Lots of strange things happened in 2023. But one thing (arguably the most notable thing to happen that year) went largely unnoticed. For the first time since the 1980s, the number of people with obesity in the US decreased.
According to the National Center for Health Statistics, the obesity rate dropped by almost two per cent – from 41.9 per cent in 2017–2020 to 40.3 per cent in 2021–2023.
So what caused this sudden change in American health? While we can't say for certain that it was a result of weight-loss drugs, data from the Kaiser Family Foundation (an independent source for health policy research) says that one in eight US adults has used a weight-loss drug like Ozempic at some point in their life.
And since around half of these adults are currently using a prescription, it's fair to say that drugs like these are likely to have played a part.
Originally created to treat type 2 diabetes, Ozempic was developed by Danish pharmaceutical company Novo Nordisk, as was its stronger successor Wegovy, which, unlike Ozempic, is specifically intended for weight loss. Both are part of a growing category of gastrointestinal hormone drugs.
When injected weekly, semaglutide (the active ingredient in both Ozempic and Wegovy) helps to lower blood sugar levels and decrease appetite. But as the research and data on these drugs’ effects increases, the potential for them to help with other medical conditions – from cardiovascular health to addiction – seems to grow continually.
So just how much could these drugs change our lives?
Ozempic's impact
We're not in a position to fully grasp Ozempic's effect on the world yet, but what we do know is that use of the drug and its counterparts has been huge.
To see the extent to which these types of drugs are flying off the shelves you need only look at Novo Nordisk’s fortunes – as of September 2024 the company was valued at $570 billion, more than Denmark’s entire gross domestic product.
Taking a wider view, the investment bankers Goldman Sachs estimates the global market for anti-obesity medications could reach $100 billion by 2030.
According to Dr Ralph Abraham, a specialist in obesity, diabetes, endocrinology, lipids and heart disease prevention, there are a few things that set Ozempic-style drugs apart from their predecessors and which may help their rapid rise.
For one thing, they’re administered with a weekly injection (not daily pills), but they’re also stronger and come with fewer side effects than previous drugs of this kind.
"After seven years of worldwide use [Ozempic was launched in 2017], we’re not hearing about common permanent side effects that will slow down its use,” says Abraham. “It doesn’t mean we won’t hear about side effects, but the drugs appear to do more good than harm in the Western population.”
Research also supports Ozempic’s effectiveness: a 2021 clinical trial found that people experienced an average of 15-per-cent weight loss when taking it over the course of 68 weeks, while those on a placebo experienced only a two-per-cent weight loss.
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The future...
The biggest concern over drugs like Ozempic is cost. "If the UK's National Health Service (NHS) were to adopt it currently, it would break the bank," says Prof Franco Sassi, Director of the Centre for Health Economics and Policy Innovation at Imperial College London.
“A drug making people think they can solve a health problem further down the line is detrimental to the government implementing policies to improve health via lifestyle,” he adds.
A policy-led approach is only going to get harder as more drugs like this appear. There’s already plenty in the press about Mounjaro, the brand name for the drug tirzepatide produced by the pharmaceutical company Eli Lilly.
Nicknamed the “King Kong of weight-loss drugs” thanks to its stronger effects, the UK’s Medicines Healthcare products Regulatory Agency recently approved Mounjaro for use in adult patients with a body mass index over 35 and at least one weight-related illness.
While this category of Ozempic-like drugs was initially created for diabetes and later found a use for weight loss, emerging research suggests their potential applications spread even further. “There’s firm evidence that they can prevent cardiovascular disease,” says Abraham.
Research published in 2023 shows that patients with a history of cardiovascular disease can reduce their risk of heart attacks and strokes by one-fifth by taking semaglutide.
Abrahams also highlights growing research on the drug’s positive effect on kidney disease, a common bedfellow of diabetes, but cautions “the actual mechanism of how this happens is complex and not fully understood.”
More research needs to be done on semaglutide to understand what other health issues it could treat and researchers are looking into unexpected areas – neurodegenerative diseases such as Alzheimer’s for example, and even some forms of cancer – to find more pieces of the puzzle.
One of the most promising areas of research suggests that these weight-loss drugs may help people with alcohol or substance addictions.
“These drugs show promise in reducing addictive behaviours by modulating the brain’s reward pathways, particularly the dopamine-driven cravings that fuel addictions,” says Dr Matt Vickers, a specialist in weight management and diabetes.
Research from Loyola University Chicago, published in the journal Addiction, found that people taking these drugs with opioid use disorder experienced a 40-per-cent lower rate of opioid overdose, while those with alcohol use disorder saw a 50-per-cent reduction in alcohol intoxication.
“If these results continue to be validated in larger human studies, we may see these drugs being prescribed for addiction within the next three-to-five years,” Vickers adds.
The wider impacts
Beyond medicine, this category of drugs could have a far-reaching effect on the food industry. Manufacturers of pre-made food are already considering how they can adapt to a landscape in which Ozempic-like drugs are so prevalent.
Nestlé, for example, is launching a line of frozen food specifically with those taking the drugs in mind. The frozen foods in the line are portion-controlled, low-calorie options and formulated to be high in protein and fibre.
Furthermore, with childhood obesity rates rising in the UK (the NHS found that around one in eight children aged between two and ten in England are obese), Ozempic-like drugs are being trialled for use in children.
A clinical trial in England with overweight children aged 12–17 found that Ozempic injections helped them reduce their body mass indexes by 16 per cent in 15 months.
“As experience and knowledge increase, these drugs will undoubtedly be at the frontline of treatments for children who’ll form the next generation of severe obesity sufferers with all the associated health costs,” Abraham says.
Looking to the future, if the research around these drugs continues to unfold as it has been, this emerging field of science is set to be an exciting one.
“In the next five years, we’ll know so much more and be able to treat patients with greater safety and efficacy for diseases that have been lost causes for decades,” Abraham concludes.
About our experts
Dr Ralph Abraham is a specialist in obesity, diabetes, endocrinology, lipids and heart disease prevention and consultant physician for London Medical.
Prof Franco Sassi is the Director of the Centre for Health Economics and Policy Innovation at Imperial College London. He has been published in PLOS Global Public Health, Food Policy and European Journal of Public Health to name a few journals.
Dr Matt Vickers is a specialist GP in weight management and diabetes and the Clinical Director at Eucalyptus.
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