Appetite suppressant drugs are the latest experiment to reduce obesity. Are they really the long-term answer to this problem, the modern self-inflicted global killer, far more dangerous than Covid? Or will they dull people’s psyche to the root of the issue, a deeply embedded addiction to ultra-processed food? Facing up to this deadly diet and changing food habits perhaps remains the real solution. If people are to make better choices, they need to embrace education on the facts. At the moment UK food strategies fall short.
FAT FACTS
Over half the world population, excluding under 5s, will be obese or overweight by 2035 according to recent projections by the World Obesity Federation; and the global annual financial cost by then will be some $4 trillion. That cost excludes accounting for the loss of quality of life, mental anguish and so on. The UK is already the fattest significant country in Europe; and it is estimated by medical reports that even in the NHS 25% of nurses are obese, and over half the staff overweight, which is more than slightly ironic. That what should be the most health-conscious section of society cannot address the issue perhaps tells us the truth about its pervasiveness. While some 64% of UK adults are overweight or obese, some 38% of children are overweight in the UK by the time they are 10-11 years old, and some 23.5% are obese. A Sherbhert article in May 2020 argued for a national obesity strategy, which it was hoped would emerge galvanised by the fact that the obese segment of the UK populace were especially vulnerable to Covid, as they are to so many ailments. To what degree could perhaps poor work productivity be down to poor health? – Many commentators are connecting the two, and it is clear that obesity is a major contributor to poor health outcomes including mental conditions. Any national food strategy must surely incorporate or mainly comprise an anti-obesity series of measures.
Obesity is a major cause of illness, especially diabetes, strokes and heart disease; cardiovascular disease accounts for over 25% of annual UK deaths, about 160,000, 80% of which are considered avoidable: that is vast numbers of people are dying too young as a result of being fat. Obesity makes people more susceptible to numerous cancers including breast and colon cancer. Obesity is far more deadly and far more damaging to the quality of life than Covid. Yet during the pandemic people obsessed about the awful number of deaths caused by Covid, mostly of very old people for whom death was already close, and the country , like most Western countries, was willing to mortgage its future to the hilt to combat the pandemic. Covid is evidently hard to avoid, but obesity is mostly a self-inflicted wound made out of poor choices.
On the other hand, worldwide obesity is not even categorised as unacceptable, let alone to be fought tooth and nail. It is clearly accepted as normal and many might consider it “triggering” and mentally damaging to suggest a person is too fat and needs to change: doctors are only now being encouraged a little bit to suggest that the overweight need to fix their food intakes and lifestyle, treading on eggshells. Sherbhert addressed this topic on 22 September 2022.
It seems generally scientifically accepted that ultra processed food, and a wide almost addiction to it, is the root cause of the obesity pandemic. As in an earlier Sherbhert article, let’s call such food “non-food”. Most home deliveries and take-aways are in this category as are store sold ready meals, and nearly all snacks and fizzy drinks. Not only do vast numbers of adults in the UK and most Western countries live largely off non-food, but parents provide their children with vast quantities of non-food, thus dooming many children to not just the exigencies associated in life with excess weight, but in many cases an early death. Some parents insist on their children taking to school packed lunch made up largely of non-food. In an article on 1 February 2023, the Times reported an Imperial College London survey, the largest ever of its kind, which established that ultra-processed food, such as crisps, frozen pizzas and sweetened yoghurts, increased cancer deaths materially with “the average UK person consuming more than half their daily energy intake from ultra-processed foods”. Consuming non-food is a hard addiction to break it seems, though it is hard to assess how many people really try.
UK FOOD STRATEGIES
Henry Dimbleby’s National Food Strategy report, an independent review commissioned by UKGOV in 2018, contains 14 recommendations. Three of these are under the heading “Escape the junk food cycle and protect the NHS” and are aimed at replacing a considerable proportion of the UK junk food diet with healthier foods. It was not especially radical. The Government’s resultant food strategy in 2022 includes a few of the suggested initiatives, but as far as non-food is concerned there are no substantial measures to reduce consumption: in fact, the approach taken was “to determine their [ultra-processed foods] exact role in driving obesity further research is needed; and a new initiative “the Diet & Health Research Club” will help address the gap”. An opportunity truly squandered, and in effect an urgent, but difficult, problem deferred. Outrageous?
