Good morning.
In the last year, a little known drug originally prescribed to people with type 2 diabetes has shot into the headlines. Semaglutide, sold by Novo Nordisk as Ozempic, has taken social media and Hollywood by storm. Elon Musk credited his new body to Wegovy, another brand of the drug, and celebrities like the Kardashians are widely rumoured to be using it to shed the curvy figures that propelled them to fame in the early 2010s.
Ozempic is still only approved in the US for diabetes, though it is prescribed for weight loss. Wegovy on the other hand has been approved as a weight management treatment. Both drugs are owned by Novo Nordisk.
Semaglutide suppresses the appetite by mimicking a hormone that is released when we have eaten, which then tricks the brain into thinking that the person using the medication is full. It is injected once a week, and while effective, can have a number of uncomfortable side effects, such as nausea, constipation and even a sense of disgust about food. However, for those struggling with their weight (in 2021 25.9% of adults in England were classified as obese), it has offered a route to weight loss without undergoing drastic surgery.
The response to semaglutide, which has now been approved for the treatment of obesity in the UK, has been mixed: many have welcomed the new medication as it gives doctors more options to help people. Some critics however feel unmoved by this argument instead claiming that it simply gives people a cheat code to weight loss without the hard work. As always with conversations about weight, it is often as much about moral judgments as health.
I spoke to health journalist Julia Belluz, who has reported on Ozempic and is writing a book on obesity, about how semaglutide is changing the way we understand weight loss. That’s right after the headlines.
Five big stories
G7 | Rishi Sunak has announced a UK ban on imports of Russian diamonds and Russian-origin copper, nickel and aluminium, with other G7 members expected to follow suit. Sunak also wants to push India and Brazil to show greater support for Ukraine.
Health | Research by a fertility charity suggests that male GPs are less likely to refer eligible patients for IVF, raising concerns about access to the NHS-funded treatment. GPs usually make the initial referral to fertility clinics, meaning that they play a key role in access.
Economy | Grocery bills that have increased by 20% over the past year are going to continue to rise, overtaking the price of energy as the driving force behind inflation over the summer. The poorest households will be hit the hardest.
Italy | Floods in northern Italy have killed 13 people, with many people still reported missing. An estimated 20,000 people have been left homeless in the worst flooding to affect the country in a century.
New Zealand | A 48-year-old man has been charged with two counts of arson after a fire swept through a Wellington boarding house on Monday night, killing at least five people. One of the charges carries a maximum prison term of 14 years and police have not ruled out more serious charges.
In depth: ‘The people who were first in line might not be the people who urgently need it’
Researchers noticed in diabetes trials that patients on semaglutide were losing significant amounts of weight, so Novo Nordisk, the company that owns Ozempic, began testing the drug for indications of weight loss specifically. “The big picture is that there hasn’t been a drug that’s safe and this effective for weight loss until now,” said Julia Belluz.
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The asterisk
Like every drug, semaglutide comes with side effects and risks, including nausea, diarrhoea, constipation, dehydration, vomiting and headaches. Then there are aesthetic side effects like “Ozempic face” – a term used to describe the gaunt look after the skin loses collagen – and hair loss, though this is because of rapid weight loss rather than the drug itself. In some rare cases, patients can develop a painful condition called acute pancreatitis.
The recent use of semaglutide as a weight loss drug also means that a lot of the long-term risks are unknown. The Food and Drug Administration (FDA) in the US has said that pregnant people should not be using semaglutide, and anyone trying to get pregnant should stop using the drug at least two months prior to pregnancy.
The warnings were based on worrying signs when the drug was given to pregnant animals, Belluz said, but the FDA believes the side effects currently seen are more likely attributable to weight loss than the drug itself. “Ultimately, you don’t want to be carrying a foetus and losing weight, it’s not optimal, you’re supposed to be gaining weight,” Belluz said. “But really we have no idea how this plays out in [pregnant] humans, and we won’t have that data for years.” Despite the lack of clarity on what this drug could do to women, the concerns have not been relayed in advertising in the US or in media coverage.
