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

新藥物可能意味著世界肥胖癥流行的結(jié)束

A new type of drug is generating excitement among the rich and the beautiful. Just a jab a week, and the weight falls o?. Elon Musk swears by it; in?uencers 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 bene?ciaries will be not celebrities in Los Angeles or Miami but billions of ordinary people around the world whose weight has made them unhealthy.

一種新型的藥物在富人和美女中引起了興奮。每周只需打一針，體重就會(huì)下降。埃隆-馬斯克信發(fā)誓到;"在TikTok上，有影響力的人對(duì)它贊不絕口；而突然變瘦的好萊塢女明星則否認(rèn)她們服用過(guò)這種藥物。但是，最新的減肥藥不僅僅是在美容上增強(qiáng)。它們最大的受益者將不是洛杉磯或邁阿密的名人，而是全世界數(shù)十億體重的普通人，他們的體重使他們不健康。

Treatments for weight loss have long ranged from the well-meaning and ine?ective 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 ?rm, 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 “o? label” for weight loss. A rival GLP-1 drug, made by Eli Lilly, an American ?rm, is due to come on sale later this year and is more e?ective still. Analysts think the market for GLP-1 drugs could reach $150bn by 2031, not far o? the market for cancer drugs today. Some think they could become as common as beta blockers or statins.

長(zhǎng)期以來(lái)，減肥的治療方法從善意的、無(wú)效的到完全不可靠的都有。新的一類藥物，稱為GLP-1受體激動(dòng)劑，似乎確實(shí)有效。由丹麥制藥公司諾和諾德Novo Nordisk開(kāi)發(fā)的Semaglutide，在臨床試驗(yàn)中已被證明可使體重減輕約15%。它已經(jīng)以Wegovy的品牌名稱在美國(guó)、丹麥和挪威銷售，并將很快在其他國(guó)家上市；Ozempic是一種低劑量的糖尿病藥物，也被 "貼牌 "用于減肥。一種由美國(guó)公司Eli Lilly生產(chǎn)的競(jìng)爭(zhēng)對(duì)手GLP-1藥物將于今年晚些時(shí)候上市，其療效也更加顯著。分析師認(rèn)為，到2031年，GLP-1藥物的市場(chǎng)可能達(dá)到1500億美元，與今天的癌癥藥物市場(chǎng)相差不遠(yuǎn)。一些人認(rèn)為它們可能會(huì)變得像β受體阻滯劑或他汀類藥物一樣普遍。

The drugs could not have arrived at a better time. In 2020 two-?fths of the world’s population were over-weight or obese. By 2035, says the World Obesity Federation, an NGO, that ?gure 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.

這些藥物的到來(lái)時(shí)機(jī)再好不過(guò)了。2020年，世界上有五分之二的人口體重超標(biāo)或肥胖。非政府組織 "世界肥胖聯(lián)合會(huì) "表示，到2035年，這一數(shù)字可能擴(kuò)大到一半以上，超重或肥胖的人數(shù)將達(dá)到驚人的40億。各地的人都在變胖。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國(guó)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 a?ects children in schools and playgrounds most cruelly of all.

這些趨勢(shì)令人震驚，因?yàn)榉逝謺?huì)導(dǎo)致一系列的健康問(wèn)題，包括糖尿病、心臟病和高血壓，以及中風(fēng)、痛風(fēng)和各種癌癥等幾十種疾病。攜帶額外的重量使人們更有可能死于covid-19。還有就是與肥胖相關(guān)的恥辱所帶來(lái)的痛苦，這對(duì)學(xué)校和操場(chǎng)上的兒童影響最為殘酷。

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.

肥胖癥對(duì)公共財(cái)政和更廣泛的經(jīng)濟(jì)造成的后果是巨大的。根據(jù)學(xué)者們的建模，到2035年，超重對(duì)世界經(jīng)濟(jì)的年度成本可能達(dá)到4萬(wàn)億美元（占全球GDP的2.9%，高于2019年的2.2%）。這包括醫(yī)療支出和因疾病而損失的工作時(shí)間以及與肥胖有關(guān)的過(guò)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 ?ghts 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.

世界上不斷擴(kuò)大的腰圍并不是數(shù)十億超重者道德失敗的標(biāo)志，而是生物學(xué)的結(jié)果。對(duì)幫助人類在冬季和饑荒中生存至關(guān)重要的基因，今天仍然幫助身體保持體重。近幾十年來(lái)，難以抵御的加工食品的過(guò)度泛濫帶來(lái)了更大的便利和更低的成本，但也引發(fā)了暴飲暴食，就像生活方式變得更加久坐不動(dòng)一樣。一旦有了脂肪，身體就會(huì)抵制任何試圖減去其總重量的嘗試。盡管去年全世界的消費(fèi)者在節(jié)食和減肥上花費(fèi)了2500億美元，但瘦身之戰(zhàn)在很大程度上已經(jīng)失敗。

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 Brie?ng). They also switch o? the powerful urge to eat that lurks inside the brain, waiting to ambush even the keenest dieter.

