Podcast Summary: LSE IQ – "Are we on the verge of a weight-loss revolution?"

Date: March 5, 2024
Host: Joanna Bale, London School of Economics and Political Science

Episode Overview

This episode of LSE IQ explores whether society stands on the brink of a “weight-loss revolution” through the advent of new anti-obesity drugs like Ozempic and Wegovy. Host Joanna Bale investigates both the promise and the perils of these medications, interviewing users, neuroscientists, economists, and clinical psychologists. The episode interrogates the drugs’ effectiveness, their impact on individuals and society, the broader context of obesity, and whether medication is the solution or if deeper societal and behavioral shifts are needed.

Key Discussion Points & Insights

Helen’s Experience: A Life-Changing Drug

• Introduction to Helen ([00:01], [02:30], [03:59]):

  • Helen took Ozempic for nearly two years to lose weight before bariatric surgery.
  • Describes "food noise" diminishing:

    "It was like a light bulb had been switched on... a little voice would go off and say, oh, we’re done now. And it was life changing. It was astonishing." ([00:01] – Helen)

• Benefits and Drawbacks:

  • Simple weekly self-injection, but bouts of nausea persisted (even after 1.5 years).
  • Surpassed expected weight loss target, losing 20% of body weight instead of the typical 5–12%. ([02:30])
  • "It does make you feel very nauseous and unpredictably so... but it was worth it because my weight was dropping and my blood sugar was getting sort of much better." ([02:30] – Helen)
  • Lost nine stone, leading to reversal of diabetes symptoms ([04:42]).
  • Still emphasized personal responsibility:

    "It’s still very possible to make bad food choices while on Ozempic... What it stops is the constant... food noise." ([03:59] – Helen)

• Post-Surgery Experience & Psychological Impacts:

  • "I feel more vulnerable physically than I did... I feel like I've lost my armor and that takes some getting used to." ([31:28] – Helen)
  • Awaiting confirmation of diabetes reversal, marking personal success.

The Science Behind Dieting, Drugs, and the Brain

• Dr. Nikki Sullivan – Neuroscientist, LSE ([05:07], [07:33], [10:16]):

  • Researches how brain regions communicate during food choices; explains why some find dieting easier.

  • Success in dieting linked to stronger neural connections allowing long-term reasoning to influence food choices:

    "People who are good at dieting, they actually have a very different pattern of brain activity..." ([05:07] – Nikki Sullivan)

  • Obese individuals battle hormonal signals (insulin, ghrelin, leptin) pushing them to regain lost weight ([05:07]).

  • Bariatric surgery alters these hormones and brain responses, reducing hunger preemptively ([07:33], [08:21]).

  • Leptin resistance in obese individuals can blunt feelings of fullness; surgery appears to restore some function ([09:39]).

• Ozempic and Related Drugs: Fad or Revolution?

  • Medications mimic satiety hormones, tricking users into feeling full.
  • Clinical trials and media show strong efficacy, but appetite quickly returns after stopping the drugs.
  • "So it's really a short term fix for a problem that's really a lifelong problem... it’s really important to frame them as a tool to help you change your lifestyle." ([11:02] – Nikki Sullivan)
  • Early evidence: medications may also curb addictive behaviors (e.g., gambling, alcohol), suggesting broader effects on reward pathways ([11:02]-[12:56]).

    "They actually don't just change your dietary choices. They seem to change any kind of behavior that we would consider bordering on an addiction." ([11:02] – Nikki Sullivan)

Economic and Societal Perspectives

• Professor Paul Freitas – Wellbeing Economist, LSE ([14:46] onwards):

  • Obesity is intertwined with self-esteem—negative self-worth can contribute to weight gain:

    "We found strong evidence for that in Australia... a period of unusual self worth... as a result, your weight went up." ([14:46] – Paul Freitas)

  • Pandemic lockdowns damaged wellbeing and contributed to rising obesity, especially in children ([16:25]-[17:23]).

    • Calls for supporting community and mental health, avoiding mass “self-worth harming activities.”

  • On weight-loss drugs and clinical trials:

    • Drugs yield a 10% weight loss over a year in users who persist, comparable to results of other diets.
    • Significant dropout rates due to side effects (GI issues, gallbladder).
    • Unknown long-term health effects, but known issues with obesity may compel risk trade-offs ([17:52]).

