The Fat of the Land

The unspoken assumption is that we are firmly locked into a future in which the principal treatment for obesity isn’t diet and exercise but pharmaceutical drugs

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Commentary

Who would have thought obesity could be such big business?

Novo Nordisk is now officially Europe’s most valuable company, almost solely off the back of its new weight-loss “wonder drug” semaglutide, also known as Wegovy or Ozempic. With a market capitalization of $570 billion, Novo is worth more than the entire economy of its home country, Denmark. Its philanthropic foundation has also become the world’s largest, with twice the assets of the Gates Foundation.

Novo and its annual tax bill of $2.3 billion is single-handedly keeping the Danish economy afloat. According to Fortune, the company’s “massive investments and heightened production” helped Denmark’s economy expand at 2 percent last year, more than four times the EU average. The massive spoils of semaglutide “drove record government spending on defense, the green transition and support for Ukraine.”

“Little in Denmark can escape Novo’s gravitational pull,” Fortune says.

“Its agenda influences educational and research priorities, and politicians consider the company’s perspective before making decisions on immigration policy or new infrastructure development. The drugmaker has created thousands of jobs in the six-million-person country—and more will come as Novo expands across multiple locations—but even citizens with no ties to the firm benefit from its gains. Danish pension funds are flush from record returns on Novo shares, and mortgages are cheaper as booming diabetes drug exports have forced Denmark’s central bank to keep interest rates low.”

And yet, some are already worrying about what will happen if Denmark becomes too reliant on one huge company to keep its economy moving. What about when the profits start to dry up? According to Forbes, that’s a question professor Herman Mark Schwartz, an expert in “small countries disproportionately dependent on single firms,” is now asking, and others are asking, too.

For the time being, I think it’s safe to assume that Denmark will be OK. The great river of weight-loss money will continue to flow to Novo, and from Novo, a steady tributary will run, without interruption, to the Danish exchequer. In fact, I think it’s safe to assume that the river will only grow broader and deeper. Exactly how much broader and how much deeper is impossible to say at this point, but what is absolutely clear is that semaglutide has reached only a small fraction of its main target demographics.

A couple of weeks ago, I reported that 12 percent of U.S. adults have now used a GLP-1-receptor agonist drug—that’s the broad class of drug to which Wegovy/Ozempic and competitor drugs such as Mounjaro belong. Twelve percent, or one in eight. That may sound like a lot, and it is, but remember that 40 percent of U.S. adults are obese. The market for weight-loss drugs still has enormous room for expansion. Ahem. And that’s before we even consider the global market for these drugs.

In 2022, 1 billion people were classified as obese worldwide. Few companies can even dream of being able to market their products to a full eighth of all the people on the planet. Novo Nordisk actually can.

There’s no reason to believe that these expensive drugs have a shelf life, either. We’re not talking about selling a billion people a drug they use once or twice or for a few months or even a year. We’re talking about a drug that most users will probably have to remain on for life if they want to maintain their weight loss. This is a truth that Novo Nordisk has studiously avoided discussing, but Eli Lilly’s chief scientific and medical officer reportedly acknowledged it during a conference call in the spring of last year.

“Unfortunately,” he said, “tirzepatide [i.e., Mounjaro] is probably like every other drug we have which requires you to take it to continue to get the benefits.”

Studies and newspaper reports have already shown that users who discontinue these drugs often experience savage weight-gain rebounds.

Oh yes—and don’t forget that GLP-1-receptor agonists are also being trialed for other conditions besides obesity and diabetes. These drugs may be used in the very near future to treat drink and drug addictions, too. It turns out that appetite is part of a wider system of mood and motivation, so if you alter appetite, it has knock-on effects on other parts of that system. Food cravings and drug cravings are pretty similar, we’re learning. And there are a lot of addicts out there. Maybe there aren’t as many alcoholics or heroin addicts as there are overweight people, but there are still many, many millions. Fifty million people are reckoned to have a substance-use disorder in the United States; 5.3 percent of all deaths globally each year, or 3 million, are the result of alcohol.

