Azempic or Monjaro have done what diets and willpower have failed to do so far make millions lose massive amounts of weight with seemingly mild side effects.
More than one in eight US adults have tried the drugs.
For the first time in history, the country's obesity rate actually fell.
Since obesity is one of the unhealthiest things in the world, this seriously poses the question should we give these drugs to everyone who is overweight to spark a medical revolution, like we did with antibiotics and vaccines?
The obesity trap.
At its core.
Being overweight or obese is a mismatch between how much you eat and how much your body needs.
Eat more calories than you burn and your body will store them as fat.
Eat less and you'll lose it.
But just because something depends on what you do, it doesn't mean it's your fault.
Your drive to eat is programmed by evolution and can easily hijack your conscious decisions.
For most of our history, food was scarce.
So when our ancestors found a calorie bomb, binging on it was the best of ideas.
The more sugar, fat and salt, the better.
Our brains are wired to love these foods.
They bring pleasure, enjoyment and mental release.
This helped us survive in a world where food was the most important thing to worry about each day.
And then the world changed overnight and suddenly food was cheap, calorie-dense and hyper-palatable.
Our ancient biology hijacked our modern behavior.
Most of us can't help ourselves and overeat regularly.
Today, over 40 of adults are overweight, and obesity affects 1 billion humans and kills almost 4 million annually.
If trends continue, by 2050 one in three adults on Earth will be obese and half of humanity will be overweight.
Since being overweight is also shamed on top of being unhealthy, we tried to fix our overeating behavior with all sorts of well behavioral methods.
The world is filled with diets and healthy habits campaigns.
But anyone who's been on a diet before knows that it's hard and no fun at all.
Not only are you fighting your deep evolutionary programming, you're cutting down on a major source of comfort, social activity and good feelings.
And if you've finally lost weight and want to ease up a little, you're back in the regular world full of amazing foods.
Self-regulating around modern food is just too hard.
So almost everybody who loses weight struggles to keep it that way or puts back on even more.
So if fixing our habits doesn't work, what if we fix our biology?
Before we get there, let's fix something easier first.
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And now back to losing weight.
Azempic and co.
Many eating behaviors eat now or later chocolate or vegetables are actually governed by an orchestra of hormones that are not within your control.
You're not hungry in the evening because you decide to be or because this is when your body needs energy, but because your body releases certain hormones.
And it turns out your fat is one of the major regulators of this orchestra.
If you're overweight or obese, the excess fat is throwing your hormonal orchestra out of tune.
This may make you more hungry or push you to overeat more, creating insulin resistance that causes type 2 diabetes, and so on.
We made a video if you want details.
But there's one specific hormone that plays its tune quietly in the background, even in obese people the glucagon-like peptide 1, or GLP-1.
It's one of the hormones your body releases after a meal.
It tells your pancreas to release more insulin to keep blood sugar in check and slows down your digestion to keep food in your stomach.
And in your brain, it increases your feeling of fullness and being satisfied, curbing your appetite.
These effects are usually modest.
Once in your bloodstream, GLP-1 disappears in barely two minutes, its song quickly fading away.
So one day scientists had an idea.
What if we made artificial copies of GLP-1 that play the same song but louder and much longer?
A GLP-1 signal that stays in your body would boost insulin and silence appetite.
The first artificial GLP-1 was approved in 2005 for diabetes and in 2014 for obesity.
But the revolution came with semaglutide and terzapatide, Ozempic and Monjaro really powerful GLP-1 agonists that play their songs in your bloodstream for up to a week.
They send out a loud and steady signal that dials down your appetite 24-7.
You still enjoy food, but you feel full and satisfied much sooner, making it easy to not overeat.
And since the song never really switches off, you feel less hungry throughout your day, making you eat less often.
How intensely you feel hunger is largely genetic, so especially people who suffer from food noise a constant urge to eat.
Feel a huge psychological relief from the drug.
Finally, their body stopped screaming at them.
Suddenly, you're dieting without expending willpower, without really thinking about it.
It feels magically effortless.
By changing your biology, a drug changed your behavior.
But, hmm, is this a good thing?
Miracle drugs.
