Weight-loss drugs: miracle or mirage?

Did your mum scold you for not eating up? Mine did: “Finish what’s on your plate. There are starving children.” I never understood the guilt-trip argument. How would eating my food – or watching her bin the leftovers — help starving kids half a world away?

Later in life I began reporting from zones of famine and war. New questions arose: why did these people have so little when I had so much? Why were our supermarkets groaning with food, when in inner cities not far away from where I lived (let alone Sudan or Gaza) kids regularly went hungry?

It’s a false analogy, of course. You won’t help the hungry by feeling guilty. A conscience can be a spur to philanthropy or more generous social policies or being a better citizen. But that’s another matter.

I’ve always enjoyed food. I’m a foodie citizen of everywhere from Tom Yum to Stilton cheese washed down with a fine Burgundy. Freshly sourced ingredients, beautifully cooked, have, as someone once said, the power to stop time. There’s a quiet joy in sharing food with family and friends.

But stress has a sly way of turning hunger into a habit. Life on a busy newspaper with its adrenaline highs and dull lows became a daily journey between one pit-stop at the vending machine and the next. Real or imagined cravings (the hunger mood) shaped my days: coffee – must have biscuit; I’m stressed, I’m bored, I’m sad, I’m excited: I need food.

The sugar-high, the sweet reward of a dopamine hit, the brief, energising, mood-lifting spike in blood sugar creates a doom loop in the brain: eat sugar, get pleasure, crash, crave, repeat. Who is immune to the sugar fairy?

Vast commercial interests perpetually beaming temptations at us lead us to eat too much too often. Food is no longer just nourishment or even pleasure. It’s a lifestyle and a habit. For some, perhaps for more of us than we care to admit, it’s an addiction.

According to the World Health Organisation, very roughly the same number of people on the planet face hunger or starvation as live with obesity. In round numbers that’s around 900 million in each category. That’s the quandary of human progress in a nutshell.

A century ago food took time, effort and money to prepare. Now we are surrounded by food: fast food, cheap food, easy food, food filled with fat, sugar and salt. My local high street has twice as many cafés serving up mainly starch than bookshops, banks and clothes shops put together.

The food industry bombards us with advertising and food designed to hit the “bliss point”, imploring us to eat, eat, eat. The ultra-processed food lobby defends its patch ferociously. Governments, trying to make us eat healthier food, tend to buckle. It’s an uphill struggle at best for parents trying to keep their kids healthy, especially if they’re on low incomes.

Inevitably I became overweight, borderline obese. I’m not unusual. As a species we’ve gone from slim, fast, lean hunter gatherers to sofa or desk-bound foragers who can summon three times as many calories as we need with the swipe of a thumb.

So exactly 12 months ago I decided enough was enough. After an inordinate amount of Googling to see what people were saying, I embarked, somewhat tentatively and with some scepticism, on a course of Mounjaro, the King Kong of weight-loss jabs.

The use of Mounjaro to assist weight loss is one of those accidental discoveries science makes when looking for something entirely different. Like its rivals, Ozempic and Wegovy, it’s been used for treating diabetes for more than 20 years.

Enter the Gila monster, a handsome poisonous lizard found in Mexico. A biochemist with an interest in venoms and a gastroenterologist, found that a hormone secreted in its gut stimulated insulin secretion. This regulated its blood sugar and therefore appetite allowing it to survive without food for weeks or months.

These drugs are reshaping the way we think about treating obesity. They’re also opening new avenues of research for metabolic medicine, the science of conditions that affect the body’s chemical process. Early trials point to possible benefits in reducing the risk of strokes and heart attacks.

If these early assumptions turn into hard facts, weight loss drugs could transform the prospects for the NHS. Obesity costs the country around £90 billion in healthcare costs and lost productivity, or almost four per cent of GDP.

But these drugs are not magic. They don’t fix obesity. It’s not a shortcut to a beach-ready body. The research so far is encouraging but thin. The drug companies have an obvious interest in keeping things rosy.

What we do know is that many people who stop the treatment pile the weight back on within two years. That poses a huge question: are they leading us up the garden path?

Putting on weight isn’t difficult. And for most of us (though not everybody) it’s not rocket science. If you consume more calories than you convert into energy, you put on weight. Temptation comes in all forms. The most dangerous is cloaked in stealth. “I’ve been good all day. This little can’t hurt.”

Losing it (temporarily) isn’t that hard either. Some of us spend our lives on the absurd, dispiriting merry-go-round of dieting: Atkins, Keto, Caveman, Fasting, Weight Watchers, Cabbage Soup. The global weight loss industry was worth around $200 billion in 2024 – and that’s before semaglutide. The industry wants you to stay on that merry-go-round.

The tricky bit, as everyone knows, is keeping it off. Perpetual dieting can feel like shedding the same ten kilos over and over again. You develop a long-term relationship with disappointment.

Of course, some people are perfectly happy with their weight whatever it is. They carry it with confidence. And they’re fine. In later life Churchill was seriously overweight and a cigar-puffing brandy-swigger. He died at 90.  “I get my exercise,” he quipped, “serving as a pallbearer for friends who believe in it.”

These are early days. The jabs are expensive and would be even with the purchasing power of the NHS. Early results are impressive. But important questions have yet to be answered.

How safe are they in the long term? If most people put the weight back on when they stop the treatment, will they have to be on the drug for life? What’s the cost benefit of that?

The new drugs have got some scientists thinking that perhaps putting on weight and losing it may be as much a function of our individual metabolism as healthy eating and exercise. In other words, it’s harder for some people to get slim and stay slim. Is this true? What does that mean?

But the pivotal question must surely be: can these drugs help to reshape how and what humans eat? That’s the billion dollar question, though not one the food and hospitality industry will thank us for asking.

I’ve lost 22kg in 12 months, or just under three and a half stone. That’s not far short of 20% of my body weight. My blood pressure is back to normal, my resting pulse is down to 55 bpm, I can fit into my old jeans and I can climb a hill without wishing the earth would swallow me up.

Weight-loss drugs are not a magic bullet. But they do present an opportunity with life-changing potential.

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