sHappy Friday and welcome to Food Fix! This issue is coming to you from Denver, where I’m attending a Healthy Eating Research meeting packed with the nerdiest of nutrition researchers. It was nice to meet several Food Fix readers here!
Food Fix on the road: In two weeks, I’ll be at Future Food-Tech in San Francisco (moderating a panel on scaling innovation). If you’re planning to be there, shoot me a note! (And don’t worry, I’m not grounded from traveling due to pregnancy until late April — a few of you asked!)
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As always, I welcome your feedback. Reply to this email to land in my inbox, or drop me a note: helena@foodfix.co.
Alright, let’s get to it —
Helena
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What we’re learning about Ozempic
Just about everywhere I go, people want to talk about Ozempic, the brand-name diabetes drug that’s become shorthand for a broader class of GLP-1 weight loss treatments. It’s a hot topic for health officials, food industry leaders, nerdy researchers and friends at dinner parties. Everyone has thoughts — and so many questions. So what have we learned so far?
These drugs are expensive, and the potential for profits is huge. It’s been well-established that these drugs are incredibly effective for weight loss — far more effective than diet and other behavioral changes alone, though the drugs in many cases can also make those lifestyle changes easier to adopt and actually stick to.
What makes these drugs blockbusters is just how big the potential market is. In the U.S. alone, more than 40 percent of American adults have obesity and some 70 percent are considered overweight, according to CDC.
Wegovy, the version of Novo Nordisk’s Ozempic that’s explicitly marketed for weight loss, can run someone $1,400 a month. And so far, it appears that patients have to take it indefinitely to see the benefits, much like drugs that tackle cholesterol or high blood pressure.
The back-of-envelope cost to the U.S. health care system if these drugs were to be prescribed en masse is kind of mind boggling. A column in the New York Times this week by economists Brian Deese, Jonathan Gruber and Ryan Cummings warned that this “miracle” treatment could also be a major budgetary threat, estimating that it could eventually cost $1 trillion per year to make the drugs available to all Americans with obesity.
“Many of us are aware that there is a new class of weight-loss drugs that offers enormous promise in addressing obesity,” they write. “But there is far less awareness of the fact that these drugs also introduce an enormous risk to America’s taxpayers.”
A good friend of mine who happens to be an actuary told me recently that the cost of GLP-1s is a huge point of discussion right now. These drugs are so expensive that the math doesn’t pencil out for a lot of health care payers — at least not yet — but the pressure is on to figure this out.
They cut how many calories you eat. One way these drugs are so effective is by curbing appetite. Some early research has found that patients on a GLP-1 will just naturally cut 20 to 30 percent of their caloric intake. Doing this on a diet would be difficult, sustaining it long-term almost impossible. Anecdotally, however, you’ll hear that individuals on these treatments just naturally cut back, no willpower needed. They feel fuller, quicker and for longer. Some people even forget to eat, and there are now actually concerns for some that GLP-1 use without proper attention to a nutritious diet could lead to malnutrition challenges. Being mindful about nutrition is key, particularly upping protein consumption, because your hunger cues are thrown way off.
They change what many people choose to eat. While GLP-1 drugs have been well studied for weight loss, one thing that has not been well studied is how individuals actually change what they’re eating. This is probably the factor that has public health folks most hopeful — and food industry executives most afraid.
A new survey from the consulting firm Eat Well Global, based on responses from 430 registered dietitians, found that GLP-1 patients’ food consumption habits changed substantially on the drugs. The survey found 76 percent of dietitians reported their patients decreased consumption of candies and desserts; 77 percent reported reduction in consumption of fatty and greasy foods; and 47 percent reported a drop in alcohol consumption. It wasn’t just what folks were cutting, either, but what they were shifting toward: 27 percent said their patients increased consumption of protein shakes, powders and bars, 17 percent increased intake of lean animal protein and fruits and veggies; and 46 percent increased water intake.
“GLP-1 consumers are not only transforming their health, they are transforming the food industry as we know it,” said Erin Kappelhof, CEO of Eat Well Global.
I’ve even seen anecdotal reports that it changes patients’ tastes, too. For example, Spencer Nadolsky, a physician who specializes in obesity and is now the medical director at Weight Watchers, posted on X this week that one patient told him they could no longer stand the taste of coffee or soda anymore. There are a whole bunch of replies from others saying their tastes have changed on the drugs, too.
They can change your mind about food — and other things. There have been numerous reports from people on GLP-1s reporting that cravings, or “food noise,” quiet down or go away completely, we’ve also seen anecdotal reports about the drugs curbing other compulsive behaviors, like drinking, smoking, shopping or gambling.
This might seem a little strange at first. Why would a weight loss drug change all these other behaviors? But researchers are increasingly learning that GLP-1s work on the brain perhaps even more than they work on the gut.
Sarah Zhang over at The Atlantic had a fascinating piece this week about how Ozempic is really a drug that targets the brain, writing: “even as scientists zero in on the likely mechanisms of these weight-loss drugs, they are encountering new and baffling questions.”
