Suppose there were such a thing as an “experience machine”, a contraption you could plug yourself into and live any life you wanted? Would you plug in? Or imagine we invented a type of zombie, a monster that looks, behaves and responds exactly like us but has no inner experiences? Would this creature have consciousness?
Or how about this. Suppose there were a magical injection that fat people could take to become thin, no effort required. Should we make it widely available?
Philosophers are fond of coming up with thought experiments involving magical ideas – they are useful for shaking up assumptions and unexamined beliefs. But last week a thought experiment seemed to come to life. News that a “weight-loss wonder drug” called semaglutide is to be made available on the NHS is presenting rather a challenge to our beliefs about fatness and what, exactly, one ought to do about it. A lot of people instinctively dislike the idea, but struggle to tell us quite why.
These people can be roughly divided into two camps. The first camp hates it broadly because it seems to excuse the obese of “personal responsibility”. The jab, in short, is cheating. Prof Karol Sikora, a prominent oncologist and health spokesperson, tweeted that he was “uneasy” about the treatment. “It sends completely the wrong message… Take a jab and all will be fine. Not the right attitude.” The commentator Julia Hartley-Brewer agreed. The jab smacked of the “nanny state”, she said. “Instead [we should be] saying, stop eating all the pizza, put down the fizzy drinks.”
This is a rather strange approach to a health condition killing 4 million a year globally. Willpower is recognised to be a puny fighter in the battle against obesity; diet and exercise only work for 10-20% of the population and weight has as much to do with genetics as behaviour. When it comes to other health conditions affected by behaviour, we are perfectly happy to treat them medically: no one is suggesting we deny statins to those at risk of stroke in case it tempts them to slack off their diets. In fact, taking “personal responsibility” for your disease usually means taking the treatments available.
So what is this group’s real problem with obesity and the jab? It can’t be health. Hartley-Brewer has previously defended an incident of fat shaming on the basis that “obesity is a concern for doctors” – but if that were her primary worry, you might expect her to embrace the jab, which is designed to address those concerns.
And it can’t be money either. In an interview about the new jab, Hartley-Brewer complains that the fat “eat themselves into an inability to work”. But she can’t really mind this because it is exactly what an appetite-suppressing jab would tackle. Obesity drains billions from the public purse each year and while semaglutide is expensive, at least now, the costs would be more than offset by its purported effect.
No, this group’s primary problem with obesity is what it symbolises. The fat have sinned: they’re guilty of greed, gluttony and probably sloth too. They can’t just get off scot-free. The only “real” solution to fatness, you sense, would be for these lazy slobs to get up at six, eat lettuce and apologise, sincerely and in full. Where once unwed mothers toiled in the Magdalene laundries, the fat must do penance on the exercise machines or possibly in full view of appointed judges on programmes such as The Biggest Loser.
Now for the second group. This group, of which I confess I am a member, has long supported interventions such as sugar taxes to combat obesity, on the morally impeccable grounds of public health. Or so we thought. Yet presented with the prospect of the state dishing out a weight-loss jab that could improve public health beyond measure, we instinctively object. Why?
Well, it turns out this second group dislikes the wonder jab for the opposite reason to the first – it gives the obese too much personal responsibility. Or, rather, semaglutide might relieve moral pressure on the real villains responsible for the obesity crisis: evil food companies.
“Am pro the drugs, but I do worry about moral hazards and feedback loops between bad food systems and drugs to treat its [harms],” tweeted one Economist journalist.
Nesta, the UK’s “innovation agency for social good”, spends a third of its considerable budget on tackling obesity, but treats the jab with suspicion, even though it can cause weight loss of 15%. The risks of “effective weight loss drugs” such as semaglutide, it wrote, was that it “might well deepen the emphasis in the public discourse on a ‘personal responsibility narrative’”, distracting from “the root cause – the food environment”.
This, again, is strange. Let us remember that obesity kills and semaglutide will save lives. Imagine greeting a new treatment for lung cancer with the concern that fewer people coughing their last in hospital might take the pressure off tobacco companies.
Neither is it inevitable that “public discourse” about the new treatment takes pressure off food companies. Add to this the fact that obesity is strongly heritable; junk food certainly contributes, but it is not the only problem.
Luckily for Hartley-Brewer and me, this new drug is not a magical solution to obesity. There are unpleasant side effects for some and for most the weight piles back on when you stop injecting. It is still rather expensive too. Both camps can gratefully use these flaws to support their arguments, but they should consider what will happen if those brilliant scientists manage to iron them out. We don’t yet have a wonder drug – but we should be aware that with a few more tweaks we might just get there. What then?
Martha Gill is a political journalist and former lobby correspondent
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