Weighty Matters [update]

This past Sunday, "60 Minutes" ran a segment on a drug, Wegovy which is used for weight loss in obese people. It seems to be in short supply, high priced, and mostly not covered by insurance.

What's funny about all this is that the chemical, semaglutide, is also sold as both Ozempic (a self-injectable) and Rybelsus (daily pill) to treat type-2 diabetics. The latter two are incessantly in adverts on the teeVee, and if you watch closely at the end of these adverts you'll see the disclaimers. They can run to multiple screen shots. Among other things, they list the 'typical' amount of weight loss by dosage. And they explicitly say that neither is to be used as a weight loss therapeutic. Say what??

According to my doctor, the latter two (he didn't say whether he prescribes Wegovy) act as appetite suppressants, not as some kind of biochemical intervention in the process of diabetes; just stops the mouth stuffing. A pretty primitive approach to the problem. Which led me to ask whether the company mixes in some other compound to act as the suppressant. He said no, that was the basic mechanism of the drug.

Which leads back to the "60 Minutes" segment. Much of it was devoted to talking heads, doctors and patients for the most part, asserting that obesity was a genetic problem, not a shoveling too much stuff into the mouth problem. Say what??? As the group assembled, they argued that Wegovy should be widely available to the Just Too Fat and fully covered by insurance; after all, being Just Too Fat wasn't the result of overeating!! It's Bad Genes!! Now, the three drugs have differing amounts of semaglutide, with Wegovy way more; which I suppose is to be expected. I didn't hear any of the group assembled assert that there's some gene that causes overeating. It might be argued that: if your four grandparents systematically overfed your parents on a diet of fried chicken and cakes, then they will likely treat you the same way. Is that a genetic pre-disposition? Or are you just a member of a long line of fat familys?

Imagine my surprise when no one, not the reporter or any of medical talking heads, noted the contradiction: Wegovy simply reduces food intake. Works for Type-2 and for Just Too Fat. Honesty in science! Dontcha love it? Semaglutide doesn't address some genetic anomaly, just shuts your food trap whether Type-2 or Just Too Fat. Note that forcing more insulin out of a cranky pancreas is, may be, not the best thing to do to a cranky pancreas.

For Type-2s, it may be a safer alternative, in that some earlier compounds which worked biochemically (addressing 'insulin resistance', for example), had some nasty (if not common) side effects. Actos is one I recall seeing in the news some years back.

Diabetes is a weird condition. Is it caused by too much mouth stuffing? Genetics? It does seem to run in families, just as some forms of Alzheimer's. Is it the result of some environmental assault? Some in the science community linked the fall of the Roman Empire to water distribution through lead pipes; over many generations, they all got stupid. Given that science, today, tells us that a bit of lead paint will derail a child's mental development, it seems cavalier to dismiss a daily dose of lead as mostly harmless. Is there some element in pollution that triggers Type-2? Only The Shadow knows; or some ground-digging -ologists a thousand years from now.

Better living through chemistry.

[update]
A STAT report (no paywall as I type) on do-it-yourself Wegovy, et al 'solution'