Altered States: transformative potential of the new weight-loss drugs - twenty-two empirical predictions (part three)

The new weight-loss drugs have the potential to be personally, socially, and economically transformative

Here, I elaborate on the claim that this new class of drugs will be at least as important for the individual, society, and the economy as the wild talk asserts about LLMs/AI. Semaglutide and other weight-loss drugs have the potential to be personally, socially, and economically transformative. These drugs can help people lose weight, improve their health, reduce healthcare costs, increase productivity, reduce stigma, and improve self-esteem. Interim takeaway: a biomedical treatment revolution seems to be in prospect. In fact, Science has named these GLP-1 drugs the Breakthrough of the Year - suggesting this new class of therapies are ‘breaking the mold’.

Background reading

Previous pieces on metabolism and on exercise:

• Burn, baby, burn: Metabolism Matters - Eating, Exercise, and Evolution

• 'Eat less, exercise more' is useless advice; Our activity levels are up

• Too hot to handle: Thermal strain - are you cool-headed or warm-hearted?

• Hypersleep in Aliens, torpor in animals: Slowing your metabolism, energy conservation, and other metabolic marvels

• Aerobic exercise is good for the brain

• Resistance training is good for the brain

Altered states: Navigating the hunger game (Part one)

Altered States: Rewiring cravings (Part two)

Photo by Owen Beard on Unsplash

Recent news

Semaglutide and GLP1 receptor agonists are in the news for all sorts of new, positive and unexpected reasons.

Here’s a few of them:

GLP-1 Receptor Agonists and Colorectal Cancer Risk in Drug-Naive Patients With Type 2 Diabetes, With and Without Overweight/Obesity: a study population comprised 1,221,218 patients reporting that ‘GLP-1RAs were associated with reduced CRC risk in drug-naive patients with T2D with and without obesity/overweight, with more profound effects in patients with obesity/overweight, suggesting a potential protective effect against CRC partially mediated by weight loss and other mechanisms not related to weight loss.’

Novo Nordisk will stop the once-weekly injectable semaglutide kidney outcomes trial, FLOW, based on interim analysis - this is because the trial was such a success, meeting all the predetermined outcome measures well ahead of time.

Novo’s obesity drug Wegovy lowers cardiovascular risk by 20%, landmark trial finds: The milestone Select trial of about 17,500 patients with obesity and heart disease is the first to show that a weight loss medication leads to long-term cardiovascular benefits.

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes: ‘In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months.’ The effect size here is small but significant, and the study brings other general good news, but with caveats.

Ground Truths

provides an excellent and readable analysis of the trial here.

And there’s a new report on a double-blinded, placebo controlled trial, on a new drug, tirzepatide (n = 670 participants), which seems to report stronger weight-loss effects than semaglutide, with fewer side-effects, and which has interesting hints regarding off-ramping from these drugs (wiki has a good article on this drug). There’s even a strong hint in this study that anxiety and depression are reduced in trial participants. I discuss this trial in more detail below (especially the seeming reduction in anxiety/depression findings).

And there's at least one tablet-based (rather than injectable) formulation on the way (more below).

And the snack industry?

"The food, beverage and restaurant industries could see softer demand, particularly for unhealthier foods and high-fat, sweet and salty options,” says Morgan Stanley’s tobacco and packaged food analyst Pamela Kaufman.

A few empirically-testable propositions and assertions:

Here, I’m going to step back a little, and I’ll assume the news continues to be as positive on these drugs as it appears to be. If so, these drugs are likely to be at least as important for individual, society, and economies as the wild talk has asserted about LLMs/AI (please be sceptical; three links) or Musk’s Neuralink (nope, and nope; two links).

I suggest this is plausible because of the wide range of benefits that they seem to confer across a whole range of our physiological and psychological functioning.

Here’s a list of 22 probable, reasonably foreseeable, short, medium, and long-term benefits, as well recent developments that are very positive indeed.

1. These drugs seem to offer collateral benefits that are dramatic for heart health (and I presume for other end organs, and for metabolic syndrome more generally). This means people's interoceptive, felt-states will improve, enhancing individual wellbeing;

2. Demand for these drugs is off the charts:

   ‘The latest hunger-suppressing weight-loss drugs are transforming the way obesity is treated in the U.S. The category has achieved blockbuster status over the course of a year, with more growth to come—Morgan Stanley Research analysts estimate that 24 million people, or 7% of the U.S. population, will be taking these drugs by 2035. This may be welcome news for the biopharma industry, but the drugs’ prevalence could have long-term implications for food-related sectors as consumers eat less and make more nutritious choices.’

   And that’s just the US. Demand is so great, that some pharmacies are starting to make their own versions in at least one OECD country (because of specific ‘in country’ legal loopholes). I assume this will lead to litigation in the future. More below.