In December, Novo Nordisk started a trial of “pre-obesity” use of its anti-obesity drug – Ozempic. Until then it had been used only in people who were already obese. But now they are trying to find out if it can stop obesity before those who are just overweight get to that stage. If it can, the implications could be very wide-ranging.

The drug, first approved in 2005, helps people lose weight by curbing hunger: it reduces the speed at which the stomach empties after having a meal. And so you feel fuller for longer and have less of an urge for a snack between meals.

But a very surprising collateral effect thing is that research now shows the drugs to have a similar effect on the desire for drink, drugs, nicotine and obsession with social media. In other words, on addiction and obsession in general. Through what must be another mechanism – so far unknown - it seems to be telling us that we don’t need to keep doing the same thing over and over again. It somehow reduces addictive and obsessive behaviour.

So then, if the trials are successful and, if in our world with its increasing childhood and adult obesity the use of Ozempic became widespread, then we could see a lot of change in the way we live our lives.

And people who were prescribed Ozempic for weight loss also found that ‘retail therapy’, amongst other behaviours, fell into decline. And so in October this year, Bloomberg, the business-orientated journalism group, ran an article headlined “Ozempic is Bad for Business”. It asked readers to imagine a drug that reduces consumption in general. “It makes the people… eat less food and drink less alcohol and buy fewer clothes and take fewer vacations and get fewer haircuts and consume less social media and click on fewer online ads and otherwise consume much less. This drug is fictional. But Ozempic is not fictional.”.

To back this up, the CEO of Walmart’s US operations, recently revealed that the company has compared customers’ prescription history with their food shopping patterns – I hope the data was anonymised! - and found a “slight pull-back in the overall basket” of food purchases which correlated with the use of the drug. Executives at well-known food manufacturers are fielding questions from investors about the drug’s potential impact. In October, Barclays Bank published a note advising clients to expect the share prices of fast-food chains and snack companies like McDonald’s and Kellogg’s to go down.

Ozempic has also been blamed recently for the reduced value of health-care stocks and for damaging the outlook for companies that make things like insulin pumps and sleep apnoea devices. Leading dialysis equipment providers saw stock prices plunge due to news that Ozempic is surprisingly effective at staving off kidney failure.

But it doesn’t stop there. The hormone in Ozempic GLP-1 (glucagon-like peptide 1) helps regulate metabolism generally. One of the drugs’ inventors, Daniel Drucker, a professor of medicine at the University of Toronto, has researched its wider effects and suggests they also show promise for treating heart attacks, strokes and Alzheimer’s disease. Phase three trials for liver disease are already underway.

Of course, the drug has side effects. In, on average, 80 per cent of users there are mostly gastrointestinal symptoms of varying severity – to be expected granted that the peptides act on the gut. A number of lawsuits over side-effects are, of course, pending in the US. There’s also the problem that even Drucker himself isn’t exactly sure of the mechanism of action: “If I could figure out how GLP-1 reduces heart attacks and strokes, and I knew where that magic was happening, maybe we could make it even better,” he said.

The winner here is, of course, its Danish manufacturer, the pharmaceutical company Novo Nordisk. Thanks mainly to the demand for Ozempic, the company has now become the most valuable company in Europe. But all of this underlines the reality of just how many big businesses are built on diet-related disease epidemics, which come at great human cost. And so Novo Nordisk’s effective treatment for obesity (and diabetes) might one day prove to be very good for public health yet, as Bloomberg pointed out, very bad for business.

Some though are saying that there may also be a business upside. One analyst has estimated, perhaps rather optimistically, that United Airlines could save $80 million a year on fuel if every passenger lost 10 pounds. Some in the dialysis industry are arguing it will be good for business because these drugs will help keep patients alive longer, thus needing their services for a longer period of time.

Indeed, If these drugs are widely adopted in first world countries, it looks as though there could be cascading effects that go well beyond changing eating habits and shrinking market capital values. The savings to the health care system (involving insurers, employers, the federal government, etc.) could be massive. There are predictions that there could be increased productivity due to better overall health.

But then if  people lived longer this would put a greater strain on housing stocks.

Of course, the cost of this drug will almost certainly need to drop for any big shifts to occur – it currently costs $900 to $1,300 per month – and considerable weight gain is likely once the treatment is stopped: so then it would have to be taken like statins – on a long term basis. This is where we need to know more about its side effects, their frequency and severity.

For now though, it’s fun watching Wall Street panic over a weight loss drug.

But I think this has other possible implications. Let’s go back to the notion of repetitive behaviour, whether addiction or obsession. Not only does the drug curb eating, drinking and smoking, but even obsessions as relatively minor as shopping and biting your fingernails.

So how should we regard this sort of behaviour? We generally think of it as bad. Take the example of addiction to heroin - initially established through pleasure or at least the dulling of a psychological pain. Unfortunately it ends up as a way of alleviating withdrawal symptoms.

But then eating is also an addiction, a vitally important one – in fact so important that it too provides us with withdrawal symptoms – our hunger. Eating too much is probably a left-over from times after famine when there was a glut and so you ate everything in sight.

Less extreme ‘addiction’, however, whether to chocolate or good wines or an obsession with sport can just be the harmless pursuit of pleasure: there are no harmful or significant withdrawal symptoms to assuage. In fact, addictions and obsessions, strong or mild, with or without withdrawal symptoms are a necessary and normal part of our lives – and they are mainly dependent on a key emotional motivation, that of enjoyment.


But it's not just consuming nice food and drink. In the Stone Age, our ancestors’ activities were not limited to hunting, eating, drinking and reproducing. They also engaged in art, making drawings on cave walls of the flora and fauna around them. Why? Probably because those doing it had an artistic flair and enjoyed doing it.

Nowadays, the range of human activities has increased substantially. There are art clubs, drama clubs, bridge societies and amateur music societies. All of them with devoted, one might even say obsessed, members. There are those who renovate steam engines and classic cars and people who run model railways around their gardens. There are even people who write essays. And, of course, there are our hobbies as children. A lot of scientists and engineers started out with chemistry and Meccano sets, soldering irons, microscopes and telescopes. Many of our early interests have shaped our adult lives.

But if Newton or Einstein had been taking Ozempic would they have bothered to pursue their obviously obsessive thought processes? Would Darwin have carried on developing his theory of natural selection? If to stop adult or childhood obesity we are medicated with Ozempic will such, rather important, addictive or obsessive activities diminish? If so, what sort of society will we become?

Probably the better answer is to eat less, rather than to interfere with our psychology on such a large scale. Otherwise I fear that it won’t just be the stock markets which will be affected!

30 December 2023

Paul Buckingham