Many people try a crash diet at some point in their lifetime.
And it's not that crash diets don't work, they do.
You can lose 20% of your weight in three months from 95 to 75 kilos or 130 to 105.
But such a sudden drop is not very healthy and for the vast majority the weight will come back within a year.
Diets that are sustainable are actually not diets, but long-term lifestyle changes.
But this is painfully slow, so a lot of people quit out of frustration.
And among those disciplined enough, results are pretty modest, 5-10% of weight lost in a year.
The new drugs change that completely.
In three months, you can lose 10% of your initial weight.
Three months later, over 15.
And after a year you may reach more than 20, a level of weight loss that used to only really be achievable through bariatric surgery.
In other words, GLP-1 drugs make excess weight melt away like nothing before.
We can't stress enough how unhealthy obesity is, causing everything from diabetes to heart attacks and cancer.
So the consequences for health are stunning.
Treatment with semaglutide cuts your risk of stroke or heart attack by 20%.
17 months of Terzepatide crashes your chances of developing diabetes by 66%.
They also reduce sleep apnea, improve kidney and liver function, lower inflammation, cut cancer risk and may potentially slow Alzheimer's.
They might even boost fertility, as obesity often disrupts hormones and increases complications during pregnancy.
And there may be more positive long-term effects.
Some of these benefits are a direct result of weight loss.
But intriguingly, they sometimes occur regardless of how much weight has been lost, and some have been seen in patients who weren't obese to begin with.
We don't know why yet, but it seems like turning up the GLP-1 signal is synchronizing the whole metabolic orchestra, restoring a balance between brain, gut and body.
And, as if that weren't enough, GLP-1 drugs may also quiet other cravings.
They seem to reduce the use of alcohol, nicotine, cannabis and opioids.
Large trials are underway to confirm these effects.
If the results hold, they could become something unprecedented.
Real anti-addiction drugs.
But of course, there are side effects.
Most commonly nausea, vomiting, diarrhea and constipation.
Not fun, but usually harmless and fleeting for the vast majority of patients.
More serious stuff like pancreatitis, kidney problems or gallbladder disease do happen, but for well under 5 of people.
Apart from this, the main downside of GLP-1 drugs may come from their greatest strength rapid weight loss.
If you don't actively check what you eat, taking these drugs is just like an unhealthy crash diet.
Any steep calorie deficit requires resistance, training and plenty of protein, or else you'll lose a lot of muscle along with the fat.
That's harmful at any age, but especially after 40, when building muscle gets harder and the risk of falls starts to rise.
So while these drugs change your biology, they don't do all the work for you.
Staying healthy still requires you to adopt healthy habits.
After about a year, the weight loss slows down and eventually stops in most people.
At this point, you usually stop using the medication.
If you use that time to change your eating habits you have a really good chance of keeping the lost weight off.
But about 25 regain a significant chunk and some 20 put back on all of it.
So for many, maintaining the results may mean staying on the drug forever.
Is this a bad idea?
Well, we don't know.
The newest generation of drugs is just too new, so there's no long-term data.
The first GLP-1s from 2005 haven't shown major issues.
Based on what we know today, it seems pretty clear that living with the drugs looks much healthier than living with obesity.
Conclusion and opinion.
A recent study modeled what would happen if millions of US adults who are obese or overweight got GLP-1 drugs for life.
In just two years, about 50% of all obesity in the country would vanish.
Over the years, it would prevent 26 million cases of diabetes, 13 million cases of heart disease and 55 million premature deaths.
Which seems like a pretty good thing.
And new drugs that are in final trials promise to work even better.
Defeating obesity suddenly feels within reach.
Right now, the biggest obstacles are actually supply shortages and high prices.
But these are artificial problems.
In the long run, increased production and plummeting costs seem almost guaranteed.
So, should we just inject obesity away?
Well, for now at least, it seems that there are few downsides.
Although please don't listen to internet videos and talk to your doctor before you make any decisions for yourself.
It's also important to remember that while these drugs are immensely helpful, they are not magic.
They make a hard thing easier, but it still requires you to change your habits and put in some effort.
But even with all of these caveats, it seems the future just got a whole lot healthier.
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