The Wegovy Class Divide – Why It’s Not What You Think

The past few years has seen a revolution in highly effective weight loss treatments, namely Semaglutide and Tirzepatide, which originally were used to treat diabetes but have been rebranded and repurposed to treat obesity under such brand names as Wegovy and Zepbound. They are often referred to as “GLP-1 drugs” for their mechanism of action of activating the GLP-1 receptor, trigging fullness and delaying gastric emptying, subsequently leading to weight loss. Given that worldwide over a billion people are overweight or obese, a figure that shows no sign of slowing, as to be expected there is a lot of enthusiasm and demand for these drugs. Much of the coverage is positive, and many people on social media report success at losing a lot of weight.

But there is a lot of skepticism too, which is understandable. These drugs are not without potentially serious side effects, and huge demand has led to shortages of the compounds for diabetics. But there is this sliver of the population that is really strongly opposed to these drugs, who never pass on the opportunity to lecture about how it’s ‘taking the easy way out’ or about the possible health risks.

The typical critic, I observe, fits a certain profile: well-educated, upper-middle-class professionals. Yet the strongest support is from either wealthy/famous people such as Oprah or various Hollywood-types, or on the other extreme, lower-middle-class people who are able to obtain these drugs despite the high price tag. It’s like the opposite of the Covid vaccines, in which opposition was strongest from working-class or religious types, whereas credentialed, upper-income people overwhelmingly supported the vaccine. But with Wegovy and related GLP-1 drugs, the intellectual-class is much more divided.

I dunno why so many high-SES people who subscribe to the credo of ‘science and progress’ in regard to other medical conditions, suc has Alzheimer’s disease or cancer, the frontier of human ingenuity in so far as weight loss is concerned must remain limited to pre-industrial era (e.g. ‘diet and exercise’). For example, I told my dad about Wegovy, who is on beta blockers and took multiple Covid vaccines and boosters and fits the aforementioned profile, and he dismissed it as ‘nonsense’. Science ‘need not apply’ as effective weight loss treatments are concerned. Why is is?

This criticism is not because they don’t need the drugs–you don’t see such opposition from these people about cancer drugs or equally costly and much less effective treatments for Alzheimer’s disease. The latest Alzheimer’s drug, Lecanemab, has about the same annual cost as Wegovy, at around $26,000 per year, so it’s not like it’s that much cheaper. Worse, the track record for Alzheimer’s drugs is much more spotty, and treatments only slow the rate of cognitive decline a bit and does not prolong survival or prevent the inevitable development of dementia. From a report, “In those analyses, participants treated with lecanemab took 25.5 months to reach the same degree of worsening on a common dementia test as the placebo group did at 18 months — a time saving of 7.5 months.” So half a year. A previous Alzheimer’s drug, Aducanumab, did not even work yet was still approved, whereas Wegovy clearly does. Yet these drugs–despite benefiting far fewer people, being less effective, and equally costly–are praised with breathless enthusiasm, but we cannot be too hasty with the new weight-loss drugs, huh? That would be reckless and dangerous.

Someone who takes antibiotics isn’t admonished for taking the easy way out. Nor Narcan for drug addiction. Telling someone with Alzheimer’s disease to ‘think harder’ or someone with cystic fibrosis to ‘breathe harder’ is understood to be cruel and ineffective. So why is obesity different? Why have so many people found success with GLP-1 drugs when dieting failed? Hell, even Oprah, despite having access to the best personal trainers and chefs money could buy, still was unable to keep the weight off, until secretly taking one of these drugs. And then the weight just melted off. So much weight, that amid public speculation she was forced to admit the truth, which saw WeightWatchers stock lose half its value after she stepped down from the board.

If you supported the Ice Bucket Challenge but oppose Wegovy, you should step back and ask yourself why one illness is more deserving of help than another, especially when obesity affects so many more people and causes more overall deaths? The Alzheimer’s Association estimates that, “6.7 million people of all ages have Alzheimer’s disease in the United States.” By comparison a third of Americans are obese, so at least 100 million people. Medical science should be about improving peoples lives. The millions of people who lost weight with these drugs can attest that their lives have been improved. This should be celebrated. And given the sometimes bad side effects for these weight loss drugs like diarrhea and cramping, including possibly more serious ones, it’s not at all like ‘taking the easy way out’, unless by ‘easy’ that means effective, which is something that I am sure people desire in medical intervention.

Why is the expectation that drug addicts get costly support networks and rehab, but obese people are scolded to ‘eat less and move more’, which to a drug addict would be as helpful as instructing to ‘put the needle down’. Imagine treating drug addicts with the same lack of imagination as obese people and being shocked that 95% of addicts relapse. When drug users relapse, the program is blamed and rehab is reinitiated, or a new treatment is tried. When weight is regained, the individual is blamed (e.g. lack of willpower), not the program.

I don’t think it has so much to do with fears or uncertainty of the new weight loss drugs being untested or unsafe, as this does not explain the enthusiasm for other new and largely unproven drugs. Like the Covid vaccines, GLP-1 drugs have seen widespread use and appear to be safe despite being new. Same for the revolutionary 2019 cystic fibrosis drug, Trikafta, which significantly prolongs survival in 90% of people with the otherwise lethal genetic disorder. No one was saying, “Yes, although Trikafta works, no, let’s wait 10 more years until we have more data, as there may be possible unforeseen consequences, even though head and shoulders this is the best drug that exists on the market for treating cystic fibrosis.” Second, such unknowns need to weighed against the known consequences of obesity. Same for critcism of such drugs not curing obesity–isn’t this true for a lot of drugs? Diabetes does not go away after taking insulin once, nor does depression after a single dose of antidepressants.

