Eat, Inject, Repeat: A Recipe for Disaster

“Eat Inject Repeat” reads the cover of The Economist this week. The notion that such an approach could actually be successful in “curing obesity, worldwide” flies in the face of all that we have learned about obesity and weight loss over the last 50 years and ignores the overmedication crisis that plagues our society today.

Have we learned nothing from the past?

If people struggling with obesity were to continue eating as they were, injecting GLP-1 drugs like Ozempic, and repeating the process, the result would be lifelong use of a drug class where the long-term effects are simply not known. This could lead to decades of treatment, especially as use of these drugs becomes more common in adolescents.

For example, a recent study on this class of drugs found an increased risk of thyroid cancer in humans, especially after 1-3 years of use. The effects beyond 3 years of use are not known, but the trend is certainly concerning. Another recent report found a 3.5-fold higher rate of intestinal obstruction in patients using GLP-1 drugs.

We have been down this road before. In the 1990s, “fen-phen” (a combination drug of fenfluramine and phentermine) grew in popularity after clinical trials showed impressive weight loss after a year of use. However, it soon became very clear that long-term use could lead to damage to the heart’s valves, leading the FDA to take the drug off the market in 1997.

Unfortunately, clinical trials are rarely long enough to elucidate all the potential issues with chronic use of drugs with powerful therapeutic effects, especially those that alter hormonal pathways like the GLP-1s. It is only after they are used in a real world setting that these issues come to light. That is precisely the moment we are in today.

Yet, there is an even deeper problem that the rise of weight loss drugs underscores: overmedication.

With the rise of telemedicine, it has never been easier to get access to prescription drugs. From opioids and stimulants to the GLP-1 agonists, all it takes is a short virtual visit with a physician to get a prescription, with the drugs arriving at your doorstep shortly thereafter. For some, this has been a boon, but for many others, it has led to harmful side effects and widespread drug shortages. Clearly, caution needs to be exercised, especially with drugs that will require lifelong use.

So, what is a more responsible way forward?

Clearly, drugs are and should be a first-line therapy for some, but for the vast majority of patients—especially in this day and age of innovation in weight loss—there is so much more that can be done before moving to an injectable drug.

An ecosystem is forming in the weight loss space that is composed of diet, exercise, devices, drugs, and even surgery that can be used sequentially or in combination to deliver results and outcomes that could truly last a lifetime. Underpinning this ecosystem are powerful software tools and algorithms that can assist physicians in finding the right therapy for the right patient at the right time and behavior change programs that actually lead to lifelong, healthy habits.

There will be no single, magic bullet that emerges. The ultimate cure for those living with obesity is not to be on a drug for the rest of their lives. Rather, it is a series of changes to lifestyle and behavior that will keep the weight off in the long run.

Like in almost every other field of healthcare, a suite of options that are tailored to individual needs will reign supreme and break us out of a harmful loop of “Eat Inject Repeat”. Thus, The Economist’s message is exactly the opposite of what it should be projecting to society, even if it did want to tout the potential of these drugs to be a part of this ecosystem.