- Semaglutide, sold as Ozempic in the U.S., is already seeing widespread uptake as a weight loss and diabetes drug;
- Obesity was a prevalent comorbidity during the coronavirus pandemic and is linked to many other chronic diseases;
- Medical experts say a general decline in weight that Ozempic may bring could lead to fewer excess deaths in another pandemic;
- They theorize it might also improve immunity and the severity of illness from a future virus.
Ozempic, the new weight-loss drug, has outperformed the GDP of Denmark—where it is produced—and is already being trialled by the U.K.’s National Health Service as a way of tackling rampant obesity and easing the strain on hospital waiting lists.
Semaglutide, sold under the brand names Wegovy, Rybelsus, and Ozempic in the U.S., works via tablets or injections to quash a person’s appetite, meaning they eat less and—when coupled with exercise—help overweight individuals shed their pounds more rapidly and with less strain than conventional methods. Originally developed to tackle diabetes, it also regulates glucose levels.
With Western nations such as the United Kingdom and the U.S. ranking highly in terms of the percentage of the population with obesity—in America, it is over 36 percent or around 119 million people—the drug has appeared much-needed in a time of processed foods and over-indulgence. A 2022 study published in The Lancet journal attributed weight to an excess 1,300 deaths a day.
While many are marvelling at Semaglutide’s primary uses, the widespread uptake of the drug may have another benefit we may not see for years: helping prevent the worst effects of another pandemic on the human population.
“I can’t see that the weight loss pills will prevent the [next] pandemic,” David Katz, emeritus professor of immunology at University College London, told Newsweek, but added that he could see they “will help people by having weight loss [which] will prevent the mortality and will make the morbidity much better.”
There are, of course, uncertainties, but immunologists have long hinted that what the coronavirus pandemic laid bare was an underlying health crisis among Western nations, which the virus was able to capitalize on to cause a greater proportion of deaths than among healthier populations.
The Large Comorbidity
Multiple studies have shown that many of the deaths attributed to the virus were because it caused a deterioration in other, underlying health conditions patients had—rather than being the sole cause of death among those worst affected. One research paper from 2021 noted that COVID “largely multiplies existing risks faced by patients.”
The COVID virus causes deaths predominantly among individuals who are already immunocompromised; it attacks the respiratory system, and so those with pre-existing lung complaints were more likely to experience a more severe version of the illness, more likely to require ventilation and were at a greater risk of death.
But being immunocompromised is not limited to just those with respiratory conditions, as there are many maladies that can strain one’s immunity that COVID could exploit.
A 2022 review of comorbidities ranked diabetes and hypertension—both caused by obesity—among the top three for COVID deaths. One of the studies it examined, from 2020, found that 67 percent of its sample were obese, of whom 15 percent died as a result of infection; among those morbidly obese, 17 percent died.
The Centers for Disease Control and Prevention (CDC) ranks obesity and being overweight as common risk factors for COVID deaths, precisely because general unhealthiness causes underlying conditions, such as hypertension, which can make it harder for that person’s immune system to fight a novel threat.
“One hypothesis is that [with] COVID—the illness as opposed to the virus—the badness is really related to inflammation, and obesity is an inflammatory state, as is diabetes,” John Buse, a medical professor and director of the University of North Carolina’s Diabetes Care Center, who has co-authored a study about the interaction of COVID with diabetes, told Newsweek.
He added that, on that basis, for a patient treated successfully with Semaglutide, “arguably, they might be in a better position to survive the inflammatory consequences of COVID,” but that it could also be that “people who are very heavy have some compromise in their ability to breathe and our ability to ventilate them artificially.”
“Having them prone and ventilating them and moving them all the time when they weigh, let’s say, 180 kilos, is a difficult task and they’re more likely to be unfit, unhealthy and not survive,” Katz said. “So doing something about obesity won’t prevent the pandemic, but… it will certainly impact the seriousness of the outcomes of the pandemic.”
At a recent meeting of immunologists he attended in Oxford, Katz noted research was being discussed on whether there were genetic reasons for higher mortality among some demographics. “And they came back at the end of the talks saying: ‘Look, the bottom line is the comorbidities are obesity, age, for certain circumstances gender, hypertension, heart disease, being treated for cancer’—those are the comorbidities that are going to be exactly the same [in the next pandemic],” he said.
As such, it would not be unwarranted to suppose that had Western populations such as the U.S. not been as generally unhealthy prior to 2019, the pandemic would have likely resulted in fewer excess deaths. After his own brush with a near-death COVID experience, then-British Prime Minister Boris Johnson made a point of losing weight and encouraging others to do the same.