More research is needed to understand all of this, as it’s becoming increasingly clear that this class of drugs can work in unexpected ways.
We’re still learning about side effects and other downsides. And speaking of unintended consequences, drugs almost always have side effects and GLP-1s are no different. So far, the most common side effects are nausea, vomiting and diarrhea. But there’s also concerns about muscle loss, and in some cases, stomach paralysis — a difficult-to-treat complication that can leave patients dependent on feeding tubes. Some reports of suicidal ideation connected to the drugs have also raised alarm.
There are also scientists who worry the efficacy of these drugs will not hold up over time — that our bodies will eventually override the power of the intervention.
Aside from all that, though, a lot of people just have a visceral reaction to a pharmaceutical solution for any of this. One of the most common criticisms I hear about these drugs is that they do not address the root causes of poor diet, nor do they in any way change the food environment that helped get us to such high rates of obesity in the U.S. (Sidenote: The U.S. government hasn’t done much to address root causes, even as the human toll and cost to taxpayers have skyrocketed. Did anyone really expect Big Pharma to?)
What the drugs do seem to do is give individuals a physiological defense against much of our food environment. There’s a reason some food industry executives are spooked about them. It will be a while before we know whether that fear is well-placed.
AMA: In the meantime, what questions do you have about these drugs? Drop me a line: helena@foodfix.co.
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What I’m reading
Biden urges a stop to ‘shrinkflation’ (Fox News). “Too many corporations raise prices to pad their profits, charging more and more for less and less,” President Joe Biden said during his State of the Union address last night. “That’s why we’re cracking down on corporations engaged in price gouging and deceptive pricing, from food to health care to housing. In fact, the snack companies think you wont notice if they change the size of the bag and put a hell of a lot … fewer chips in it. … It’s called shrinkflation.” (The Consumer Brands Association and FMI – The Food Industry Association, which represents retailers, issued statements pushing back on the presidents’ claims.)
In rowdy speech, Biden details some ag and food issues, but fails to tout a farm bill (DTN). “In a State of the Union speech Thursday night that amounted to the opening of the 2024 presidential election campaign and that analysts described as forceful and feisty, President Biden addressed several issues of interest to the agriculture and food industries,” writes Jerry Hagstrom. “The president’s speech included a long list of legislation and while he gave a nod to family farmers and Agriculture Secretary Tom Vilsack, Biden did not call on Congress to pass a farm bill this year. At least one farm group noted that omission and cited some of the challenges facing producers.”
Ground cinnamon sold at discount stores is tainted with lead, FDA warns (Associated Press). “Ground cinnamon sold by U.S. discount retailers is contaminated with high levels of lead and should be discarded, federal health officials said Wednesday,” per JoNel Aleccia. “The U.S. Food and Drug Administration said cinnamon sold by stores including the Dollar Tree and Family Dollar contains lead at levels that could be unsafe for people, particularly children, with prolonged exposure to the spice. The agency urged suppliers to recall the products voluntarily.”
FDA approves first OTC continuous glucose monitor (Medscape). “The US Food and Drug Administration (FDA) has cleared Dexcom’s Stelo Glucose Biosensor System as the first over-the-counter continuous glucose monitoring (CGM) system,” writes Miriam Tucker. “Stelo is intended for adults with or without diabetes who don’t use insulin. … ‘CGMs can be a powerful tool to help monitor blood glucose,’ said Jeff Shuren, MD, JD, director of the FDA’s Center for Devices and Radiological Health. ‘Giving more individuals valuable information about their health, regardless of their access to a doctor or health insurance, is an important step forward in advancing health equity for US patients.’”
These countries are doing nutrition labels the right way (Washington Post). “More than 40 countries have adopted easy-to-understand, front-of-package nutrition information showing, at a glance, which foods are more — or less — healthful. Thus far, the United States has not required front-of-package labeling, relying instead on the food industry’s voluntary efforts, laden with confusing numbers and percentages. Compare that with the ‘excess sugar’ stop signs you’ll see in Mexico, the Nutri-Score system used in France, or the Health Star Ratings in New Zealand,” write researchers Christina Roberto, Alyssa Moran and Kelly Brownell. “It is crucial that the FDA make a science-based decision, as other countries have done.”
My company makes cultivated meat. I have one big regret (Fast Company). Nuanced perspective from Didier Toubia, CEO of Aleph Farms, which is working on cell-cultivated beef: “I’m optimistic about cultivated meat’s prospects of complementing conventional meat, yet at this stage, I have one regret. I look back at the last few years and wish that we—the cultivated meat ecosystem at large—had done more to form realistic expectations. As people began to appreciate cultivated meat as more science than fiction, their excitement grew very quickly—perhaps even more quickly than the industry had anticipated. When asked how much time cultivated meat needs to reach a significant share of the global animal protein market, we provided estimates that reflected our ambition. In hindsight, these estimates assumed too smooth a road.”
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