Millions of people experiencing overweight and obesity are losing significant amounts of body fat for the first time, thanks to Ozempic and other drugs like it in a new class of obesity medications called semaglutides.
Though the mechanisms by which semaglutides operate are complex and still not completely known, they seem to work predominantly on the brain. Here’s Maia Szalavitz, writing in the New York Times:
The new weight loss drugs do much of their work in the brain, reducing the way that hunger centers attention on seeking food. This affects one of our two primary types of pleasure, which Kent Barrage, a professor of psychology and neuroscience at the University of Michigan, has labeled “wanting.” The positive side of wanting is feeling empowered and focused on getting what you desire; the negative side, of course, is craving that goes unsatiated.
The second kind of pleasure, which Dr. Berridge calls “liking,” is linked with the satisfaction and comfort of having achieved your goal. While there is less downside here, if people felt forever satisfied, they’d probably lack motivation to do much. The psychiatrist Donald Klein eloquently distinguished the two joys as the “pleasures of the hunt” and the “pleasures of the feast.”
Semaglutides appear to down-regulate ‘wanting’ without altering ‘liking.’ As a result, people whose brain chemistry once demanded more become satisfied with less.
Food is but one of many examples where striking the right balance of wanting and liking is imperative. Just about every behavioral addiction—from sex to porn to gambling to workaholism to shopping to television to social media—is essentially wanting in excess of liking. It’s fascinating, but also unsurprising, that many physicians are reporting people on Semaglutides are not only losing weight but also finding relief from other cravings and addictions.
We may be entering an arms race between big consumerism and big pharma.
The whole point of the consumer-industrial complex is simple: get us to consume. If we felt satisfied—if our liking was equal to or greater than our wanting—we wouldn’t come back for more, at least not as often.
Consider highly processed foods. The entire point is to get us to eat more. It’s no accident that once you pop, you just can’t stop. Pringles and a million other highly processed foods have been heavily engineered in that way. Some of us may have the neurochemistry and environmental circumstances to limit ourselves enough to maintain a healthy body weight (albeit with plenty of effort). But at least two-thirds of Americans cannot, and by no fault of their own. If the new weight loss drugs continue to be effective without a heavy side effect burden they will be a wonderful advancement.
And yet, and yet…
Is it not unfortunate that we got here in the first place?
- Single-ingredient foods to basic potato chips to Pringles and Big Macs.
- Sex with a human to softcore porn to the most stimulating fantasies, now with virtual reality immersion.
- Posting on a forum to comments to retweets and likes and shares with instantaneous feedback and social rankings.
- A card game in the basement with friends to casinos to online sports betting in real-time with up-to-the-minute odds on everything from who scores the next point to which team commits the next foul.
- Clothing for warmth to fashion to shopping as therapy.
- Dating people in your town to online dating to apps with infinite possibilities where the next person is always better than the last.
In one scenario we live in a world where people’s lives (and perhaps the earth, too) are ruined by increasingly addictive consumption behaviors. In another scenario, we live in a world where we are increasingly medicating away desire, which is a precarious needle to thread. The same mechanisms involved in the desire that leads you to overeat are involved in the desire that leads you to start a new company that develops drugs to help you not overeat. All of this brings to mind the Dystopian Pixar movie Wall-E.
Perhaps Semaglutides will be marvellously effective across the board, or lead to other drugs that are. Maybe they’ll be so effective that no amount of food or behavioral engineering can compete. That would be wonderful. But I’m not crossing my fingers. Hoping for the best is a crappy strategy.
We can’t control our endowed neurochemistry but we can work to modulate it; in particular, by being aware of the dichotomy between wanting and liking, and being wary of things that lead to an excess of the former. We’d be wise to consider the long-term implications of something versus the short-term implications—not just in our brains but also in our bodies, trying to feel our way into the future. We can also do everything possible to build lives where we nourish ourselves with satiating nutrients. We can ask of just about anything, from food to people to entertainment, Is this the ‘real’ version or the highly-processed version? And we can do everything possible to choose the former while showing ourselves and others grace for inevitable slip-ups.
Whether or not Ozempic comes to the rescue, an escalation of voracious and hollow wanting, of empty calories in all areas of our lives, is good for neither us nor society.