Honestly with Bari Weiss

Podcast Recap: Will Ozempic solve obesity in America? A debate

May 4, 2023

Podcast length - 1 hr 18 min

In this often heated Honestly with Bari Weiss podcast, Dr. Chika Anekwe (CA), an obesity medicine physician at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, Dr. Vinay Prasad (VP), a hematologist-oncologist and professor at the University of California San Francisco, and Calley Means (CM), a former food and pharmaceutical consultant, who now works to expose their practices offer divergent perspectives on whether Ozempic, a once-weekly injectable medication formulated to help adults with type 2 diabetes manage their blood sugar, can solve America's obesity epidemic.

How did we get to a place where more than 40% of people in this country are obese?

CM: Eight of the 10 leading causes of death are food-related conditions and obesity is not really the cause or really the disease to be treated as much as it's a symptom. The reason we're getting sick, the reason life expectancy is going down is because we're feeding ourselves with processed food—processed, highly available foods. Those foods taste better; they're more pleasurable than eating an apple; they are marketed heavily.

VP: Sugar-sweetened beverages are a major problem that’s not been adequately tackled. All of the incentives in farming, agriculture, nutrition, and school lunches have all favored cheap, empty calories. And combining that with taking us out of a lifestyle where we get any exercise, I think, has been catastrophic. For all those reasons, I think we’re in this predicament where obesity is a huge problem.

CA: 'Lifestyle creep' . . . You really don't even have to leave your house anymore to do anything. . . plus the added stress that we're dealing with in the modern world, [as well as] social media pressures. There are so many things that are kind of altering our realities and our awareness and really not allowing us to kind of go back to those basic lifestyle habits that we discussed earlier: diet, exercise, stress management, sleep.

Is obesity a disease or a symptom of lifestyle choices?

CA: When you start to look at the examples of individuals who were actually following [obesity management] guidance and those treatment options, those lifestyle behavioral interventions but are not having success in reducing their body weight, that's when you start to understand some of the other underlying contributors. And as more research has come out in regard to the brain-gut connection, the hormonal axis, the appetite control regulation processes, we start to understand more of the complexity that goes on behind weight management and understand some of the physiological barriers that prevent people from just eating less or just moving more to solve their problem.

There are many components. . . So that's where this quote comes into play: 'Genetics loads the gun and then the environment pulls the trigger.' . . . our environment has really capitalized on the underlying genetic susceptibility to excess body weight. It's been there the whole time, but now we're doing more and more things in our day-to-day lives to augment and make the body weight excess increase.  

VP: It is clear that the genetic studies do show links, but . . . I think you just can't get around that central thesis, which is that genetics did not change from 1960 to now. But obesity has changed a lot. . . I think the financial bias does play a role here. How many [studies] do we actually have—really large, well done, randomized studies? A tiny fraction, maybe a few dozen? That's the bias of the system, which is that we're not even studying this an ounce of what we ought to be because we're so complacent in this agricultural subsidy system. 

CM: The $4-trillion healthcare system and the $6-million food system is slanted against patients. . . We should not be conducting thousands of nutrition studies. We should not be spending on marginal drugs for metabolic conditions like obesity and Alzheimer's. . . Sugar consumption has gone up 100x in 100 years, and our food [has] literally been weaponized by a highly addictive drug. . . Sugar is a highly addictive drug that has been exponentially added to our food. It's not hunger we feel, it's addiction.

What role does “Big Pharma and Big Food” play in the obesity epidemic?

CM: I think we're being gaslighted to think that this is complicated. It's happening because of food. Early in my career, I consulted for food and pharma companies and what was very clear to me is that there's a devil's bargain between food and pharma that has occurred over the past 50 years. Food companies want food to be cheaper and more addictive. We've totally changed our food supply to three core ingredients, added sugar, highly processed grains, which turn into sugar in the bloodstream and make the food more addictive, and inflammatory seed oils. . .

The medical system is based on interventions, on sick folks, and people have been getting very sick on food. The experiment of medicalizing chronic conditions over the past 50 years has been an utter failure. The more statins we prescribe, the more heart disease goes up. The more metformin we prescribe, the more diabetes goes up; the more SSRIs we describe, the more depression goes up. . .

VP: The answer is somehow going to be more than just dietary advice to really cut the head off the snake. I think you do have to reform lobbying in Congress. . .I think we have to start thinking about the built environment. Should everything be a sprawling suburb [resulting in people being in their] cars all day. These are really deep problems and that’s why I think simply telling people eat less sugar and avoid seed oil. . . that's not going to get you that far.

CA: Well, I think also this comes down to the question of the decision makers, the policymakers, [and] physicians are just one piece of that puzzle. . .Physicians play a role in some degree in terms of what we're saying day-to-day, but we don't really have the power as prescribers or providers of healthcare to kind of set the recommendations that are coming up from the top down.

Should children over 12 be approved to take Ozempic and what might the implications be of such a choice?

CM: This is what concerns me about the drug is that if you have a child and they're eating inflammatory food, they're eating processed food and you go into Dr. Anekwe's clinic and they say this is a disease, we're going to treat you. . . this is a treatment for life. That child is actually almost being instructed that diet doesn't matter. They're gonna lose weight, but they're continuing to feed themselves with processed food. And the reason we're getting sick, the reason life expectancy is going down is because we're feeding ourselves with processed food. So, actually this is a moral hazard. It's actually not attacking the problem.

