Ozempic is the perfect trap for modern day Americans. The sales pitch is nuanced. It claims that the drug can help patients with Type 2 diabetes control blood sugar, and in conjunction with diet and exercise, help them lose weight. Unfortunately, what most Americans have heard is that this is a miracle once a week self administered injection that will magically shed pounds. The craze has lead to patients demanding that they be put on this drug “off label” in the pursuit of easy weight loss.
I know this for a fact because as an anesthesiologist I interview patients prior to their surgeries every day. I have noticed a stark uptick in the use of GLP1 agonists (there are many on the market now, Ozempic is just the most popular at the moment). These drugs have a multitude of effects on the body, including early satiety and delayed gastric emptying. This has posed a dangerous issue in the peri-operative period because the delayed gastric emptying has lead to patients with retained food products in the stomach, despite normally adequate fasting times. There have been numerous case reports of aspiration events around surgery, and even some deaths. This has lead to a statement from the American Society of Anesthesiologists recommending that GLP1 agonists be stopped at least one week prior to elective surgery. As practitioners we are even considering routine pre-operative point of care gastric ultrasound in these patients, in order to determine whether or not it is safe to proceed with surgery.
This update to my medical practice is not a big deal for me. Updating medical practice in response to new public health phenomena is part of being a good doctor. What bothers me is that this is yet again another step in the wrong direction in the American Obesity Epidemic. More and more I am seeing our healthcare efforts go towards treating the downstream effects of obesity. More stroke treatment, more open heart surgery, more knee replacements, more bariatric surgery and the list goes on and on. The downstream effects of obesity and metabolic syndrome are under-recognized and under-appreciated in the general media. The medical industrial complex intervenes too late, and when they do intervene it costs enormous amounts of money. Too often this is at the expense of the patient’s well being. Rather than emphasizing the importance of preventative care and individual responsibility for one’s health, we have medicalized it.
Oh you have this disease? Here is this medicine.
It is hopeless to point fingers about this. The obesity epidemic is a complex phenomenon due to a multitude of factors, including but not limited to the profound lack of basic nutritional understanding in the general public, ancient evolutionary mechanisms that mediate primal human appetite, and the clear market incentive to sell the most delicious and addictive foods at the lowest price point. For some context on why this is so important, consider that most estimates of total COVID-19 deaths in the United States come in at around 1.2 million. Compare this to the 300,000 deaths per year from obesity related diseases since we have been keeping track in 2001.
The burden for a solution rests on each and every one of our shoulders. At the very least it begins with the rejection of short cuts, like off label GLP1 agonists, that will ultimately lead to more bad than good. The absolute best thing would be to educate the next generation of Americans on how to develop a better relationship with the modern food landscape.
I personally will start with my son. I will teach him that eating requires a discerning eye and conscious effort. I will show him that the food we eat is as important as the air we breathe and the water we drink. I will lead by example and show him that by eating properly, I will build and maintain a body that is capable of not only surviving, but thriving in this world.