The answer to obesity may be Wegovy, but it leaves me depressed
Like Britain, America has always had regional differences in the shape and habits of its populace. Thus, as a child on the East Coast, in a New England town where people played tennis and swam all summer, I don’t remember seeing much obesity. But as soon as we travelled south or west, it was obvious that the enormous, delicious and, at that time, cheap national cuisine – squidgy folds of sugar, corn syrup, fat and salt – was having a lethal effect, especially combined with the reliance on driving everywhere.
And the problem has only got worse: there are now more than 100 million obese adult Americans, which is around 40 per cent of the population.
Like many other American trends, from automatic cars to wokeness, we in Britain have imported the lovely, fatty food of America – and the weight crisis that goes with it. The Health Survey for England in 2021 estimated around 26 per cent of adults are obese and a further 38 per cent are overweight.
Now we are mimicking the American answer to all ills too: drugs. Don’t get me wrong. The arrival of Wegovy – a safe injectable that all but guarantees substantial, effortless weight loss – is like a dream come true. How we have fantasised about such a drug, which last week was announced as approved for NHS use. The weekly shot of semaglutide, which imitates the gut hormone that makes us feel full, will be offered to people who are obese and who have at least one weight-related condition, from high cholesterol to sleep apnea.
I have mixed feelings about Wegovy. On one hand, finding a way to help people lose weight that doesn’t depend on radical lifestyle change or willpower or indeed a lobotomy, which would be required to stop people like me passionately loving cookies (and eating too many of them), is clearly a great thing. There is nothing good about being fat. It is bad for you and it often goes with a panoply of selfesteem issues.
While there is no excuse for fat-shaming, we should not kid ourselves that being obese is just another identity. And so long as we live in a country whose health care revolves around the NHS, which simply cannot cope as is, then the only way forward is to reduce the burden on it.
This is an efficient and realistic way to do it. Unlike its alternatives, this is going to work.
But there is rather a lot to mourn about the arrival of Wegovy. Americans are good at insulating themselves from nature. They led the way with warmer houses and mod-cons, which were great, and the envy of the Western world. But then they went too far, never walking when they could drive, never opening a window when they could yank on the AC, getting plastic surgery to fight the facts of time. Killing off hunger with a drug to control weight is just the latest such step.
But it’s not very British. Indeed, however shambolic and patchy the NHS, British medicine is known for intelligence, investigating root causes or letting bodies sort themselves out before slapping people with drugs. And because of the NHS, GPs are far more hesitant and sparing about prescribing pills than those in the for-profit American system. In America, as we know all too well from the opioid crisis, the recourse to meds is utterly ingrained in doctors’ incentive structure, leading to greater ill-health that, ironically, comes from eating handfuls of pills instead of living better.
In Britain, attempts to deal with obesity on the NHS have until now involved help with diet and exercise, largely through information and encouragement. This is the right idea, but the sheer force of gut biology combined with the neurology of over-eating easily overpowers helpful tips for leading a healthier life. Getting the millions who need help on the right track would involve both therapy and personal training.
But there’s always a risk, when bemoaning Britain’s overzealous import of American culture of slipping into downright anti-Americanism, and forgetting the good, even wonderful, imports from our transatlantic friends.
One can argue that it is a testament to huge improvements that we have this problem at all. We are only fat, like Americans, because we have American problems: too much tasty, fattening, affordable nosh. And while we may shake our heads at this, it’s worth remembering what life was like for most people throughout British history: full of hunger and deprivation. There was no obesity crisis in 1904 or 1943 or
One can argue it is a testament to huge improvements that obesity is a problem
1954 (the year rationing ended), but people would have killed for the kind of options cheaply available today.
And we are fat, like Americans, because, like them, we have a dynamic capitalist economy, which gives us a marketplace in which a bevy of fast-food joints, bakeries, and other purveyors of fatty deliciousness thrive. But if tens of millions of us wind up dead from all this lovely choice, then it rather ruins its upsides.
We need to strike a balance between choice and health. Wegovy is one solution to a problem that has long plagued us: let’s just hope it doesn’t become yet another problem in itself.