Yes, there was the whole fen-phen mess, but again, why do weight loss drugs deserve this extra scrutiny even though there have been many notable recalls for a wide range of drug types, not just weight loss drugs? If we want to go down this route, then let’s limit our options to Penicillin, Aspirin, and Tylenol, as those have a sufficiently long track record, I suppose (even though acetaminophen, the active ingredient of Tylenol, kills far more people every year than fen-phen ever did, but let’s ignore that inconvenient fact). Acetaminophen is responsible for “56,000 emergency department visits, 2,600 hospitalizations, and 500 deaths per year in the United States,” yet considered by many to be perfectly safe.

True, ALS and Alzheimer’s are terminal, but the stats on obesity and weight loss are abysmal too, with most dieters eventually regaining what little weight is lost. Unlike Covid mask efficacy, in which one can readily cite studies of cities or countries where masks may have worked or not worked at mitigating the virus, the data on dieting efficacy is unequivocally dismal. As someone who lost weight the virtuous way, it’s nice knowing the option of effective weight loss drugs exists if I should need it. But to limit our options because the treatment impugns on some arbitrary notion of Puritan morality, is like shooting oneself in the foot or a step back for society. Yes, science cannot be totally divorced from ethical concerns, but this is not about making ‘superbabies’ or the debate if embryos deserve ‘personhood’, but about making fat people merely un-fat, like in the ’70s, before obesity got out of control for reasons that are still not well understood.

To butcher that famous Rumsfeld quote, we live in the society we have, not the society we want. In today’s society, people become obese really easily despite exercising more than ever, a plethora of dieting and fitness apps and content, and possibly eating fewer calories compared to generations ago. Why so many people are suddenly storing so much fat, who knows (maybe it’s pesticides, antibiotics, seed oils, falling core body temperatures, or microplastics as proposed mechanisms), but we’re stuck with this problem–hence we need better solutions even if they are imperfect–compared to what we’ve always done in the pre-Wegovy era, which is clearly not working. When it comes to solving obesity, I say let’s bring on the science, like we do and is expected for other medical conditions. Enough with the willpower.

In addition to the above factors, I think an overlooked explanation is resistance to these drugs is also motivated by status, specially, the fear of losing social status and the need to distinguish oneself from the masses. If you’re on the top rungs of society, your position in life is pretty much secured. Sure, the media may criticize Oprah for using a weight loss drug, but she still has tons of fans, social status, and money anyway. And those in the middle or the bottom the hierarchy either don’t care or don’t see themselves as competing for status. This can explain the class dichotomy.

For top 1-5 percent, however, these people are always in a precarious position of being demoted to the bottom 95%. But now there is a class of drugs that can improve the ‘social market value’ of the bottom 95%, which means more competition from individuals who are at the cutoff. Weight loss doesn’t only improve your health, but makes you more socially desirable, too. This is not the case with Alzheimer’s drugs or Cochlear implants, as restoring bodily functions or treating dementia does not raise one’s social status in the same way weight loss, which is visible, does. Same for insulin or anti-depressants, in which weight gain is a common side effect and hence a lowering of one’s status. [Antidepressants often cause significant weight gain, which ironically compounds the depression.]

All of the ‘big tech’ CEOs, save for Elon Musk, like Sundar Pichai of Google and Satya Nadella of Microsoft, are wafer-thin. When seventy-five percent of the US is overweight or obese, thinness is one of the few ways to stand out, and signifies socially desirable traits–that being self-restraint and self-control–in contrast to projecting impulsivity, sloth, or gluttony by being overweight. It’s why rock climbing or bouldering are conspicuously common hobbies on male dating profiles, as those activities signal an athletic build, but also socially-desirable personality traits like ‘openness to experience’.

Luxury goods are not as exclusive as a signal anymore, as those too have become more common. In the ’80s and ’90s, luxury cars and designer clothes signified uncommon wealth, but the distinction between the rich and the upper-middle-class has become increasingly blurred thanks to social media. So many people are flaunting expensive stuff. The foreign luxury car has been replaced by the ubiquitous but equally expensive lifted truck or luxury SUV. And whereas luxury goods are props which are only correlated with conveying the trait or attribute one seeks to project, by contrast, one’s physical appearance is intrinsic to the individual–no prop required.

If there were a safe and affordable pill that could give anyone six-pack abs, those who earned their abs the hard way may feel miffed that this signifier of fitness is suddenly more accessible and hence devalued. Likewise, these new weight loss drugs are effective, and despite the high price tag makes the social signal attainable for the masses, which consequently and axiomatically also dilutes its exclusivity. [Although this is not to oversell the efficacy of these drugs; they will not turn an overweight couch potato into a lean rock climber, and up to a quarter of people lose no weight or only a little bit of weight.] But what is at stake goes beyond social status or superficial leanness; we’re talking public health and individual well-being.