New obesity drugs may shift blame toward food industry

An essay presented at this year's European Congress on Obesity in Istanbul, Turkey (12-15 May) suggests that new age of obesity drugs could shift the blame for living with obesity from individuals to the food industry – just as smoking has been blamed on tobacco industry and to a lesser extent alcohol consumption on the alcohol industry.

Authors Assistant Professor Luc Louis Hagenaars (Department of Public Health, Amsterdam UMC, Amsterdam, Netherlands) and Professor Laura Anne Schmidt, Institute for Health Policy Studies, University of California, San Francisco, USA, say they believe that "these medications could redirect blame for obesity from individual failings to the pervasive influence of commercial food systems, drawing parallels with historical public health successes against tobacco and alcohol. This reframing is crucial for addressing escalating obesity rates and associated chronic diseases".

Their analytical essay presents a theory on how the current GLP-1 era affects the conceptualisation of obesity. By integrating multiple lines of evidence, Hagenaars and Schmidt examine emerging medical and public health data regarding GLP-1 agonists' effects, particularly their impact on weight loss and cravings (food noise) for ultra-processed foods (UPFs) (see links in notes to editors). The analysis draws on historical parallels with successful public health movements that regulated harmful substances like tobacco and alcohol. Furthermore, it incorporates insights from the authors' prior analyses of the food system, which identified feedback loops that both hinder policy responses to obesogenic environments and could trigger change.

Those analyses revealed cultural assumptions and systemic roadblocks that all pertain to the assumption that obesity is a problem of individuals, fostering policy inertia by obscuring the epidemic's root cause: commercialized food systems locked into maximising sales of hyper-palatable, ultra-processed foods.

The authors say that the success of new obesity drugs in achieving significant weight reduction and, crucially, a reported reduction in cravings for UPFs could drive 3 key changes:

1) A decrease in consumer demand for UPFs, as flagged by early food industry reformulation (e.g, smaller portion sizes) – the food industry is developing, and major stores are selling - "GLP-1 friendly" foods in smaller packages, with protein and fibre additives.

2) A scientific paradigm shift, aligning the understanding of obesity more closely with addiction models (e.g., "ultra-processed food noise" and the depiction of ultra-processed foods as addictive, industrially engineered substances) 

3) A transformation in public discourse, moving away from individual culpability towards recognising the role of hazardous commercial goods in driving obesity (e.g., increased public scrutiny of ultra-processed foods).

The authors say: "These convergent impacts could create an environment conducive to adopting public health policies similar to those successfully implemented for tobacco and alcohol." The authors conclude: "The 'Ozempic Era' offers a pivotal moment to challenge deeply ingrained cultural assumptions about obesity as a personal failing. By leveraging the broader impacts of new obesity drugs, society can foster collective responsibility and generate the necessary policy momentum to mitigate the root cause of the obesity crisis through comprehensive food system reforms. While we acknowledge this new era also has potential risks for further medicalisation, we believe there is an opportunity for a societal reorientation that could finally address the systemic drivers of obesity."