I just want to [add] a quick point about the gastrointestinal dysfunction. 95% percent of the serotonin in our body, which regulates our outlook on the world, that's not produced in the brain, that's produced in the gut. So, you're also seeing an increase in depression on semaglutide and [that’s] very predictable because any gastrointestinal issue is generally associated with depression because that's where the serotonin is made. So, we're absolutely . . . gonna see an increase in depression and potentially suicide among teens as we mass prescribe this drug because it's literally acting on the center in ways we don't fully understand.

Treatments that silo diseases don't work. . .I think that is a statement we can make when we look at the complete and utter failure of, I would say, close to every chronic disease treatment to lower the chronic disease. . . I think we can really use this moment to not throw up our hands but ring the alarm bell, and I would hope medical leaders who have a voice say let's hold off on mass prescribing this to teens.

CA: Well, what we have for long-term data so far for the GLP-1 agonists is that they've shown a decreased risk in CV outcomes, including. . . both fatal and non-fatal stroke, and heart attacks. In terms of the serotonin piece, yeah, I think there's definitely more work to be done in terms of truly elucidating the long-term effects. There hasn't been, so far, [a report about] an increased risk of suicidality or suicidal ideation. It's not something I've seen in my practice, either. . .

We know that there are risks associated with being at an excess weight—metabolic risks and risks of other comorbid conditions developing. And so, if you're mitigating one risk and potentially increasing another, it's up to that discussion between the patient and the doctor to decide if it's worth it to pursue that.

VP: I think the AAP got a little bit ahead of the evidence. . .They have a 68- week study of 200 kids who are 12 and up who are at the 95th percentile. They showed me that if they take this product for 68 weeks, they're gonna have lower weight than if they don't take this product. But what I have no idea [about] is what happens when you extrapolate this to kids in the community who may not take it with the religious fervor of a clinical study. They may take it, [or] forget to take it. It's an injectable product to inject themselves. They may not take it. Their weight may rebound, they may have yo-yo gains on this product because they're not taking it exactly like the people on the trial.

I don't know what happens if you take it for five years, 10 years, 20 years, 40 years, 60 years. . . I think there’s so many uncertainties. And so, I would not extrapolate the cardiovascular data from diabetics to young children. Any outcome beyond two or three years with Ozempic in a 12-year-old is simply unknown. I know they lose weight. Well, then why are we mass prescribing it? I agree it shouldn't be. . .I actually strongly disagree.

Is Ozempic a long-term approach to weight loss or a quick fix?

CM: Well, healthcare is now the largest and the fastest growing industry in the United States. And you know, I come from tech where usually innovations lower cost and [enable] better outcomes. [In] healthcare. . . the faster it grows, the worse outcomes we get. And this is another example [of] the biggest problem in healthcare, which is that everyone's getting sick primarily because of food. And then we have these band-aid cures. Once people get sick, that's how the healthcare system makes money. That is how. . . 95% of dollars in the medical system work. It is interventions on people that are already sick. A patient who comes in the clinic learns healthy habits, loses weight, leaves. That's not a profitable patient.

What we have to understand with Ozempic is that this is a lifetime customer, a 13-year-old. These incentives, the incentives of Ozempic, which we're all being told is going to be the most profitable and highest selling drug in American history, are extremely problematic. And I think they're blinding us from what the real problem is, which is that we're feeding our children horrible food and that's causing a host of issues. . .

CA: We've been using [them], what we call anti-obesity medications, for decades. Some have varying levels of success and varying levels of efficacy . . .but the amount of weight loss that you can see with the injectables, semaglutide, in particular, is just way beyond what other medications have been able to achieve. So, the trial results with semaglutide showed the average weight loss was about 15% body weight compared to some of the other oral medications, which showed maybe like 3 to 5 at the most, I'd say, maybe 7% body weight reduction. . .

There's a specific PowerPoint slide that we show to every patient that comes into the weight center, which outlines the intensity and the escalation of treatment that they're going to be offered. . . [At] the base of the pyramid are all the lifestyle interventions that we should all be doing, whether you struggle with weight management or not—dietary intake, increasing your physical activity, stress management, adequate sleep. . .Of course, we have medication options and then bariatric surgical options. Each of these interventions is targeted towards a particular group of people based on their starting weight, BMI and metabolic conditions. . .

VP: Even if it's the case that these sorts of factors that Calley is rightly pointing out have led to the rise of obesity, I think we do have to acknowledge that diet and lifestyle has really had a tough path in the biomedical literature, going back to the 1990s to randomized trials on obese youth. We haven't had a lot of success. Now, I think there is an important problem of financial conflict, and I don't want to disparage individuals. I don't think that's the root of it. I think the root is that because we have a system the way it's constructed, we have tremendous incentive to build pharmaceutical products rather than really invest in broader studies of different diet and lifestyle interventions, different levels of intensity. But I think to Chika's point, we've tried very hard, and nothing has really worked as well as this drug.


Any views, thoughts, and opinions expressed in this podcast recap are solely that of the host and guests and do not reflect the views, opinions, policies, or position of epocrates and athenahealth.

Source:

Honestly with Bari Weiss. (2023, Feb 15). Will Ozempic solve obesity in America? A debate. https://podcasts.apple.com/us/podcast/will-ozempic-solve-obesity-in-america-a-debate/id1570872415?i=1000599769750