The Mayor of London, Sadiq Khan, has published a London Food Strategy which recognises the obesity problem, which in London is worse than the UK average, and includes some ideas, albeit limited, on how to promote “good food”. It is a somewhat self-serving paper.
Both strategies focus considerable attention on school food initiatives, understandably as it is through schools in meals and education that good food can be promoted, in a way within authorities’ control. Poorer children, most at risk, can be easily identified in this way and perhaps helped. But as so often happens, schools are being asked to be parents which is not their role. Children eat most of their food at home or when otherwise away from school, and so the war on obesity will be lost unless the battle against non-foods is fought with adults and parents as the focus, requiring them to take responsibility.
SO, WHAT THE FAT?
Despite all the knowledge about and harm caused by obesity and non-foods, governments around the world, perhaps in cahoots with a powerful lobbying processed food industry, and supermarket sector, are choosing to do almost nothing to slow the obesity pandemic. Obesity is well established in most Western rich nations, but the growth of the obesity pandemic is at its greatest in poor and middle-income countries. Again, the root cause is the spread of Western non-foods.
There is a strong freedom argument, that people should be free to eat as they want, whatever the human cost. Even if that is accepted, would it not be better if people were well informed about the consequences of their actions, if not for themselves, then their children? Does society not have a safeguarding duty at least to children: for example, parents are not encouraged to allow infant children to drink gin or to smoke but they are not impeded from pumping in non-foods.? Are non-foods that different? There is an argument that making non-food less available, taxed heavily perhaps like tobacco and alcohol, or making it demonised would hurt the poorer in society more than the wealthy, presumably because the wealthy may be less inclined to eat non-food or assimilate advice more enthusiastically, though Sherbhert has no evidence of that. But it is a strange argument that leads to the poorer therefore being left to kill themselves with non-food instead of discouraging that, because it offends a dogma of inequality. Perhaps a clampdown on non-food would cost short term votes and so it is a political hot potato: if so, that reinforces the proposition so prevalent today that democracies are fettered by a political cowardice and short-termism that has displaced the courage needed to act in the long-term interests, of a nation.
The fast and processed food industry, and supermarkets, make profits at the expense of consumers’ health, knowingly. Is it not reasonably clear that, to tackle obesity and associated consequences, non-foods must be strongly discouraged? If so, attractive, affordable and healthy food options must replace them. Such foods already exist. If a national food strategy promoted them, even making them more affordable, adults could be incentivised to minimise non-foods. The current government food voucher scheme and the Healthy Start Scheme, limited to essential foods, are a start.
However, in fact, there may now be the ideal excuse which may distract from the tough long-term decision to wean a nation off non-foods, and that is the potential of GLP-1 Agonists, drugs which may make some groups of people very wealthy. Enter the pharmaceutical industry to join the lobbyists to keep people fat.
GLP-1 AGONISTS – PANACEA OR DANGEROUS DISTRACTION
In recent publicity, drugs known as GLP-1 Agonists, such as brands Wegovy (semaglutide) and Mounjaro (tirzepatide) are being hailed as a potential game-changer in tackling obesity. Weekly injections of such drugs, in use in growing volumes in the U.S.A. but not yet the UK or the rest of Europe, over a course for a period of months, have produced material weight loss results. They are appetite suppressants, put simply keeping the stomach fuller for longer. If these take off in a big way, the global market could be in the many tens of billions of dollars a year, comparable perhaps to cancer drugs. These new drugs are under review in the UK.
Given usage of these drugs is at a fairly early stage, there is concern to gain understanding of side effects. Vomiting and diarrhoea have been identified as possible negative effects. But the Economist for example in its 4 March edition, under the “Obesity” section, suggests that if these drugs can materially impact obesity for millions of people “they should be welcomed with open arms”, suggesting too that many people may take considerable risks to benefit from serious weight loss impacts.
