The Guardian view on weight-loss jabs and addiction: there is too much moralising about these remarkable medicines | Editorial

IIn the years since the widespread use of so-called weight loss injections, reports have shown that these medications may not only reduce cravings, but actually reduce cravings and desires, period. Earlier this month, a study using large-scale data from U.S. veterans undergoing treatment for diabetes suggested that those who received injections were less likely to develop dependence on a wide range of drugs. Patients already using substances appeared about half as likely to suffer an overdose or drug-related death if they also took the vaccine.

This is an exciting avenue for future research. These drugs act in part on the satiety and reward centers of the brain. It’s likely that problematic food and drug cravings share a similar biological basis, and next-generation drugs could be more potent or more targeted to one or the other. But in the meantime, we should expect existing weight-loss drugs to be recommended (or prescribed off-label) for addiction treatment. This should cause us to rethink our approach to these remarkable drugs.

To put it bluntly, drug addiction is considered a disease, while obesity is not – despite some progress – considered a disease. Since GLP-1 agonist drugs emerged, many have argued that their use for weight loss was a cop-out of sorts – an answer to a problem that should be solved through willpower and strength of character. These range from articles claiming that “weight loss isn’t supposed to be easy”, to countries like Germany covering medications to treat diabetes but not obesity in general, with a government spokesperson saying weight loss is “a matter of individual responsibility and personal lifestyle”.

GLP-1 agonists certainly have drawbacks. They are expensive and have unpleasant side effects, and rare but serious additional complications can still occur – a recent study suggests they carry an increased risk of vision loss. England’s chief medical officer, Professor Chris Whitty, recently objected to prescriptions being seen as an alternative to policies promoting healthier diets which he says are urgently needed. He’s right. To be truly healthy, a simple vaccine is not enough.

But it’s important to be pragmatic and recognize that people have already made their choice: one in eight Americans, and around one in 20 people in the UK, have taken a GLP-1 drug. They shouldn’t be prescribed to lose a few pounds while on vacation, but it’s hard to imagine another drug treating a serious health problem — like obesity — facing such stigma.

This is where the overlap with addiction treatment is instructive. When methadone and suboxone were introduced, there was considerable resistance to their use, based on the belief that abstinence was the only way to overcome opioid addiction. Few people think that now. Once we became less moralistic about addiction, we were able to be pragmatic about treatment. If GLP-1 drugs also work on addiction, it should lead us to think about why there is such aversion to their use for a disease with equally disastrous health effects.

After all, as former U.S. Food and Drud Administration Director David A. Kessler writes in his recent book Diet, Drugs and Dopamine, “the fact that new anti-obesity drugs are highly effective underscores the fact that being overweight or obese is not the product of a lack of discipline or willpower.” If a drug can target it, “it’s more a question of biology.” This is a lesson we have learned about addiction. It’s time to expand this knowledge.

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