文章來源：《經濟學人》March 4th 2023 期 Leaders 欄目 Eat, inject, repeat

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.

一種新型藥物在富人和美女中引起了轟動。每周注射一次，體重就會下降。埃隆·馬斯克(Elon Musk)對它信誓旦旦;有影響力的人在TikTok上歌頌它；突然變得苗條的好萊塢小明星們都否認自己服用了這種藥物。但是最新的減肥藥不僅僅是美容。它們最大的受益者將不是洛杉磯或邁阿密的名人，而是全球數十億因體重而不健康的普通人。

?

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.

長期以來，減肥的治療方法從善意的、無效的到徹頭徹尾的欺騙。這種被稱為GLP-1受體激動劑的新型藥物似乎確實有效。由丹麥諾和諾德制藥公司開發(fā)的賽馬魯肽在臨床試驗中已顯示可使體重減輕約15%。它已經以Wegovy的品牌在美國、丹麥和挪威銷售，很快將在其他國家上市；Ozempic是一種低劑量的糖尿病藥物，也被“非標簽”用于減肥。美國Eli Lilly公司生產的GLP-1藥物的競爭對手將于今年晚些時候上市，而且效果更好。分析師們認為，到2031年，GLP-1藥物的市場規(guī)?？赡苓_到1500億美元，與目前抗癌藥的市場規(guī)模相差不遠。一些人認為它們可能會像受體阻滯劑或降低膽固醇藥物一樣普遍。

?

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.

藥物來得正是時候。到2020年，全球五分之二的人口超重或肥胖。非政府組織世界肥胖聯合會表示，到2035年，這一數字可能會膨脹到一半以上，超重或肥胖的人將達到驚人的40億。世界各地的人都在變胖。體重增長最快的不是富裕的西方國家，而是埃及、墨西哥和沙特阿拉伯等國家。

?

?

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.

這些趨勢令人擔憂，因為肥胖會導致一系列健康問題，包括糖尿病、心臟病和高血壓，以及中風、痛風和各種癌癥等數十種疾病。超重使人們更有可能死于covid-19。此外，肥胖還帶來了恥辱，這種恥辱最殘酷地影響著學校和操場上的孩子們。

?

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.

肥胖對公共財政和整體經濟的影響是巨大的。根據學者們的建模，到2035年，超重對世界經濟的年度成本可能達到4萬億美元(占全球GDP的2.9%，高于2019年的2.2%)。這既包括醫(yī)療保健支出，也包括因疾病和肥胖導致的過早死亡而損失的工作時間。

?

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.

世界上不斷擴大的腰圍并不是數十億超重人群道德淪喪的標志，而是生物學的結果。那些幫助人類在冬天和饑荒中生存下來的重要基因，今天仍然幫助人體保持體重。近幾十年來，令人難以抗拒的加工食品的過剩帶來了更大的便利和更低的成本，但隨著生活方式變得更久坐不動，也引發(fā)了暴飲暴食。一旦脂肪長出來，身體就會抵制任何減肥的企圖。盡管去年全球消費者在節(jié)食和減肥上花費了2500億美元，但減肥之戰(zhàn)在很大程度上還是失敗了。

?

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.

這種新型減肥藥的出現純屬偶然，此前人們觀察到針對糖尿病患者的治療方法可以減輕體重。Semaglutide模擬激素的釋放，刺激飽腹感并降低食欲(見簡報)。它們還能切斷潛藏在大腦中的強烈的吃東西的欲望，即使是最積極的節(jié)食者也會受到這種欲望的伏擊。

?

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

由于注射疫苗的需求已經很高，投資者幾乎和新減肥的用戶一樣興奮。處于淘金熱前沿的Novo Nordisk公司的市值在兩年內翻了一番，達到3260億美元，使其成為世界上市值第二高的上市制藥商。分析人士預計，到2020年，半數尋求幫助的肥胖美國人將服用GLP-1藥物。但是，就像任何對如此多的人有如此大希望的新藥一樣，也存在不確定性。兩大問題是安全性和可承受性。

?

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.

安全第一。這些藥物的新特性意味著它們的長期后果尚不清楚。對于治療糖尿病的低劑量藥物，如嘔吐和腹瀉等副作用是輕微的。但隨著藥物的廣泛使用和更高劑量的使用，其他藥物可能會突然出現。動物研究表明甲狀腺癌的發(fā)病率較高，而賽莫格拉肽與一種罕見的胰腺炎有關。很少有人知道在懷孕期間或懷孕前使用它們的效果。所有這些都需要通過受控縱向研究進行仔細分析。

?

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.

了解這些風險很重要，因為許多服用這些藥物的患者可能在余生都需要它們。就像放棄節(jié)食一樣，停止服用高劑量的塞莫蘆肽會導致體重反彈。有些人增重甚至比減重時還多。

?

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.

政策制定者關注的另一個問題是成本。在美國，Wegovy每月的費用約為1300美元；Ozempic大約900美元。從這樣的價格來判斷，終身處方看起來貴得嚇人。然而，從長遠來看，情況更令人鼓舞。隨著時間的推移，公司可能會與政府和醫(yī)療服務提供者達成協議，覆蓋整個人口，確保以低價格換取高數量。利潤前景已經在吸引競爭，刺激創(chuàng)新。安進(Amgen)、阿斯利康(AstraZeneca)和輝瑞(Pfizer)都在研發(fā)競爭對手的藥物；Novo Nordisk有一個完整的后續(xù)藥物流水線。再往后，專利將到期，從而使低價仿制藥得以開發(fā)。

?

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.

在此期間該做什么?政府必須確保那些最需要藥物的人得到它們，讓那些為了美容目的而服用藥物的人自掏腰包。長期影響必須仔細研究。各國應繼續(xù)推行其他反肥胖措施，如運動、健康飲食和更好的食品標簽，這可能有助于從一開始就防止人們變胖。但也要抽出一點時間來慶祝一下。這些新藥意味著全世界對抗肥胖的斗爭可能最終取得勝利。