The festive season tends to be a time of overindulgence when the last thing many people are worrying about is shedding a few Ibs or saying no to a second, or third, mince pie. Diets are for January.
Yet - as any dieter can attest - it is much easier to put weight on than it is too lose it, and much better for your health to never become overweight or obese in the first place.
Prevention is always better than cure.
To date, however, efforts at either preventing or reversing obesity at a population level have floundered.
Statistics published earlier this month for Primary One schoolchildren in Scotland indicate that just over one in 10 five-year-olds is at risk of obesity, a figure unchanged in 20 years.
What has changed is the widening gulf between pupils depending on where they come from, with obesity rates creeping up for youngsters in the poorest areas and falling for those in the most affluent postcodes.
In 2001/2, their obesity levels were the same; by 2022/23, five-year-olds from the most deprived areas were twice as likely to be at risk of obesity by a rate of 13.9% to 6.8% for the least deprived.
Among adults, the latest Scottish Health Survey, also released this month, shows that 67% of adults in Scotland are overweight or obese, rising to a peak of 77% among the 65-74 age group.
Overall, adults in Scotland are 3% heavier on average today than they were in 2003. Not a dramatic increase, but the wrong direction of travel nonetheless.
Against this backdrop has been a string of anti-obesity measures paused or delayed by the governments at Westminster and Holyrood.
In December 2022, the UK Government announced that advertising restrictions on junk food - first unveiled in 2018 and originally due to come into force in January 2023, banning online and pre-watershed marketing of foods high in fat, sugar and salt - would be postponed until October 2025.
Meanwhile, trailblazing legislation set out by the Scottish Government back in 2017 which would have made Scotland the first country in the world to outlaw multi-buy price promotions on items such as crisps, chocolate and confectionary were put on ice when the pandemic struck in 2020, pending a renewed consultation.
It is now unclear if or when it will ever be implemented, or what shape it might take, having been kicked into the long grass again when Humza Yousaf took over as First Minister.
Critics argue that food and drink lobbyists simply hold too much sway over policy, while opponents insist that the priority for consumers is value for money.
READ MORE:
- Obesity in an ageing population is 'biggest issue' for NHS
- Goal to halve childhood obesity by 2030 'unachievable'
- The surprising truth about obesity, women, and deprivation
So what if you could tackle obesity not by changing the environment, but by altering what customers desire?
It is an idea being explored in new research by Novo Nordisk, the Danish pharmaceutical company behind the blockbuster diabetes and weight-loss drugs Ozempic and Wegovy.
Earlier this month, the company's chief executive Lars Fruergaard Jørgensen revealed that it has set up a new unit focused on unravelling why some people are more susceptible than others to developing obesity.
It will harness data from the Select clinical trial - a study into cardiac outcomes among 17,000 people taking Wegovy, who provide DNA and blood samples - as well as other national resources, such as the UK's Biobank database.
They will use this to examine patterns in genomics, epigenetics (the way environmental triggers switch genes 'on and off') and proteomics (how the body’s proteins interact and function).
The goal is to develop a Wegovy-type drug which could be prescribed prophylactically to individuals at high risk of obesity.
Preventative medicine is not unusual - patients at increased risk of heart disease can be given statins, for example - but such a move for obesity would be controversial.
On the one hand, there are the side effects which in rarer cases can include problems like stomach paralysis, but there is also a sense that it feels like giving up.
Summing it up to the Financial Times this month, Naveed Sattar, a professor of metabolic medicine at Glasgow University who was recently appointed to chair the UK Government's "obesity mission", said: "If we want to go down this route, does that mean we’re saying we’re not going to ever tackle prevention through lifestyle changes, or taxation, or food reformulation or building more cycle lanes?”.
What is intriguing about Wegovy and other forms of GLP-1 agonist drugs is that they work by making patients feel full and curbing appetite, so that they no longer crave food.
There is some evidence that they have a similar effect on other addictive and compulsive behaviours.
A study of Americans prescribed Ozempic for weight loss found that many also reported a sharp decline in their desire for alcohol, nicotine, shopping, social media and even habits like nail-biting.
There has been enough market concern about the potential for these drugs to blunt consumerism that Barclays reportedly advised its clients in October to "short" fast-food chains and snack companies such as McDonald’s and Kellogg’s - in other words, to bet that these firms will see a drop in their stock price.
Around the same time, financial news website Bloomberg warned that Ozempic is "bad for business" as it ran a column detailing how the drug, and those like it, make people "eat less food and drink less alcohol and buy fewer clothes and take fewer vacations and get fewer haircuts and consume less social media and click on fewer online ads and otherwise consume much less".
Even Walmart, the US supermarket giant, has stepped into the fray after its CEO John Furner recently revealed that when they tracked customers' prescription history against their purchasing records they were buying "less units, slightly less calories".
By 2035, nearly 7% of the US population is projected to be on some form of GLP-1 drug.
Can we medicate our way out of obesity? Probably not - any more than nicotine patches offer a silver bullet for smoking.
But blunting the desire to overindulge in the first place might be a useful start, and one less vulnerable to food lobby interference.
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