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America Isn’t Ready for the Weight-Loss-Drug Revolution That’s Coming

Derek and Susan Z. Yanovski talk about the stakes of anti-obesity medication, why diet and exercise don’t work for so many people, and how these weight-loss drugs could help American health care

Cough Medicines Manufacturing In Shenyang Photo by VCG/VCG via Getty Images

We have historically thought about weight as the mere outcome of our deliberate choices about diet and exercise. We have not typically thought about weight like a disease. But in the past 18 months, there’s been an extraordinary revolution in weight-loss medication that’s putting in our hands a therapy that can help people easily shed weight without major side effects. You may have heard these drugs go by the names Wegovy or Ozempic.

What happens when you take a country obsessed with self-image and diet and tell it that the mystery of weight loss has now been reduced to a daily injection? You change a lot more than body mass index. You change society. Today’s guest is Susan Z. Yanovski. She is the codirector of the Office of Obesity Research and the program director of the Division of Digestive Diseases and Nutrition at NIH. We talk about the stakes of anti-obesity medication, why diet and exercise don’t work for so many people, and how these weight-loss drugs could help American health care, strain American insurance, and revolutionize America’s sense of willpower, responsibility, and diet.

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In the following excerpt, Susan Z. Yanovski discusses the potential impact of weight-loss drugs on American society.

Derek Thompson: I want to talk a little bit about how this changes the future. It seems to me that if you tell the American public, “Here’s a weight-loss drug, and it actually works. It seems to be extraordinarily effective. It programs your body and your metabolism to lose weight in a way that we’ve never seen before without surgery,” you’re going to change the world. You’re going to change the world in some ways that are just obviously fantastic and some ways that are a little bit more complicated. On the obviously fantastic side, it seems like it’s the same with statins or medications that reduce cholesterol and reduce the likelihood of heart disease. It’s just clearly wonderful to see a mortality rate for certain kinds of diseases that might be downstream of obesity come down in the decades after these kinds of medications come online. There’s nothing bad about that.

At the same time, in a society that so values thinness, it seems inevitable to me that more people are going to try to use these drugs to escape weight stigma, even if they’re not obese. They want to lose 10 pounds. They’re not overweight or they’re barely a little bit over average in terms of their BMI. They just want to lose weight. They want to do it easily, and they want to keep eating ice cream and bread, because they like ice cream and bread. And so they take these pills. And they don’t necessarily need them, but they can afford them. And it changes the way that society thinks about thinness and body types, because we have taken this incredibly complex matrix of considerations in terms of what you eat and how much you eat and whether you work out and how long you work out and how much willpower you have and how responsible you are, and you reduce all this extraordinary array of factors to a pill. That changes the world, it seems to me. I wonder, does any of it concern you in terms of how the mainstreaming of weight-loss pills like this might change the way that society values and even stigmatizes body type?

Susan Z. Yanovski: Obesity is already a stigmatized condition, and what we don’t want these medications to do is to increase stigma for anybody, which I think is one of the reasons we really need to be focusing on this as health, changing people’s health, helping them to live more healthy lives. So I think that that’s something we really need, to get that message out: That obesity, it’s not a matter of willpower. It’s not a moral failing. It’s a biological condition, with certainly having environmental contributors. Once people have developed obesity, there are physiologic changes that make it really, really hard for them to lose that weight and keep it off long term. So I think we really need to get that message out.

The other thing I think we want to get out is that this is not a magic bullet or a magic pill. You mentioned that people say, “I want to be able to eat ice cream and eat bread and take a pill.” What these medications may do is help people to make those healthy changes in their diet and physical activity. They’re not going to allow people to eat whatever they want and not exercise and be healthy. And in fact, things like physical activity, regardless of your weight, can improve health. So I think we want to move the conversation away from appearance and toward health.

The other thing is these medications aren’t going to work for everybody, and I don’t want to see people who can’t lose weight with semaglutide or tirzepatide thinking again that there’s something wrong with them, that if they were only a better person that it might work. And obesity’s a very heterogeneous condition, and what we really want to do is be able to understand more about the mechanisms about why some people develop obesity, why some people have trouble losing weight with a given treatment, so that we can actually help match appropriate treatments to appropriate patients.

This excerpt was edited for clarity.

Host: Derek Thompson
Guest: Susan Z. Yanovski
Producer: Devon Manze

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