新的肥胖藥物是偶然出現(xiàn)的，在觀察到糖尿病患者的治療導(dǎo)致體重減輕之后。Semaglutide模擬荷爾蒙激素的釋放，刺激飽腹感并降低食欲。他們還關(guān)閉了潛伏在大腦內(nèi)部的強(qiáng)大進(jìn)食沖動(dòng)，即使是最熱衷于節(jié)食的人也會(huì)被伏擊。

With the jabs already in high demand, investors are nearly as giddy as newly slim users. The market capitalisation of Novo Nordisk, the ?rm 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 a?ordability.

由于這種針劑的需求量已經(jīng)很大，投資者幾乎和新的瘦身者一樣興奮不已。處于淘金熱前沿的諾和諾德公司的市值在兩年內(nèi)翻了一番，達(dá)到3260億美元，使其成為世界上價(jià)值第二高的上市制藥商（見(jiàn)熊彼特）。分析家們預(yù)計(jì)，到十年之交，尋求幫助的美國(guó)肥胖者中有一半人將服用Glp-1藥物。但是，就像任何對(duì)這么多人有希望的新藥一樣，也存在著不確定性。兩個(gè)大問(wèn)題是安全性和可負(fù)擔(dān)性。

Consider safety ?rst. 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-e?ects, 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 e?ects of using them during or just before pregnancy. All this will require careful analysis through controlled longitudinal studies.

首先要考慮安全性。這些藥物的新特性意味著它們的長(zhǎng)期后果尚不清楚。對(duì)于低劑量的糖尿病處方，其副作用，如嘔吐和腹瀉，都很輕微。但隨著這些藥物被更廣泛地使用和更大的劑量，其他的副作用可能會(huì)出現(xiàn)。動(dòng)物研究顯示，甲狀腺癌的發(fā)病率較高，而semaglutide與一種罕見(jiàn)的胰腺炎有關(guān)。關(guān)于在懷孕期間或懷孕前使用這些藥物的影響，我們知之甚少。所有這些都需要通過(guò)受控的縱向研究進(jìn)行仔細(xì)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 ?rst place.

了解這些風(fēng)險(xiǎn)將是很重要的，因?yàn)樵S多服用這些藥物的病人可能在他們的余生都需要這些藥物。與放棄節(jié)食一樣，停止大劑量的semaglutide與許多失去的體重重新堆積在一起有關(guān)。有些人的體重甚至比他們一開(kāi)始減去的還要多。

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 pro?ts is already luring competition and spurring innovation. Amgen, AstraZeneca and P?zer 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.

決策者的另一個(gè)關(guān)注點(diǎn)是成本。在美國(guó)，Wegovy的賬單每月約為1300美元；Ozempic的賬單約為900美元。從這樣的價(jià)格來(lái)看，終身處方看起來(lái)貴得嚇人。然而，更長(zhǎng)遠(yuǎn)的觀點(diǎn)則更令人鼓舞。隨著時(shí)間的推移，公司可能會(huì)與政府和醫(yī)療機(jī)構(gòu)達(dá)成協(xié)議，覆蓋整個(gè)人口，確保以低價(jià)格換取高數(shù)量。利潤(rùn)的前景已經(jīng)在吸引著競(jìng)爭(zhēng)，刺激著創(chuàng)新。安進(jìn)(Amgen)、阿斯利康(AstraZeneca)和P?zer都在開(kāi)發(fā)競(jìng)爭(zhēng)對(duì)手的藥物；諾和諾德(Novo Nordisk)有完整的后續(xù)藥物管道。再往前走，專利將到期，使低價(jià)仿制藥的開(kāi)發(fā)成為可能。

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 e?ects 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 ?rst place. But spare a moment to celebrate, too. These new drugs mean that the world’s ?ght against ?ab may eventually be won.

在此期間該怎么做？政府必須確保那些最需要這些藥物的人得到這些藥物，讓那些出于美容目的服用這些藥物的人自掏腰包。必須仔細(xì)研究其長(zhǎng)期影響。各國(guó)應(yīng)繼續(xù)推動(dòng)其他反肥胖措施，如運(yùn)動(dòng)、健康飲食和更好的食品標(biāo)簽，這可能有助于防止人們從一開(kāi)始就變胖。但是，也要留出時(shí)間來(lái)慶祝一下。這些新藥意味著世界反肥胖的斗爭(zhēng)可能最終會(huì)取得勝利。

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