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The global food system
It is important to look at the growing diabetes and obesity crisis in the context of a global food system that has been “catastrophic for the health of many populations,” said Belluz. And the problem is felt most acutely by the poorest and most marginalised populations – in England adults in the most deprived regions have almost double the prevalence of obesity compared with the least deprived (36% compared with 20%). Among children the gap is even wider.
In the US, semaglutide highlights some of the very inequalities that lead to the disparities in obesity and diabetes. “A lot of the places with the highest rates of obesity have the lowest rates of insurance, and they tend to be communities of colour, particularly in southern states,” Belluz said. “It seems many of the people who were first in line for the drug, in Hollywood circles for example, might not be the people who urgently need it and are living with extreme forms of obesity.” Musk was not obese before his weight loss, nor were any of the other stars rumoured to have used it. The increased demand has on occasion led to a shortage of the drug in the US.
While these systemic issues need to be addressed to deal with the underlying factors, Belluz said that the people who are living with weight-related health issues need help now. Essentially it is not an “either or” situation. Medical interventions should be deployed in tandem with policy decisions that address the environmental drivers of obesity and type 2 diabetes.
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The results
There is not a uniform experience of semaglutide. Some people find it extremely effective, others don’t have a great response. “Some people end up losing so much weight they have to go off the drug,” Belluz added. On average, people who were obese who were taking semaglutide alongside a healthy lifestyle lost about 15% of their body weight in the first year. The research suggests that weight regain is likely if patients stop using semaglutide.
In the search for ever more effective medicine, new, different compounds are being trialed that are seemingly leading to even more weight loss, said Belluz. “On tirzepatide people are losing closer to 20% of their body weight – and this is just the beginning.”
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An evolving discussion around weight loss
The introduction of this drug came at a complicated moment, when there has been significant backlash against the diet industry and more and more groups have been pushing to decouple body weight and health. Belluz spoke to patients who were grappling with the “Health at Every Size” movement and trying to embrace their larger bodies but who simultaneously knew that their weight was causing them some degree of health issues that the medication could help: “They felt conflicted about it because they did not want to participate in another form of diet culture.”
Semaglutide is not a magic “skinny jab” or a simple shortcut to losing weight as it is sometimes portrayed. As well as possible adverse side effects, the drug is more of an aid than a solution in and of itself – it facilitates a shift to more healthy eating. “A lot of the patients I’ve spoken to are really resentful of this idea that these are just thin injections where you do nothing and you lose a lot of weight because that’s not the case,” said Belluz. “They are typically undergoing a lot of accompanying lifestyle changes – the drugs are just making those easier.”
What else we’ve been reading
“It’s not a pop-the-champagne moment any more”: Safi Bugel asks whether the UK album charts are broken, after a spell of No 1 releases that have quickly dropped out of view. Hannah J Davies, deputy editor, newsletters
This week’s Dining Across the Divide was a hoot. 75-year-old June spent the afternoon with 25-year-old Shelby. They have five decades and a slew of conspiracy theories separating them and no amount of discussion and chips could bridge the gap for Shelby who said: “She was so agreeable that we got to the end of the meal and she said, ‘I feel like we agreed on everything,’ and I thought, ‘No, we definitely didn’t.’” Nimo
In an extract from his new book on the county, Tim Burrows writes about “the rubbishscapes of Essex”, and how coastal erosion has laid bare the sheer scale of junk and pollutants seeping out from landfill sites. Hannah
For Harrison Ford fans everywhere, Ryan Gilbey has compiled a list of the veteran actor’s 20 best performances from over the years. Nimo
“Seeking it out in the first place seemed, to me, like a blemish, an admission of defeat”: the New York Times’s Ismail Muhammad has contributed a short but beautifully written piece (£) to their series on therapy. Hannah
Sport
Tennis | Rafael Nadal, pictured above, has withdrawn from the 2023 French Open after failing to win his fitness battle after a hip injury he suffered in January, despite trying to recover over the last four months. “It’s not a decision I made, it’s a decision my body made,” he told reporters at his tennis academy in Mallorca.
Football | Newcastle’s 4-1 victory over Brighton at St James’ Park means that they only need one more win for the team to secure a return to the Champions League for the first time in 20 years.
