Eat, inject, repeat

New drugs could spell an end to the world’s obesity epidemic

新药物可能意味着世界肥胖症流行的结束

A new type of drug is generating excitement among the rich and the beautiful. Just a jab a week, and the weight falls off. Elon Musk swears by it; influencers sing its praises on TikTok; suddenly slimmer Hollywood starlets deny they have taken it. But the latest weight-loss drugs are no mere cosmetic enhancements. Their biggest beneficiaries will be not celebrities in Los Angeles or Miami but billions of ordinary people around the world whose weight has made them unhealthy.

一种新型的药物在富人和美女中引起了兴奋。每周只需打一针，体重就会下降。埃隆-马斯克信发誓到;"在TikTok上，有影响力的人对它赞不绝口；而突然变瘦的好莱坞女明星则否认她们服用过这种药物。但是，最新的减肥药不仅仅是在美容上增强。它们最大的受益者将不是洛杉矶或迈阿密的名人，而是全世界数十亿体重的普通人，他们的体重使他们不健康。

Treatments for weight loss have long ranged from the well-meaning and ineffective to the downright dodgy. The new class of drugs, called GLP-1 receptor agonists, seems actually to work. Semaglutide, developed by Novo Nordisk, a Danish pharmaceutical firm, has been shown in clinical trials to lead to weight loss of about 15%. It is already being sold under the brand name Wegovy in America, Denmark and Norway and will soon be available in other countries; Ozempic, a lower-dose version, is a diabetes drug that is also being used “off label” for weight loss. A rival GLP-1 drug, made by Eli Lilly, an American firm, is due to come on sale later this year and is more effective still. Analysts think the market for GLP-1 drugs could reach $150bn by 2031, not far off the market for cancer drugs today. Some think they could become as common as beta blockers or statins.

长期以来，减肥的治疗方法从善意的、无效的到完全不可靠的都有。新的一类药物，称为GLP-1受体激动剂，似乎确实有效。由丹麦制药公司诺和诺德Novo Nordisk开发的Semaglutide，在临床试验中已被证明可使体重减轻约15%。它已经以Wegovy的品牌名称在美国、丹麦和挪威销售，并将很快在其他国家上市；Ozempic是一种低剂量的糖尿病药物，也被 "贴牌 "用于减肥。一种由美国公司Eli Lilly生产的竞争对手GLP-1药物将于今年晚些时候上市，其疗效也更加显著。分析师认为，到2031年，GLP-1药物的市场可能达到1500亿美元，与今天的癌症药物市场相差不远。一些人认为它们可能会变得像β受体阻滞剂或他汀类药物一样普遍。

The drugs could not have arrived at a better time. In 2020 two-fifths of the world’s population were over-weight or obese. By 2035, says the World Obesity Federation, an NGO, that figure could swell to more than half, with a staggering 4bn people overweight or obese. People everywhere are getting fatter. The populations putting on pounds the fastest are not in the rich West but in countries like Egypt, Mexico and Saudi Arabia.

这些药物的到来时机再好不过了。2020年，世界上有五分之二的人口体重超标或肥胖。非政府组织 "世界肥胖联合会 "表示，到2035年，这一数字可能扩大到一半以上，超重或肥胖的人数将达到惊人的40亿。各地的人都在变胖。胖得最快的人口不是在富裕的西方，而是在埃及、墨西哥和沙特阿拉伯等国家。

These trends are alarming because obesity causes a host of health problems, including diabetes, heart disease and high blood pressure, as well as dozens of illnesses such as stroke, gout and various cancers. Carrying extra weight made people more likely to die of covid-19. And then there is the misery that comes from the stigma associated with being fat, which affects children in schools and playgrounds most cruelly of all.

这些趋势令人震惊，因为肥胖会导致一系列的健康问题，包括糖尿病、心脏病和高血压，以及中风、痛风和各种癌症等几十种疾病。携带额外的重量使人们更有可能死于covid-19。还有就是与肥胖相关的耻辱所带来的痛苦，这对学校和操场上的儿童影响最为残酷。

The consequences of obesity for the public purse and the wider economy are large. According to modelling by academics the annual cost to the world economy of excess weight could reach $4trn by 2035 (2.9% of global GDP, up from 2.2% in 2019). That includes both spending on health care and working time lost to illness and premature deaths tied to obesity.

肥胖症对公共财政和更广泛的经济造成的后果是巨大的。根据学者们的建模，到2035年，超重对世界经济的年度成本可能达到4万亿美元（占全球GDP的2.9%，高于2019年的2.2%）。这包括医疗支出和因疾病而损失的工作时间以及与肥胖有关的过早死亡。

The world’s expanding waistlines are not a sign of the moral failure of the billions who are overweight, but the result of biology. The genes that were vital to helping humans survive winters and famine still help the body cling on to its weight today. The superabundance of hard-to-resist processed foods in recent decades has brought greater convenience and lower costs, but also triggered overeating just as lifestyles became more sedentary. Once the fat is on, the body fights any attempt to diet away more than a little of its total weight. Despite the $250bn that consumers around the world spent on dieting and weight loss last year, the battle to get slim was largely being lost.