Given the potential for such drugs to earn billions of dollars for pharmaceutical companies, one might expect a wave of positive promotions of the benefits, in medical and other journals and media. It will be important, if the public are to make a proper assessment of the drugs, benefits and risks, that the source or sponsorship of publicity will need full disclosure, for example if published or supported by those with a direct or indirect financial interest in the success of the products.
It is possible that, if the data provides sufficient positive evidence, these could become, like statins, “drugs for life”. However, the lessons of the past must be kept front of mind. Drug dependence can become dangerous. For example, for years millions of people have been hooked on antidepressant drugs to fight mental health issues. Now the need to unhook is getting a lot of traction, and it is appreciated that excessive drugs may not be the best answer. Anti-biotics have been recklessly over hyped and prescribed, to keep patients quiet, and now their effectiveness, so crucial in modern medicine, is under threat. A number of drugs seem to suppress the impact of a problem without dealing with the root cause. Perhaps more drugs are not the ideal answer to help people make better dietary choices.
If an overweight person, having had a course of these new drugs has lost weight, and is happy, possibly the knowledge of this panacea may mean simply that they continue with or return to non-foods knowing the drug can be taken later to solve the recurring problem. These drugs will do nothing to help prevent children becoming obese, and could make parents even more careless of addicting their offspring to non-food, believing there is the magic cure. These wonder drugs, enticing and indeed beneficial, carry the risk that they will justify avoidance of tough decisions.
BEWARE QUICK FIXES – THE OBESITY WAR HAS MULTIPLE FRONTS
Governments going to war on obesity, largely a war on non-foods, has perhaps to be a long term project backed by all political parties for example in the UK. It will not be popular at first with non-food addicts, and will have a cost up front, but non-food profiteers could be made to shoulder some of that cost. Intense lobby groups and the media pursuing an agenda of negativism could jeopardise efforts to change for the better. Nanny State arguments will be dispensed as if a religious mantra, obscuring facts and real information. Freedom to choose will have to be weighed with other social needs. The anti-tobacco campaigns can provide precedent and experience to hasten action. Perhaps the biggest lesson to be learnt from the fight against tobacco is that the resistance to action was allowed to persist for too many years.
In the U.S., a Wegovy course costs about $1300, not cheap, and so if made widely available for free would cost the State billions: but, for example, in the UK that could be spun again as a government sparing no expense, that is taxpayers’ money, to look after mainly the poorest in society. However, if these new drugs can seriously impact the obesity pandemic, a global and growing problem, then they surely will form a powerful addition to the armoury, as long as other initiatives are fully promoted too.
But does not perhaps the first weapon have to be a national and global resolve which accepts that obesity, and so non-food, is an evil to be tackled vigorously, in the interests of human beings, their longevity, quality of life and economic prosperity in the long run. Proper consistent information campaigns with factually unassailable information should be at the heart. Visual portrayal of the nasty effects of diseases brought on by obesity and non-foods would perhaps be influential, just as they are on tobacco products. Explicit and prominent warnings on non-food packaging and menus are necessary. The conspiracy theorists will seek to denigrate a campaign, maybe supported, if not openly perhaps indirectly, by those for whom non-food is their deep profit mine. Schools must educate, not brainwash, so that children will see that non-food is shortening their parents’ lives and will seriously harm their own. Promotion of healthy foods as opposed to non-foods would be equally important, perhaps with subsidies to give incentives. To achieve impact, the modern and so harmful tendency not to dare even discuss difficult topics for fear of people being upset must be overcome.
Shying away from a serious anti-obesity strategy and real action by any government is surely reprehensible, cowardly and reckless towards citizens. It would be good if the UK could lead the world in tackling this self-inflicted deadly pandemic, but it means a no-nonsense public denouncing of non-foods and a positively healthy national food strategy.
See other relevant Sherbhert articles:-
Balance and Food – People, Planet, Plants and Processed – Non-Food, Obesity and Mortality – Time For a National Diet Strategy – Families, Graft and Fatness – Calling a Shovel a Spade
