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Few aspects of being human have generated more judgment, scorn and condemnation than a person’s size, shape and weight – particularly if you happen to be female. As late as 2022, the Times’s columnist Matthew Parris published a column headlined “Fat shaming is the only way to beat the obesity crisis” in which he attributed Britain’s “losing battle with fat” to society’s failure to goad and stigmatise the overweight into finally, shamefacedly, eating less. The tendency to equate excess weight with poor character (and thinness with grit and self-control) treats obesity as a moral as well as physical failing – less a disease than a lifestyle choice.
One of the great strengths of Reuters journalist Aimee Donnellan’s first book is its insistence on framing the discovery of the new weight-loss drugs within the fraught social and cultural context of beauty norms, body image and health. For those who need them, weekly injections of Ozempic, Wegovy or Mounjaro can be revolutionary. Yet for every person with diabetes or obesity taking the drugs to improve their health, others – neither obese nor diabetic – are obtaining them to get “beach-body” ready, fit into smaller dresses, or attain the slender aesthetic social media demands of them. Small wonder some commentators have likened the injections to “an eating disorder in a pen”.
Donnellan opens the book with a case in point, a poignant interview with “Sarah”, a 34-year-old marketing executive from Michigan. She recounts a summer of unprecedented success at work – suddenly being included in important meetings, being assigned new management responsibilities and receiving a raise. Yet nothing had changed about her behaviour at work. It was her appearance – after six months on Ozempic – that had undergone a metamorphosis. In the eyes of her employers, shedding five stone (32kg) of weight had transformed her worth: Sarah mattered more because she weighed less.
Like all great tales of scientific discovery, the weight loss saga is rich in serendipity, rivalry and obsession – all of which Donnellan recounts with relish. Wonderfully, it includes a starring role for the only venomous lizard in the US, the Gila monster, though I will refrain from spoilers here. Another key protagonist is Svetlana Mojsov, a young Macedonian immigrant to the US who arrived at New York’s Rockefeller University in 1972 to do post-grad chemistry. (Today, one imagines, ICE would probably deport her.) At this time, the causes of obesity were seen as self-evident – eating too much and exercising too little – and therefore unfit for serious scientific inquiry. Mojsov disagreed. She was fascinated by why some people seemed to feel sated earlier than others, or metabolised food more quickly. Her research – for which she is tipped to win a future Nobel prize – successfully engineered a synthetic version of a natural hormone, glucagon-like peptide (GLP-1), which helps control blood sugar.
Scientists at Danish pharma giant Novo Nordisk seized on GLP-1 as a potential new treatment for diabetes. Decades of effort at last culminated in a drug, semaglutide, that people with diabetes could administer once weekly, unlike multiple daily injections of insulin. But the drug trials revealed something unprecedented. Not only did semaglutide control blood sugar beautifully, it caused participants to lose up to 20% of their body weight, seemingly without even trying. Novo Nordisk had stumbled across the holy grail – a safe chemical treatment for obesity that worked to astonishing effect. As word of the miracle jab leaked, celebrities began to seek it out. When a newly svelte Oprah Winfrey told her podcast fans that taking the drug was the cause, suddenly everyone was clamouring for Ozempic. That this had occurred in her lifetime, said Winfrey, “felt like relief, like redemption, like a gift”. It was certainly a gift to Novo Nordisk, whose market value is now, thanks to Ozempic, bigger than the entire GDP of Norway.
Commendably, Donnellan is careful not to treat the GLP-1 drugs an unalloyed good. She addresses their side-effects, such as severe nausea, and their use by non-obese people to the potential detriment of their health. The one omission is that she doesn’t dig into what is surely the most intriguing aspect of weight-loss drugs: incredibly, scientists simply don’t know why they excel at treating obesity, beyond the fact that GLP-1 receptors are present in the brain. It appears that saturating the brain with abnormally high levels of the hormone dials down people’s craving for food. A lifetime of incessant chatter about eating is dampened. Restraint becomes easy, effortless. Does this mean drugs like Ozempic will be licensed in the future to treat drug, alcohol, gambling and sex addiction? What would that do to our concept of free will? Ozempic is a miracle drug, a rebuke to a century of condemnation of those who are obese, and a profound challenge to the very definition of what it means to be human. Watch this space.
