New Weight Loss Drugs: Of Course It’s About Vanity

Eli Lilly does not want its new weight loss drugs to be used for vanity purposes:

This is so disingenuous of Eli Lilly. The ineluctable reason these new weight loss drugs are a hundred-billion-dollar industry, a sensation on social media and even a cultural phenomenon featured on Oprah, is because of vanity purposes–and they know this. Yes, health such as improved blood markers matter, but vanity and envy are bigger drivers of demand for these drugs than seeing one’s A1C fall or other purely health reasons.

When formerly obese people lose weight, they show-off their before and after pictures, not photos of improved blood markers. What more evidence do you need that it’s about vanity primarily, and health second. If the objective is better blood markers or controlling hypertension, there are far cheaper and equally effective drugs or lifestyle modifications, like reducing salt and sugar intake, to accomplish this. Hardly anyone is spending hundreds of dollars a month out of pocket for ‘better blood markers’ when existing generic medicine already does that and is covered under insurance.

To pretend otherwise is like believing that young people are going tens of thousands of dollars into debt because they suddenly at the age of 18 developed an interest in Chinese history–not because of a credential that confers a lifetime of better job prospects. But weight loss, especially (mostly) safe and effective weight loss, is a far more difficult problem than, say, lowering cholesterol, hence why Eli Lilly and others can get away with charging so much for these drugs, and why people will pay up.

Although obesity is an illness in the sense it reduces quality of life and is indicative of an energy or homeostatic imbalance, there is no obvious pathophysiological cause or flag that can be identified and subsequently treated, like how diabetes can be reversed by simply injecting insulin. Humans having a preference for palatable, calorie-dense foods is not really a disease. And it’s generally easier to slowly gain weight than to lose it. From an evolutionary or survival perspective this makes sense, as extra calories can be stored as fat for times of scarcity, which thanks to modernity never comes. This makes obesity uniquely hard to treat.

From corticosteroids, to insulin, to antidepressants, weight gain as a side effect is almost universal, compared to weight loss, which is much rarer and potentially more toxic or addictive (e.g. DNP, simulants). Whereas insulin as treatment for diabetes was discovered almost a century ago by Dr. Frederick G. Banting and saw immediate use, the road to drugs like Wegovy and Mounjaro took far longer. [1]

Like sex and height, weight is an obvious defining human characteristic. When someone is reported missing, among the first things listed is the individual’s weight. A mugshot, like on a dating profile, is sufficient to assess if someone is obese or not. Good blood markers will never be as enviable as a nice jawline, and no one on dating profiles is bragging about their low A1C or low resting heart rate. To try to separate weight loss from vanity goes against everything known about human nature or incentives.

There is no way we can expect people to not subconsciously judge each other on based on weight. In spite of fat acceptance, overweight people have every reason to want to increase their social market value. Like one’s choice of wardrobe, losing weight is one of many ways of accomplishing this and necessary when first impressions matter, which is true of every society, not just America.

Is it a coincidence the top tech CEOs, save for Elon Musk, are all on the slender side even if 3/4 of the general US population is overweight or obese? Because being thin signals self-control and discipline, which are traits that make for effective leaders, or at least convey confidence to investors.

But unlike skin color, ethnicity, or height, weight can be altered. Why would we expect the majority of overweight or obese people to accept fatness when there’s an effective drug that fixes, or at least attenuates it. Even fat acceptance influencers, despite years of programming and mental conditioning about ‘loving one’s body’, are choosing to lose the excess weight when the opportunity presents itself to do so with minimal effort, compared to having to ‘diet and exercise’.

From an economics perspective, Eli Lilly is shooting itself in the foot. Let’s assume that maybe only 20% of people on these drugs are severely obese and whose health is jeopardized. The sales from cosmetic or vanity purposes makes the drug so profitable in the first place and thus incentivizes the development of such drugs, in the process helping those very people who need it most. Instead of the government subsidizing the cost, it’s the millions of rich and upper-middle class people who want to lose those last stubborn 10-20 pounds. This is a win for everyone.

[1]To go off on a digression, when people eat, GLP-1 is released from the small intestine and slows gastric emptying and in the process decreases appetite. Trying to replicate this artificially to induce fullness for weight loss proved difficult because naturally-occurring GLP-1 in humans is extremely rapidly metabolized, in minutes. Semaglutide, the active ingredient of Wegovy and Mounjaro, which artificially replicates the GLP-1 action, was revolutionary because the half life was extended to a week, so people only need a single weekly injection. Otherwise it would have not been practical. Trying to make a long-half-life synthetic GLP-1 took decades after the discovery of GLP-1 in the early ’80s, and with the help of Gila Monsters, so one can see why these drugs are so expensive.