Out of Balance Review by Amy Donelan – Inside the Ozambian Revolution | books

FNew aspects of being human have generated greater judgment, contempt and condemnation of a person’s size, shape and weight – especially if you are female. In late 2022, The Times Columnist Matthew Parris published a column entitled “Fat-shaming is the only way to beat the obesity crisis”, in which he attributed Britain’s “losing battle with fat” to society’s failure to encourage and stigmatize overweight people, eventually forcing them to shamefully eat less. The tendency to equate excess weight with bad character (and thinness with determination and self-control) treats obesity as a moral and physical failure – less a disease than a lifestyle choice.

One of the great strengths of Reuters journalist Amy Donelan’s first book is his insistence on framing the discovery of new weight-loss drugs within the fraught social and cultural context of standards of beauty, body image, and health. For those who need it, weekly injections of Ozempic, Wegovy, or Mounjaro can be revolutionary. However, for every diabetic or obese person who takes medications to improve their health, others — neither obese nor diabetic — take them to get a “beach body,” wear smaller dresses, or fulfill social media’s thin aesthetic demands. No wonder some commentators have likened the injections to “an eating disorder in the pen.”

Donelan opens the book with a case in point, a poignant interview with Sarah, a 34-year-old marketing executive from Michigan. She recounts a summer of unprecedented success at work – where she was suddenly included in important meetings, given new management responsibilities and received a pay raise. However, nothing changed in her behavior at work. It was her appearance – six months after Ozempic – that underwent a transformation. In the eyes of her employers, losing five stone (32 kg) in weight changed her value: Sarah became more important because she weighed less.

Like all tales of great scientific discovery, the weight-loss saga is rich in serendipity, rivalry, and obsession—all of which Donnellan recounts with relish. Surprisingly, it includes a starring role for the only venomous lizard in the United States, the Gila monster, though I will refrain from spoilers here. The novel’s other main protagonist is Svetlana Moisov, a young Macedonian immigrant to the United States who arrives at Rockefeller University in New York in 1972 to study postgraduate chemistry. (Today, one imagines, ICE might deport her.) At this time, the causes of obesity were seen as self-evident – ​​eating too much and not exercising – and therefore unfit for serious scientific research. Moisov disagreed. I was fascinated by why some people feel full earlier than others, or why they metabolize food more quickly. Her research – for which she is expected to win a future Nobel Prize – has successfully engineered a synthetic version of a natural hormone, glucagon-like peptide (GLP-1), which helps control blood sugar.

Scientists at Danish pharmaceutical giant Novo Nordisk have seized on GLP-1 as a potential new treatment for diabetes. Decades of effort have finally culminated in semaglutide, which diabetics can give once a week, as opposed to multiple daily injections of insulin. But drug trials revealed something unprecedented. Not only did semaglutide provide beautiful blood sugar control, it caused participants to lose up to 20% of their body weight, apparently without even trying. Novo Nordisk has found the Holy Grail – a safe chemotherapy treatment for obesity that has achieved amazing results. As news of the miracle injection leaked, celebrities began searching for it. When a newly fit Oprah Winfrey told her fans on her podcast that taking medication was to blame, suddenly everyone was clamoring for Ozempic. Winfrey said having it happen in her life “felt like a relief, like a redemption, like a gift.” It was certainly a boon to Novo Nordisk, whose market capitalization, thanks to Ozymbek, is now larger than the entire GDP of Norway.

It is commendable that Donelan was careful not to view GLP-1 drugs as an unblemished commodity. It addresses its side effects, such as severe nausea, and its use by people who are not obese, which may harm their health. The only thing they left out is that they didn’t delve into what is certainly the most interesting aspect of weight-loss drugs: Incredibly, scientists simply don’t know why they’re so good at treating obesity, other than the fact that there are GLP-1 receptors in the brain. Saturating the brain with abnormally high levels of the hormone appears to reduce people’s desire to eat. The lifespan of constant chatter about eating is diminishing. Self-control becomes easy, effortless. Does this mean that drugs like Ozempic will be licensed in the future to treat drug, alcohol, gambling and sex addictions? What would that do to our concept of free will? Ozempic is a miracle drug, a rebuke to a century of condemnation of those who are obese, and a profound challenge to the definition of what it means to be human. Watch this space.