    "You're trading in one set of side effects, which are still somewhat unknown, for a sort of known major health problems in being obese. The jury is a little bit out as to what the long run health consequences will be." ([17:52] – Paul Freitas)

  • Views drugs as medicalizing what is fundamentally a behavioral/social issue ([20:03]):

    "If you want permanent changes, then behavior has to change. But in that sense, drugs are the wrong answer, because we are such social animals that to change our behavior in isolation is almost impossible for us as humans." ([20:03] – Paul Freitas)

  • Argues that true transformation requires collective action and leadership by example (e.g., politicians cycling to work, national conversations about habits) ([21:24]).

Challenges in the Healthcare System

• Dr. Sarah Appleton – Clinical Psychologist, Guy's and St Thomas' NHS ([25:20], [26:48], [28:59]):

  • Extreme shortages: 4.1 million eligible for NHS Tier 3 support, but only 35,000 places existing ([25:20]).

    "There's already a huge difficulty in access... areas just not having Tier 3 provision." ([25:20] – Sarah Appleton)

  • Medication can be a helpful “tool” but not a panacea; psychological and social roots of obesity still unaddressed ([26:48]).

  • Notes patients can feel emotionally unfulfilled or stigmatized despite weight loss ([26:48]).

  • Drugs should be used as a window for additional psychological work and long-term habits.

    "It's a really useful tool, but it's not going to address some of the underlying reasons why someone might be experiencing difficulty with their weight." ([26:48] – Sarah Appleton)

  • Long-term efficacy and safety of current and future medications still unknown ([28:59]).

  • Stresses need to focus on prevention, not just treatment (“whole system” change, not just medication) ([29:50]).

Notable Quotes & Memorable Moments

• Helen, on her experience:

  "It was like a light bulb had been switched on..." ([00:01]) "It gives you the ability to just stop and think about what you're doing rather than feeling in the grip of a compulsion..." ([03:59]) "I feel like I've lost my armor and that, that takes some getting used to." ([31:28])

• Dr. Nikki Sullivan, on the role of self-control and medication:

  "What's really good news about that is that you can actually strengthen those connections by practicing self control..." ([05:07]) "So as soon as you go off the drug, your appetite returns and you will go back to eating the way you did before." ([11:02]) "They actually don’t just change your dietary choices... These drugs are going to help you to say no to those things [addictive behaviors] in the same way. And this is a real mystery for us biologically." ([11:02])

• Professor Paul Freitas, on behavioral solutions:

  "Behavior has to change. But in that sense, drugs are the wrong answer, because we are such social animals that to change our behavior in isolation is almost impossible for us as humans." ([20:03]) "You don't make friends with salad... if I alone change my behavior, I'll be the outlier. But we can make a kind of a national deal out of this." ([21:24])

• Dr. Sarah Appleton, on system limitations:

  "Medication... is a really helpful tool... but it’s not going to address some of the underlying reasons why someone might be experiencing difficulty with their weight." ([26:48])

Important Timestamps

• Helen’s account of Ozempic’s effects: [00:01]–[04:42]
• How Ozempic is administered and side effects: [02:30]
• Discussion on brain/hormones in obesity, value of self-control: [05:07]–[07:33]
• Bariatric surgery’s impact on the brain and hormones: [07:33]
• Discussion of drugs potentially treating addictions: [10:16]–[12:56]
• Economic and psychological factors in obesity: [14:46]–[17:23]
• Analysis of clinical trials, side effects, long-term unknowns: [17:52]
• On changing behavior/societal solutions: [20:03]–[21:24]
• NHS strain and access issues: [25:13]–[26:48]
• Drug criteria and long-term questions: [26:07], [28:59]
• Helen on vulnerability post-weight loss: [31:28]

Conclusions

• Promise & Limitations of Drugs: Anti-obesity medications can be effective for weight loss and show potential for aiding in other behavioral addictions, but are not a standalone solution—weight typically returns after stopping unless fundamental behavioral changes are made. They can bring significant side effects and long-term health impacts remain unknown.
• Systemic & Societal Issues: Access to these medications is limited in the NHS, with millions eligible but very few places available. There are also regulatory and ethical challenges around private online provision.
• Underlying Causes Remain: Real answers to obesity require addressing deep systemic, psychological, and societal problems—emphasizing prevention, community, and systemic change. Drugs should complement, not replace, efforts to promote behavioral and policy-level shifts.
• Emotional and Social Dimensions: Weight loss has complex psychological effects—with some feeling newfound vulnerability or unresolved mental health challenges after losing weight.

“It's a really useful tool, but it's not going to address some of the underlying reasons why someone might be experiencing difficulty with their weight.”
– Dr. Sarah Appleton ([26:48])