveness in weight loss among obese patients and FDA approval for that was granted in 2023. Sales exploded with year on year growth of 68%. However it became pretty clear that much of the demand was and is not coming from diabetic patients nor even those greatly overweight, but from those with the wherewithal to afford to pay what can annually cost up to US$40,000 without insurance.

This has raised some ethical issues. Firstly patients who genuinely need the drug for their diabetes have experienced shortages, and secondly there is the larger moral question about whether access to such a drug should be so dependent on one’s income.

Meanwhile Novo Nordisk’s share price has risen five fold since 2019 and there has also been a rather odd economic fallout. Walmart which operates pharmacies in its stores saw a shrinkage in the food baskets of customers taking the drug. The Investment bank Morgan Stanley is estimating that some 24 million people could be taking a version of GLP-1 by 2035, likely meaning a decline in sales of snack foods. Gym memberships may also decline although loss of muscle mass is one side effect which exercise can address.

Finally over the decades of modern medicine there have been several drugs that were once considered miracle cures but ended up causing catastrophic health issues. In the 1950s the German drug

Thalidomide, prescribed to ease morning sickness in pregnant women, caused a surge in severely deformed babies. Perhaps the worst case has been that of Oxycontin, a slow acting synthetic opioid developed by the Sackler family, that has caused the deaths of tens of thousands of Americans.

We would expect the FDA and other regulatory bodies worldwide have learnt their lessons and done their research on Ozempic and similar drugs. And it might be the case that any side effects will be statistically outweighed by those taking it losing significant amounts of weight that will improve their cardiovascular health.

Naturally the Ozempic craze has hit Guyana albeit surreptitiously and not necessarily for the right reasons. Let us hope that the government finds a way to provide it for those who are really in need the estimated 60,000 diabetics among us. Many of them live very circumscribed and depressed lives while an estimated 600 die each year from related diseases such as kidney failure.

Perhaps the administration could call on Novo Nordisk for help in improving and extending the lives of our fellow Guyanese.