Weight-loss drugs

The history of weight-loss medication is a sorry tale. In 1934 as many as 100,000 Americans were using dinitrophenol to shed excess pounds. It is toxic, causing cataracts and, occasionally, deaths. By one estimate 25,000 people were blinded by the drug; it was banned as a drug for human use in 1938 but deaths continue to this day as people are still enticed to buy it online. Next amphetamines became popular—until the risk of addiction and other side-effects became apparent. Ephedra, a herbal medication which in 1977 was taken by an estimated 70,000 people, was also banned in America after it led to deaths. Two other weight-loss drugs, rimonabant and sibutramine, were withdrawn from sale because of safety concerns.

The new generation of weight-loss drugs, which seem far safer, were discovered by accident. They were developed to improve glucose regulation in diabetics, who suffer from an excess of sugar in the bloodstream. The drugs use short chains of amino acids to mimic the hormones produced naturally by the body after a meal, but which diabetics sometimes produce in insufficient quantities.

The drugs semaglutide (sold as Wegovy) and tirzepatide (sold as Mounjaro) imitate the action of glucagon-like peptide-1 (GLP-1), one such hormone. This increases the production of insulin (which transports blood sugar into body cells) and reduces the production of glucagon (which releases sugar into the bloodstream from the liver). It also slows down the rate at which the stomach empties, creating a feeling of fullness that reduces appetite. In addition, the drug may increase energy expenditure by changing fat tissue into brown adipose tissue, which is more likely to be burned at rest. These effects not only help diabetics but also promote weight loss.

Following their approval for active component use in 2018, the prevalence of weight loss prescriptions within the active component increased nearly 100-fold, from 1.2 to 104.1 per 100,000 service members.