Wegovy injections risk encouraging the kind of behaviour that leads to anorexia
I can map my life through the different weight-loss methods urged on the public. When I was a kid, in the 1980s, the cool women did Jane Fonda workouts, the chic ones did the cottage cheese diet and everyone’s mum bought books by Rosemary Conley. In the 1990s there was the low-fat diet, in which bread was good and butter bad, followed by the Atkins diet, in which the reverse was true. Mini trends have hummed along in the background: the blood type diet, the 5:2, hot yoga, sweaty spinning.
Now I’m of an age when friends discuss whatever plan they’re following and we can pretend it’s for health reasons (gotta watch that cholesterol in middle age!), not just that we are trying to stave off the day when we no longer fit into the clothes at Zara.
And yet, even though people have spun through weight-loss plans with the speed of a SoulCycle class, none of them has worked in the long term and none has boiled down to anything other than: stop eating so much and try to move more. Last weekend a friend told me of his excitement when he finally — after months on the waiting list — got his Zoe plan, a personalised nutrition programme designed by the epidemiologist Tim Spector. My friend had been intrigued by Zoe because not only did it involve someone inspecting your poo (you get your kicks where you can in your forties); it also promised he could eat carbs, which have been verboten for dieters since Atkins. “But it turned out that meant vegetables and fruit, which I guess are technically carbohydrates,” he said in the tone of someone saying, “Well, I guess a four-hour production of Hamlet in Danish technically counts as entertainment.”
So who can blame anyone for the excitement over semaglutide, the injectable medication marketed as Wegovy, which promises effortless weight loss? Semaglutide simulates the feeling of being full, so self-denial never felt less self-denying, and celebrities including Elon Musk and Kim Kardashian are rumoured to be fans. It was originally marketed, under the name Ozempic, for type 2 diabetes, but the suggestion that it can make — to use 1980s diet lingo — the pounds melt away has led to such a run on it that actual diabetics are reportedly struggling to get their meds. I’ve oscillated over which late author would enjoy this 21st-century plotline more, JG Ballard or Tom Wolfe. Ballard would appreciate the dystopian image of Hollywood celebrities jacking up Wegovy to fit into their Oscars outfits while people with diabetes collapse in the streets. But this is a story made for Wolfe, who would relish the thought of the skinny socialites he named “social x-rays” now cleaning out the local pharmacy to kill what remains of their appetite.
It’s not just the 1 per cent who are desperate for help with their weight, although they’ve been the only ones able to obtain semaglutide for weight loss. Until now. Rates of obesity in the UK have risen steadily over the decades, so semaglutide has been approved for use by the NHS, with the government keen for us to start injecting so we stop eating ourselves to death (and, possibly more pressingly for this government, so that we stay in work for longer and off health benefits). For most people, not even semaglutide’s extremely unsexy possible side effects, from diarrhoea to “facial ageing”, cancel out the gilded prospect of thinness.
There have been previous efforts to curb our increasingly uncontrollable appetites. Diet pills were little more than amphetamines; gastric bands literally restrict the stomach’s capacity, and they work for some, but others stretch the band through continued overeating. And that’s because eating problems have very little to do with appetite.
Eating should be an instinctive response to a physical need, like going for a pee. But for most of us it is not. My experience with eating problems comes at seemingly the opposite end of the spectrum to that of Wegovy patients, in that I was in and out of hospital for three years with anorexia as a teenager. But anorexia and overeating are similar. I didn’t starve myself because I wasn’t hungry, just as most people don’t become obese because they are; we did and do it out of anxiety, self-loathing, terror of our emotions and confusion about our needs.
Eating, like sex, is rarely just about physical need, and bingeing and starving become a form of self-soothing, a kind of medication that many now need another medication to stop themselves taking. As a recovered anorexic, I find it a little surreal to see doctors advocating a cure that looks oddly like my former disease, with Wegovy fans gleefully reporting they can now skip meals, as I once did.
It’s less surprising to see the focus remaining so myopically on the physical. Dealing with the psychology of overeating takes time and meanwhile, people are dying from heart attacks. For similar reasons, hospital treatment for anorexia usually involves little more than feeding up the patient. But what happens when Wegovy patients in Britain finish their two-year course? Probably the same as happened to me, again and again, when I left hospital: I relapsed, because I had no idea how to feed myself without medical intervention.
I hope not. I hope everyone can learn, as I eventually did, to respond to their body’s needs without fear or confusion. Our appetites are part of what make us human, which is why efforts to deny them, through taking in too much or too little, are so joyless, so fruitless and ultimately an act of self-harm.