Rugby | The Rugby Football Union withdrew the Wasps’ licence to play in next season’s Championship and, by doing so, consigned the former English champions to the basement of the entire league pyramid.
The front pages
“Fresh sanctions against Russia as PM seeks to rally support for Kyiv” is the Guardian’s Friday splash. “£10bn dirty trick – you’ll foot bills for sewage spills” says the Metro on its unappetisingly illustrated front page. And we all pay again on the cover of the Daily Telegraph: “Net zero drive will add £120 to energy bills”. The Times has “UK reliance on foreign nurses at critical level” while the Daily Express shows the PM arriving in Hiroshima for the G7 and says: “Confident Rishi: I’ll be PM for years”. “Is this the start of the great AI jobs bloodbath?” – the Daily Mail is talking about BT wanting to computerise the jobs of 10,000 workers. The Financial Times’ version is “BT plans to cull 55,000 jobs this decade in most radical cuts since privatisation”. The i has “UK warns: new rules needed to tame AI”. “Mummy, am I dying?” – the Daily Mirror runs a terrifying story about a dog attack on a little boy. “Saturday night taken away” – Ant and Dec are shutting it down, says the Sun, but not just yet.
Something for the weekend
Our critics’ roundup of the best things to watch, read and listen to right now
TV
Rolf Harris: Hiding in Plain Sight (ITVX)
When Rolf Harris was arrested in 2013 and charged as a result of the Operation Yewtree police investigation, there was genuine shock and disbelief. This programme follows what is now, sadly, an established formula. The entertainer’s career is outlined, salient points emphasised, and commentary supplied from TV insiders – all of which is interspersed with accounts from those who were exploited by him. Lucy Mangan
Music
Lewis Capaldi – Broken By Desire to Be Heavenly Sent
Lewis Capaldi has been bullish about his second album offering more of the same – not, he’s suggested, because he’s repeating a formula, but because this is the music he wants to make. The mid-tempo Forget Me, which sounds a little like the Lighthouse Family’s pop-soul, represents the most dramatic departure – unless you count the Max Martin co-write Leave Me Slowly, which steers Capaldi towards an 80s power ballad. Alexis Petridis
Film
Are You There God? It’s Me, Margaret
Judy Blume’s proto-YA classic from 1970 gets a screen adaptation; it is a sweet-natured, undemanding, oddly inconsequential movie about a lonely, smart 12-year-old anxious about the onset of puberty and adulthood. Blume herself gets a producer credit and a blink-and-you’ll-miss-it cameo, while Ant-Man’s Abby Ryder Fortson is engaging as Margaret. Peter Bradshaw
Podcast
Scamanda
Back in 2012, just before Instagram usurped the blogosphere, a young woman called Amanda Riley blogged about her cancer journey after a Hodgkin’s lymphoma diagnosis. In this eight-part series, journalist Charlie Webster reveals how Riley went on to scam her community and solicit more than $100,000 in donations to help pay for treatments she never received. Hollie Richardson
Today in Focus
National Conservatism: a Tory fringe or the party’s future?
A conference run by a rightwing American thinktank attracted Tory MPs and influencers this week. Is its Trumpish populist philosophy a taste of where the Conservative party is heading?
Cartoon of the day | Sarah Akinterinwa
The Upside
A bit of good news to remind you that the world’s not all bad
An acrimonious or distressing end to a relationship can be a bruising experience, as underscored in Emine Saner’s Guardian article about dipping a toe into dating after heartbreak. Taking your time is crucial, says psychologist Jo Hemmings, while psychotherapist Hilda Burke stresses the importance of “training [people] to believe that they are lovable, that all of us are worthy of love. That starts with being more loving towards ourselves. When you’re in that frame of mind, you think: ‘Why wouldn’t someone like me and love me?’” Saner also spoke to Lauren, who went through a difficult divorce but is now in a healthy relationship with a partner who “has completely restored my faith in men. Whatever happens to our relationship, it feels so joyful to have healed my heart enough to be able to open it up completely to someone, to know that I might get hurt again, but feel strong and optimistic enough to take a chance.”
Sign up here for a weekly roundup of The Upside, sent to you every Sunday
Bored at work?
And finally, the Guardian’s puzzles are here to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.
