Doctors weigh societal costs of using drugs to treat obesity crisis

It could be one of the most transformative medical advancements since the contraceptive pill: an injection of a peptide that mimics a hormone to suppress appetite.

This is not hyperbole. Recent data from the US Centers for Disease Control and Prevention (CDC) shows obesity rates there are declining. They're still higher than 10 years ago but it signals progress.

Until about two years ago, the best direct, medical intervention for obesity was metabolic surgery — an expensive, invasive procedure that reduces stomach capacity. While effective, it wasn't accessible to everyone.

Then came Ozempic (semaglutide), a drug for type 2 diabetes that turned out to be exceptionally effective at curbing appetite and promoting weight loss.

Since its emergence, the cultural and economic ripple effects have been profound. Celebrities flaunted dramatic transformations, and social media exploded with before-and-after videos showcasing the results of drugs like Mounjaro, Wegovy, and Zepbound — semaglutide derivatives tailored for weight loss.

Demand soared, triggering a global shortage and sparking a heated ethical debate as diabetic patients publicly pleaded for priority access.

Yet beyond the controversies over side effects — nausea, headaches and even pancreatitis — these drugs mark a pivotal moment in addressing one of the world's most pressing health crises.

The economic case for tackling obesity

Obesity affects billions globally, with staggering costs: trillions of dollars in healthcare expenses and lost productivity. The World Obesity Federation projected that by 2035, more than half the global population would be obese, exacerbating economic strain.

The numbers are sobering in Australia, too. PwC estimated obesity-related costs could reach $87.7 billion by 2025.

A national report — Tipping the Scales — led by 36 health groups found in 2011-12 that annual costs associated with obesity were $8.6 billion, including direct healthcare expenses and indirect losses like absenteeism.

Weight-loss drugs could reshape this grim economic outlook. By reducing obesity rates, they promise healthier populations, higher workforce productivity and lower healthcare expenditures.

But the path forward is not straightforward.

The costs of progress

Jonathan Karnon, a health economist at Flinders University, highlights three key areas impacted by GLP-1 medications: individual health, workforce productivity and healthcare costs.

On one hand, healthier populations could reduce immediate healthcare burdens. On the other, Dr Karnon cautions against assuming long-term savings.

"Obese individuals often incur higher healthcare costs but have shorter life spans, which limits those costs over time," he said.

"I think this is a critical area to really think about, because, whilst we know that people who have obesity incur more costs than people of a similar age who are not obese, we also know that obese people don't live as long.

"Which leads to questions over how much the government should be willing to pay for the medications to be listed on the pharmaceutical benefits scheme.

"When we're thinking about cost savings, we really need to be very careful in the assumptions that we make. I don't think we should be incorporating significant cost savings down the line into the price that we're willing to pay for these drugs at the current time."

It's a bit of a catch-22: those most in need of the medications are often the least able to afford them.

Subsidising the drugs could give millions access but at a significant cost to taxpayers, and increased use of these medications would drive more people into the healthcare system, potentially uncovering and treating comorbidities like cardiovascular disease, asthma, and sleep apnoea — conditions with treatments that are already heavily subsidised by state and federal governments.

And then that raises concerns about equity, Professor Karnon said.

"Currently, the government only subsidised these drugs for people with diabetes. They've looked at subsidising them for a broader population, obese people without diabetes, and to date, they've decided that the price that the drug companies are requesting doesn't justify the benefits.

"In the absence of government subsidy, that raises even more questions around the fact that only the more well-off members of society are going to be able to afford these drugs, and what impact will that have?

"Potentially very significant, important effects on society, if only the rich can afford these drugs. So this is a very complex picture."

Should children be given weight-loss drugs?

Weight-loss drugs are already being prescribed to children in the US. Earlier this week, I spoke with an Indiana mother whose 12-year-old daughter has been on these medications for a month.

The changes in her daughter, she said, have been enormous: improved mental health, greater confidence at school, and a new-found love of exercise — exactly the habits we have been trying to instil in, well, everyone, for decades.

But the idea of medicating children raises health and ethical concerns. Not least because the side effects can include muscle loss, hair loss, pancreatitis, headaches, nausea and vomiting, and the long-term side effects of the medications are largely unknown.

Is prescribing Ozempic to children a reflection of society's deep-seated unwillingness to accept overweight bodies in any form — even if it means placing trust in Big Pharma, an industry with a checkered past?

Critics warn that prioritising medical solutions over lifestyle interventions risks dependency and avoids tackling the root of the issue — but then again — what if medical solutions are what we need to encourage changes to the root cause?

Melbourne metabolic surgeon Alex Craven is seeing this play out in real time.

He said many patients were seeking surgery only after experiencing success with weight-loss drugs.

"They're experiencing what we call 'real obesity treatment', that is, treatments that focus on the biology rather than the behaviour of obesity," Dr Craven said.

It's a revelation for some, showing them the transformative potential of combining medication and surgery.

"I think there's a group of people coming through that never would have come forward for surgery if it wasn't for that experience of trying an effective medication."

The big picture

Weight-loss drugs like Ozempic offer a promising, albeit complex, intervention in the global obesity crisis.

Their economic potential is enormous, there's even talk of them being able to curb addiction and make us live longer, but the societal cost of such promising outcomes demands careful scrutiny.

Are we prepared to embrace the financial and ethical challenges of a world where these medications could reshape not just waistlines but healthcare systems, economies and even societal norms?

The answer lies not just in science but in the difficult choices governments and societies must make about who gets access, who pays, and how we define progress.