世界上不断扩大的腰围并不是数十亿超重者道德失败的标志，而是生物学的结果。对帮助人类在冬季和饥荒中生存至关重要的基因，今天仍然帮助身体保持体重。近几十年来，难以抵御的加工食品的过度泛滥带来了更大的便利和更低的成本，但也引发了暴饮暴食，就像生活方式变得更加久坐不动一样。一旦有了脂肪，身体就会抵制任何试图减去其总重量的尝试。尽管去年全世界的消费者在节食和减肥上花费了2500亿美元，但瘦身之战在很大程度上已经失败。

The new obesity drugs arrived by serendipity, after treatments meant for diabetics were observed to cause weight loss. Semaglutide mimics the release of hormones that stimulate a feeling of fullness and reduce the appetite (see Briefing). They also switch off the powerful urge to eat that lurks inside the brain, waiting to ambush even the keenest dieter.

新的肥胖药物是偶然出现的，在观察到糖尿病患者的治疗导致体重减轻之后。Semaglutide模拟荷尔蒙激素的释放，刺激饱腹感并降低食欲。他们还关闭了潜伏在大脑内部的强大进食冲动，即使是最热衷于节食的人也会被伏击。

With the jabs already in high demand, investors are nearly as giddy as newly slim users. The market capitalisation of Novo Nordisk, the firm at the front of the gold rush, has doubled in two years, to $326bn, making it the second-most-valuable listed drugmaker in the world (see Schumpeter). Analysts expect half of obese Americans who seek help to be on GLP-1 drugs by the turn of the decade. But, as with any new medicine that holds so much promise for so many, there are uncertainties. Two big ones will be safety and affordability.

由于这种针剂的需求量已经很大，投资者几乎和新的瘦身者一样兴奋不已。处于淘金热前沿的诺和诺德公司的市值在两年内翻了一番，达到3260亿美元，使其成为世界上价值第二高的上市制药商（见熊彼特）。分析家们预计，到十年之交，寻求帮助的美国肥胖者中有一半人将服用Glp-1药物。但是，就像任何对这么多人有希望的新药一样，也存在着不确定性。两个大问题是安全性和可负担性。

Consider safety first. The newness of these drugs means that their long-term consequences are not yet known. For the lower dose forms prescribed for diabetes, the side-effects, such as vomiting and diarrhoea, have been mild. But others could crop up as the drugs are used more widely and at higher doses. Animal studies have shown a higher incidence of thyroid cancer, and semaglutide is associated with a rare pancreatitis. Little is known about the effects of using them during or just before pregnancy. All this will require careful analysis through controlled longitudinal studies.

首先要考虑安全性。这些药物的新特性意味着它们的长期后果尚不清楚。对于低剂量的糖尿病处方，其副作用，如呕吐和腹泻，都很轻微。但随着这些药物被更广泛地使用和更大的剂量，其他的副作用可能会出现。动物研究显示，甲状腺癌的发病率较高，而semaglutide与一种罕见的胰腺炎有关。关于在怀孕期间或怀孕前使用这些药物的影响，我们知之甚少。所有这些都需要通过受控的纵向研究进行仔细分析。

Understanding these risks will be important, because many patients who take the drugs may need them for the rest of their lives. As with ditching a diet, stopping a high dose of semaglutide is associated with much of the lost weight piling back on. Some people even gain more weight than they lost in the first place.

了解这些风险将是很重要的，因为许多服用这些药物的病人可能在他们的余生都需要这些药物。与放弃节食一样，停止大剂量的semaglutide与许多失去的体重重新堆积在一起有关。有些人的体重甚至比他们一开始减去的还要多。

Another preoccupation for policymakers is cost. In America the bill for Wegovy runs at around $1,300 a month; for Ozempic about $900. Judged by such prices, lifelong prescriptions look forbiddingly expensive. The longer view, however, is more encouraging. In time, companies may strike deals with governments and health providers to cover the whole population, ensuring high volumes in return for low prices. The prospect of profits is already luring competition and spurring innovation. Amgen, AstraZeneca and Pfizer are all working on rival drugs; Novo Nordisk has a full pipeline of follow-on drugs. Further ahead still, patents will expire, enabling the development of lower-priced generics.

决策者的另一个关注点是成本。在美国，Wegovy的账单每月约为1300美元；Ozempic的账单约为900美元。从这样的价格来看，终身处方看起来贵得吓人。然而，更长远的观点则更令人鼓舞。随着时间的推移，公司可能会与政府和医疗机构达成协议，覆盖整个人口，确保以低价格换取高数量。利润的前景已经在吸引着竞争，刺激着创新。安进(Amgen)、阿斯利康(AstraZeneca)和Pfizer都在开发竞争对手的药物；诺和诺德(Novo Nordisk)有完整的后续药物管道。再往前走，专利将到期，使低价仿制药的开发成为可能。

The shape of things to come

What to do in the meantime? Governments must ensure that those who most need the drugs get them, leaving those taking them for cosmetic purposes to pay out of their own pockets. The long-term effects must be carefully studied. States should keep pressing other anti-obesity measures, such as exercise, healthy eating and better food labelling, which may help prevent people from getting fat in the first place. But spare a moment to celebrate, too. These new drugs mean that the world’s fight against flab may eventually be won.

在此期间该怎么做？政府必须确保那些最需要这些药物的人得到这些药物，让那些出于美容目的服用这些药物的人自掏腰包。必须仔细研究其长期影响。各国应继续推动其他反肥胖措施，如运动、健康饮食和更好的食品标签，这可能有助于防止人们从一开始就变胖。但是，也要留出时间来庆祝一下。这些新药意味着世界反肥胖的斗争可能最终会取得胜利。

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