On August 14, the Wall Street Journal published an article by Betsy McKay titled Ozempic Settles the Obesity Debate: It’s Biology Over Willpower. The article postulated how the success of a new class of drugs called glucagon-like peptide-1 (GLP-1) agonists all but prove that biology is the primary determining factor of a person’s weight. The author quoted endocrinologist Dr. Florencia Halperin who argued, “This is not about willpower or personal choice…This is about your brain driving behaviors” and Dr. Louis Arone, professor of metabolic research at Weil Cornell Medical College who argued that “What these drugs have proven is that patients are right: It’s not their fault.”

Not at all? While biology is a meaningful determining factor of one’s body weight and should not be discounted, in our view, the article did not give proper credence to important social factors and personal accountability in determining one’s health.

The Drugs

The drugs cited in the article are Ozempic and Wegovy, manufactured by a Danish company called Novo Nordisk, and Mounjaro, made by Eli Lilly. Ozempic was initially developed to control diabetes, but patients treated with it reported decreased levels of hunger, which led to significant weight loss. Wegovy is a later iteration of Ozempic – they both contain the active ingredient semaglutide - but is administered at a higher dose. Mounjaro, which acts on both GIP and GLP-1 receptors and contains the active ingredient tirzepatide, was shown to effectuate even more weight loss than Wegovy and Ozempic. New findings suggest all three drugs might also combat heart disease and stroke.

Though only Wegovy has been explicitly approved for weight loss, “off-label” usage of Ozempic and Mounjaro has surged. In fact, all three drugs have proven so popular (and effective) that Novo Nordisk and Eli Lilly cannot satisfy current levels of demand.

Biology

To be certain, biology is a powerful driver of a person’s susceptibility to becoming obese. To that end, people should tread carefully before judging others and instead consider that certain individuals are, in fact, predisposed to get heavy. Indeed, thousands of genes are associated with how much a person weighs. The effectiveness of GLP-1 and GIP agonists buttress this fact. Per the article:

“…Primitive parts of the brain that control breathing, heartbeat and other essential functions collaborate with hormones and the central nervous system to determine how much fat the body wants to have and keep it at the set point. The system has been shaped by thousands of years of humans foraging to survive…The brain maintains the dial setting or set point by regulating how much a person eats. Ozempic, its sister drug Wegovy and another, Mounjaro, lower the dial setting, or set point, by acting on the brain to reduce hunger and make a person feel full sooner…”

The article chronicled a patient named Jon Weisman. Mr. Weisman was obese and sought the advice of Doctor Halperin, who prescribed Wegovy. It worked. Mr. Weisman’s hunger dissipated. His cravings for “onion rings, mac and cheese and other heavy foods” abated. He lost weight and now subsists on a healthier diet consisting of greens and proteins.

As evidenced by the success of Wegovy, biology certainly played a part in Mr. Weisman’s obesity. And we are glad he’s been able to control his weight. However, after pondering Mr. Weisman’s predicament, we thought it only equitable to pose these questions: who doesn’t crave onion rings, mac and cheese, and other fatty foods loaded with salt and other unhealthy but very tasty inputs with names so long you can’t pronounce them? And ultimately, is it not a personal choice whether somebody indulges in or substitutes those foods with something less tasty but more healthy?

Weight A Second

In our view, the title of the WSJ’s article (and much of its content), “Ozempic Settles the Obesity Debate: It’s Biology Over Willpower”, is misleading and an oversimplification of various interlocking factors that contribute to the Obesity epidemic in America and what can be done to combat it. The second sentence of the article read, “It isn’t so much about willpower: It’s about biology.” We disagree; it is not about either/or; it’s about both those factors, and more. Obesity is complicated and rarely relegated to black-and-white-binaries.

For instance, we concur that Jon Weisman (or any other male) can be biologically wired to consume 4,000 calories per day vs. the ~2,500 that health practitioners generally recommend, yet there is scant mention in the Journal’s piece about what type of calories Mr. Weisman consumes.

Point being eating 4,000 calories comprising leafy greens, fruits, veggies, and lean meat is healthier than eating 2,500 calories of mac and cheese, onion rings, and soda. We agree that Mr. Weisman might very well be genetically predisposed to consume more fat, yet there is scant mention of what type of fat Weisman consumes. Saturated and trans fats found in foods like butter, biscuits, bacon, commercially fried food, and mac and cheese are unhealthy, even dangerous. Unsaturated fats (monounsaturated and polyunsaturated) found in foods such as avocados, nuts, seeds, fatty fish, and olive oil are generally healthy.

In nutrition, when you drill down to a level of granularity, things become complicated and case-specific. That said, certain facts are well-established. For instance, there is conclusive, indisputable evidence that eating fruits, vegetables or fish is better for you than eating a Snickers bar…many of us, your correspondent included, prefer the Snickers bar, which dovetails into our next point.

Notwithstanding the number of calories somebody is genetically predisposed to consume, maintaining a healthy weight, especially into middle age, is hard. It takes willpower, dedication to a healthy diet, and consistent exercise for almost everybody. That fact does not comport well with another fact regarding food access: Americans are used to things being easy.

The stark reality is that when a person can lounge on their couch, open their UberEATS app, and order a pizza loaded with unhealthy toppings and have it delivered to their door in 20 minutes, it can easily morph into a sedentary, unhealthy lifestyle unless that person makes a conscious effort to counterbalance that via healthier outlets.

Body Positivity

Perhaps another reason the percentage of obese adults in America has spiked from 1 in 5 in the late 1980s to over 40% today is due to the “Body Positivity movement.” To be fair, we do not have concrete statistical data to buttress this view, but a lot of anecdotal evidence supports this hypothesis.

The Body Positivity movement is rooted in the belief that all human beings should have a positive body image and be accepting of their bodies and others as well. Taken at face value, this seems reasonable enough. Humans come in all shapes and sizes. But where do today’s “trendsetters” distinguish between promoting a healthy self-image and enabling a self-destructive lifestyle? Too many people in the Body Positivity movement either tell people who overindulge in food or whose genetics and environmental factors make it more challenging to lose weight: “you look good no matter what can be healthy at any weight.” That is untrue.

“You’re perfect just the way you are” has now become the mantra of corporate ad campaigns and media outlets motivated by social agendas and financial gain. That is shameful.

The “Body Positivity” movement should support and encourage obese people in their objective to love themselves enough to live a healthier lifestyle; not encourage people suffering from dangerous conditions to love the way they are without question and/or point to genetics as the sole determining factor of their fate.

Exhaustive data clearly demonstrates that obesity directly correlates with poor health. Is diabetes, heart disease, high blood pressure, fatigue, sleep apnea, mental health issues, etc., “fabulous”? Where is the true compassion?

Fat Shaming

Often, those who express genuine concern for obese people’s physical or mental health are accused of “fat shaming.” This is ridiculous. Those who, with facts in hand, offer their argument in disagreement are very often not hateful people.

Obesity is a combination of biological factors, social influences, and self-discipline. Arguments can be made over proportion, but all factors matter. If there is one thing everybody should agree on it is that obese people should be afforded the same level of warmth, compassion, and respect as anybody else.