Losing weight is hard for a plethora of reasons, and it is even harder when someone reaches a level of obesity that impairs their ability to exercise effectively. Our bodies are built to want sugary foods because they provide more energy—an advantage in the wild, where food is scarce—but in a world of sweet treats and sugary drinks, this inclination is often hard to resist.
This is where Semaglutide steps in. It mimics the hormone produced in the gastric system after eating, and, in higher doses, interacts with the brain to suppress appetite.
It does not shed the weight itself, instead making the individual taking it less likely to eat and therefore more likely to burn the energy already stored in their body. But medical experts say it must be coupled with a regime of exercise and a healthier diet if the person is to move from being obese to overweight, or overweight to healthy. In this sense, it is more of a facilitator than a cure.
This is not to say it is a wonder drug, though, as the National Library of Medicine notes, it has been known to cause tumors in lab animals, but it remains unclear if it causes a higher risk in humans.
Buse said that while the benefits of Semaglutide to the highest-risk patients were clearly measurable, it was unclear the benefits to those who are overweight and seeking “moderate” weight loss, and “what we don’t know yet is what combination of risk factors actually are necessary to be able to demonstrate the benefits.”
Yet, several medicine regulatory authorities—including the Food and Drug Administration in the U.S. and its parallel body in the U.K.—have approved it, and it is rapidly becoming a tool in the fight against groaning waistlines.
“Obesity was a major risk factor for poor outcomes with COVID—but I would actually go further that obesity is a major risk factor for poor outcomes basically in all walks of life,” Buse noted. “Bariatric surgery is associated with better cancer outcomes, so there’s just links to obesity to virtually every one of the scourges of modern society.”
The Next Pandemic
Before the coronavirus, previous pandemics had been predominantly caused by the influenza virus: the Spanish Flu of 1918-1920, the Russian Flu of 1977-1979, and the Swine Flu of 2009-2010.
Influenza circulates in the general population, and the healthcare industry usually steps up the production of flu vaccines for the variant they think will be the most prevalent in a given winter. The Swine Flu pandemic occurred because a novel and unexpected variant of the virus developed.
Before 2019, coronaviruses had typically caused epidemics that were far more deadly, but far more localized, such as SARS in 2003 and MERS in 2012. This was partly due to infection prevention measures that were easier to enforce among a smaller populous, but also because the viruses tended to be deadlier than influenza, killing off their hosts before having a chance to spread much further.
Historic precedents are no indication of future trends, as the COVID pandemic showed, but Katz argued it does not matter whether the next pandemic is caused by a coronavirus, influenza, or something else—a reduction in the number of overweight people will lead to fewer deaths.
“Let’s assume that there’s going to be another pandemic, the comorbidities are going to be the same,” he said. “It will be another virus—a mutated virus or another [type of] virus, or something like that—but these comorbidities are going to be the same.”
But one question that remains is whether Semaglutide or the general decline in weight in the population that it might bring about could limit the spread of a new virus.
Katz suggested that though “it’s always difficult to prove” as viruses tend to spread within a population regardless of demographics, a “sensible interpretation” would be that a general decline in the weight of a population would “lessen the rapidity of the spread and lessen the severity of the disease to whom it will spread.”
“Most of the studies to date have been done in people with diabetes, where truly making people’s blood sugars better has a lot of benefits with regards to immune function,” Buse noted.
He said: “These are the most powerful glucose-lowering drugs on the planet—they are more effective at getting the average glucose lower than even insulin, in the setting of Type 2 diabetes. And it’s really poorly-controlled diabetes which is where the problem…largely was in the setting of the COVID pandemic.”
Aside from its benefits for diabetics, before the advent of Semaglutide, the only way to effectively lose weight was to exercise and a healthier diet—a regime recommended with the use of the drug anyway, and one which must be continued after a patient stops taking it to avoid that weight being regained. So could the same effects be achieved through the old-fashioned means?
Buse said that clinical trials—which he and his team have been running on Ozempic and its predecessors since 1998—had yet to demonstrate the same benefits as a healthy lifestyle, but added jocularly that “if you could hypnotize people and they changed their lifestyle forevermore—their appetite was reduced; they were exercising on a regular basis; and their BMI got down to 24—I suspect you would have similarly miraculous results” as with Semaglutide.
Note: Dr. Buse informed Newsweek that UNC School of Medicine has received funding to provide consultation services to Novo Nordisk, among other pharmaceutical companies. This work has contributed a small percentage to his salary, but has not changed or increased his salary.