Many people in the medical community are calling it a breakthrough in treating obesity: It's a drug called Wegovy, which got FDA approval for obesity treatment in individuals above the age of 12 years old in December. But while Wegovy has been showing promising results, another drug under consideration for approval to treat weight loss could work even better.
Dr. Michelle Guy, director of the American Board of Obesity Medicine, says obesity, which already affects more than 41% of Americans, has been on the uptick in recent years.
"We are becoming a more obesogenic society," Guy said. "We have more access to calorie-dense foods, as well as sometimes our infrastructure doesn't support having more access to commuting, walking, having a more healthy lifestyle outdoors."
Dr. Judith Korner, the founder and Director of the Weight Control Center at Columbia University, also spoke with Scripps News about obesity, diving into deeper issues that can lead to people gaining weight.
"It's probably somewhere between 50 to 80% genetic," Korner said. "Of course, then there are other factors. There are environmental issues, socioeconomic issues, life issues, psychological issues. It's really very complex."
Both Guy and Korner told Scripps News how Wegovy was originally created to treat diabetes and sold in a slightly different formula as Ozempic — an antidiabetic medication similar to Wegovy — before it was popularized as a treatment for obesity.
There’s been a shortage of Ozempic because of a heightened demand for ways to lose weight, but those who are able to get their hands on Wegovy — again, a similar drug — are seeing big results with few risks.
"We compare it to other medicines, say, such as Contrib or Kissimmee, which are other medicines that we've had around for weight loss," Guy said. "On average, those are about 7% weight loss, and so about 15% weight loss with Wegovy as a medication for weight loss is really coming close to what we see with bariatric surgery."
Another drug under fast-track consideration by the FDA for weight loss treatment, Mounjaro, also called Tirzepatide, has been showing up to 22% weight loss in clinical trials — more than triple what older drugs for obesity promised.
For patients, that could mean an even more effective way of losing weight without invasive surgeries.
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Today’s weight loss drugs pull from the science of diabetes treatments. Those have been proven for years to have fewer and less serious side effects.
"This has been a very exciting time for people who have health care practitioners who are trying to treat obesity," Korner said.
Mounjaro’s producer, the Eli Lilly Company, has boosted production of the drug in anticipation of big demand and to bypass any potential supply issues. These new medicines also promise fewer side effects than their predecessors.
But behind the breakthrough treatments for obesity are the complex issues of self-love, body positivity and society views and treats individuals with obesity.
Lisa Legault, a psychologist and associate professor at Clarkson University, shared more about the psychology behind body positivity movement and where it began.
"Social psychology research suggests that weight and fatness stigma are among the most powerful and prejudiced of the social stigma," Legault said. "So it sort of started with this effort in the 60s, 70s, 80s among Black women living in marginalized bodies to question these narrow standards of beauty."
While Black women led the charge against largely Eurocentric standards of beauty and body image by general society — things like thinner noses and lips, fairer skin, bigger eyes — the body positivity movement today has expanded even further. And one of the issues it addresses is stigma within the medical community, which even doctors admit is a problem.
"Weight bias and stigma has been very prevalent, starting with the media and society," Guy said. "Of course, then that trickles down to individuals and humans, including physicians and medical providers."
Many body positivity advocates claim the medical community shrugs off health issues facing individuals with obesity, associating them all with weight and claiming weight loss as the only solution.
These advocates also call for a re-examination of the importance many medical experts place on body mass index, or BMI. Experts like Doctors Guy and Korner agree it’s an incomplete metric meant to be used just as a starting guideline; it’s not necessarily an indicator of overall health.
"The medical community defines obesity as having a body mass index, and that's your height to weight ratio calculated over 30," Guy said.
"Someone can have a higher BMI, but if they're very athletic, a lot of that may be muscle," Korner said. "And we're not really talking about excess fat. That's where you would have to do more sophisticated considerations of body composition."
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The global cost of obesity is expected to be in the trillions of dollars as obesity rates in the U.S. and worldwide skyrocket.
While doctors are supposed to consider the bigger picture of someone’s health before prescribing anti-obesity drugs, some practitioners have also been prescribing these medications to people who don’t have obesity and just want to lose weight. Confessions from celebrities like actress Chelsea Handler or tech CEO Elon Musk about their use of Wegovy have also shined a spotlight on this issue. Experts Scripps News spoke to warn that these drugs are long-term medications, and the risks of intermittent use are not clear.
"We haven't studied any weight loss treatments outside of a really, kind of, regimented lifestyle interventions with medical supervision," Guy said. "There's always risks for misdosing. Like I said, especially with the higher doses, you have risk for nausea, vomiting, diarrhea, constipation, which then can lead to other medical problems."
At the heart of this entire issue lies a conflict between aggressive theories of body positivity and society’s historical preference for thinness, which can understandably create a lot of confusion for people considering treatment for obesity. Each camp can dig into their views hard, with medical providers and individuals who prefer thinness too much on one end and body positivity advocates who insist on self-love above all else on the other.
Legault’s research into popular body positive messaging explores the complexities behind this issue.
"Just like it can be toxic to expect people to be happy all of the time rather than sad, this is actually, it turns out, not good for overall wellness," Legault said. "It can also feel very stifling or pressuring to always feel like we should be satisfied with our bodies and that if we're not, we're somehow failing. If we express any degree of dissatisfaction or disappointment that we're failing to live up to this positivity standard."
Experts like Legault say feeling positive about your body and weight needs to be an internal process, not something done out of obligation.
