The seemingly inexorable rise in global obesity is being reflected in the sales of diabetes and weight-loss drugs. One example is Ozempic, which has been used as both a treatment for type 2 diabetes (T2D) and obesity. According to forecasts by GlobalData, Ozempic will reach global sales of $23.4bn in 2030, up from $13.9bn in 2023, showing how the T2D and obesity markets are growing. One of the main causes of this is likely to be ultra-processed food.
The rise of ultra-processed food
Ultra-processed food (UPF) has been described using the NOVA scale as foods that have gone through several processing steps. Consuming UPF has been linked to obesity, cardiovascular diseases, and T2D. This is likely a result of UPF making up over 50% of people’s energy intake in the UK and up to 80% in the US and Canada.
Examples of commonly used UPFs found on ingredient lists include gums, such as guar gum and xanthan gum; emulsifiers such as lecithin and sodium phosphates; as well as glycerines. Primarily they are used because they are cheaper than traditional ingredients, but they also allow foods with reduced fat or sugar to maintain the properties of the normal calorie options and make products easier to transport. For example, UPFs can be added to ice cream to allow transportation at lower temperatures while ensuring it does not melt.
UPFs and obesity
Though some of these advantages may seem beneficial to the food industry, UPFs have been extensively linked to the obesity epidemic. Direct associations of UPFs with increased cardiovascular disease-related mortality, obesity, and T2D in a dose-dependent manner were shown.
According to the World Health Organization (WHO), adult obesity levels have doubled since 1990 and quadrupled in adolescents, which is around the time UPF began to gain popularity. One in eight people by 2022 will be living with obesity globally, with the UK having an even higher rate of 26.2%. The WHO estimates the number of diabetes patients grew from 108 million in 1980 to 422 million in 2014, with it causing two million deaths in 2019. It is estimated that 90% of those living with T2D are overweight or obese, with diet being the significant risk factor that could be controlled.
Studies comparing diets have shown that when on an ultra-processed diet, the same participants generally consumed 500 more calories than on a minimally processed diet. These diets had similar sugar, fat, and sodium content, which is generally not seen between UPF and minimally processed food but did differ in some values such as their added to total sugar. Explanations for this increase in caloric intake are the reduced satiety levels after consuming UPFs and their ‘hyperpalatability’, leading to their addictive nature.
The Ozempic surge
To combat these figures, the race for obesity medications began. Ozempic was initially developed as a drug for diabetes but showed a weight loss efficacy of around 15%. Other health benefits, such as lowering the risk of major adverse cardiovascular events (MACE), were observed in diabetics.
Wegovy is marketed as a weight loss drug, but both this and Ozempic contain the same active compound, semaglutide. GlobalData forecasts that Wegovy will reach sales of $19.4bn in 2030, up from $4.5bn in 2023. Forecasts for drugs containing semaglutide, combined with Mounjaro, an important competitor, are predicted to reach sales of $95.7bn in 2030. This shows how large and profitable the diabetes and obesity markets have become, largely a result of the changing modern environment driven by the food industry.
Ozempic has negative side effects, including nausea, vomiting, and diarrhoea—as well as some more serious but less common side effects such as thyroid tumors and pancreatitis. For patients with obesity and T2D, the beneficial effects of Ozempic outweigh these side effects. However, it seems that combatting the root cause of obesity and avoiding both the side effects and the economic costs is a more efficient solution.
Changes in food policy are crucial to protect public health. Legislation and policy should be implemented to halt the cycle of the food industry producing patients for the pharmaceutical industry. This is important for government-funded institutions, such as the NHS, to save money and protect their patients. It also facilitates a move towards preventative medicine, to end the obesity epidemic and reduce T2D rates rather than funding the pharmaceutical industry.