My prediction is that in a few years, maybe five but certainly within a decade, Novo Nordisk will be the most valuable company in not just Europe but the whole world.

So, good news for Novo Nordisk and good news for Denmark. The social welfare dream, the “decarbonization” agenda, and the funding of NATO proxy wars can continue—all thanks to the profits of global obesity.

But how do things look at the other end of that great river of money, at its headwaters, thousands of miles away in the United States?

The Senate’s Health, Education, Labor, and Pensions (HELP) Committee recently issued a report that spells out some of the implications for the U.S. economy if uptake of weight-loss drugs continues on its current trajectory or increases. If even half of U.S. adults with obesity end up taking one of these drugs, by 2031, the total cost will be an estimated $411 billion a year, or $5 billion more than the $406 billion that Americans spent in 2022 on all prescription drugs combined.

While most of this spending is predicted to occur in the commercial market, taxpayer-funded Medicare and Medicaid could also be forced to pay as much as $166 billion a year, which is almost as much as both programs’ total expenditure in 2022.

These are insane projections: perfectly credible, but insane in their implications. We can expect health care spending in the United States to double in seven years because of the uptake of just a single drug. This isn’t sustainable.

The U.S. government knows this. In response to these projections, which it says could “bankrupt the health care system,” the HELP Committee has recommended that manufacturers such as Novo Nordisk significantly reduce the cost of their new drugs in the United States.

There’s definitely room to do that. As the Martin Shkreli affair revealed, U.S. drug prices are pretty much plucked out of thin air, and Wegovy is no exception. A month’s supply of Wegovy is more than four times as expensive in the United States as in Denmark: $809, after rebates, against $186. Independent analysis suggests the drug could be made for as little as $5 a month.

Novo’s patent on Wegovy expires in 2031, which means the price may come down in the years that follow, but the company will surely do its best to ensure it retains control over the drug beyond that point. Insulin manufacturers have used a variety of strategies to extend the exclusivity of their products in the United States and avoid direct competition from other companies, such as seeking renewals of existing patents and registering further patents for new combination drug-delivery devices.

The unspoken assumption underlying the HELP Committee’s analysis is that we are firmly locked into a future in which the principal treatment for obesity isn’t diet and exercise, but pharmaceutical drugs; a world where Big Pharma is in control of our weight, not us. Such a world has never existed before: Weight management was always in the hands of the individual, the individual’s family, and the local community. It was our responsibility.

Big Pharma, as well as Big Food, want us to believe there is no alternative, which is why they’re pushing “anti-diet” influencers on social media who tell us there’s no shame about being overweight because there’s nothing you can do about it. It’s our genes. It’s the environment. Being overweight is just an unfortunate fact of life—like having a toothache or foot fungus—and is to be treated in exactly the same dispassionate manner.

I’ve said it before and I’ll say it again: Drugs such as Wegovy are a Band-Aid for obesity. They do nothing to address the underlying causes of our massive ill health, which all have to do with changes that have taken place over the past century and put us totally at odds with our evolved nature as human beings: everything from the way we eat to the way we sleep—or don’t. The problem of obesity won’t be solved until we address those root causes.

In my optimistic moments, I believe we could see the emergence of a new health-based political movement that would do just that. Such a movement would break the corporate stranglehold over food and health, advocate for local food systems that prioritize the needs of the communities they serve, clean up the environment, and recognize, above all, the simple truism that a nation is only as healthy as the people it comprises. This is the vision I lay out in my book “The Eggs Benedict Option.”

But then, in my darker moments, I see a very different world. A world where we’re drawn ever further into medicalization, where we surrender our agency, or what’s left of it, to corporations and government. That’s the world described above, a world of staggering profits. A world of staggering costs—but none greater than the loss of our freedom to take responsibility for the course of our own lives.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.