Weight-Loss Researchers Make a Breakthrough

Happy Thursday! Did you know the Library of Congress has a “free to use and reuse” section featuring millions of photos, books, films, and sound recordings that are either in the public domain, have no known copyright, or have been cleared by the copyright owner for public use?

Did you know one of the most popular items in said section is a picture of a cat dressed as Brünnhilde from Wagner’s Der Ring des Nibelungen?

Quick Hits: Today’s Top Stories

• Members-elect failed once again to elect a Speaker of the House on Wednesday, as no candidate for the position received the requisite majority support in the fourth, fifth, or sixth round of voting before the chamber adjourned for the evening just after 8 p.m. ET. Despite another endorsement from former President Donald Trump, Rep.-elect Kevin McCarthy faced 21 Republican defections on all three rounds of balloting, with 20 lawmakers throwing their support behind Rep. Byron Donalds of Florida and one voting “present.” But after another round of concessions—which included promises not to back candidates in certain Republican primaries, spots for additional Freedom Caucus members on the powerful Rules Committee, and a lower threshold to oust the speaker—McCarthy and his allies remain hopeful he can break the logjam when the House reconvenes today at noon. It’s far from certain, however, that he’s converted enough opponents to secure the gavel.
• Despite the Federal Reserve’s best efforts, the U.S. labor market remains incredibly tight, the Bureau of Labor Statistics reported Wednesday. Job openings in the United States remained essentially unchanged month-over-month in November at a near-record 10.5 million, down from the measure’s peak of 11.9 million in March. The quits rate—the percentage of workers who quit their job during the month—ticked up from 2.6 to 2.7 percent, while the number of layoffs and discharges held steady at 1.4 million.
• U.S. Central Command announced Wednesday that two rockets had targeted Mission Support Site Conoco, a base housing U.S. and coalition troops in northeast Syria. Though no individuals or entities claimed responsibility for the attack, it came shortly after the third anniversary of the United States’ killing of Iranian Gen. Qassem Suleimani. No injuries or damage were reported.
• Maria Van Kerkhove, the World Health Organization’s COVID-19 technical lead, told reporters Wednesday the latest Omicron strain—confirmed to be in at least 29 countries, including the United States—is the “most transmissible subvariant that has been detected yet,” though she added there’s no reason to think it causes more severe illness than previous iterations of the virus. According to the Centers for Disease Control, the variant in question—XBB.1.5—has gone from accounting for less than 3 percent of new infections in the United States a month ago to about 40 percent last week.
• With a new Senate sworn in, President Joe Biden announced dozens of nominations this week for various posts within the federal government, from circuit court judges to members of the Amtrak board of directors to the ambassador to Cabo Verde. Biden also re-nominated several people who had not been confirmed during the previous Congress—like Gigi Sohn at the Federal Communications Commission—in the hopes they’ll now have enough support in a 51-49 Democratic Senate. The FCC has been deadlocked—with two Republican-appointed commissioners and two Democratic-appointed commissioners—for Biden’s entire term.

A New Era for Obesity Treatments

No offense to the doctors in the room, but the average medical research conference presentation—often held in a stuffy hotel ballroom, maybe just after lunch—is more likely to put its audience to sleep than get them on their feet cheering. 

But in November, one such talk reportedly elicited a round of applause not unlike what you’d hear after a Broadway show. Why? Researchers affiliated with Denmark-based pharmaceutical company Novo Nordisk shared results showing the anti-obesity drug semaglutide was effective for teens, not just adults: After nearly 16 months of weekly injections and lifestyle interventions, more than a third of the study participants had lost at least 20 percent of their body weight. 

Semaglutide isn’t the only new weight-loss drug showing promising results. Researchers have rolled out several drugs, often used in lower doses for Type 2 diabetes, which studies suggest are more effective for weight-loss—and far less dangerous—than the dodgy diet pills of yesteryear. Though the new drugs are expensive and so far plagued by shortages, medical researchers hope they’ll help roll back the decades-long climb of obesity rates in the United States.

About 42 percent of adults in the United States are considered obese, according to the Centers for Disease Control and Prevention, and the World Health Organization reports the global obesity rate has tripled since 1975. People naturally tend toward different weights—and one study found almost 30 percent of technically obese people are still metabolically healthy—but heavier weights often come with an increased risk for heart disease, Type 2 diabetes, and other medical problems. 

The new drugs work by mimicking naturally occurring hormones that control blood sugar and hunger. “These drugs act on a gut pathway to influence insulin levels, and on brain pathways that mediate satiety,” Dr. William Dietz, director of the STOP Obesity Alliance at George Washington University, told The Dispatch. Feeling full more quickly helps people eat less, while still consuming enough to stay healthy. Though doctors still recommend improving diet and exercise to achieve weight-loss—and for a host of other reasons—the new class of obesity medications certainly seem to supplement those efforts.

Previous weight-loss drugs, from the amphetamines used post-World War II to more recent pharmaceuticals, were less useful than this new class of medication and often included severe—and even life-threatening—side effects. Bariatric surgeries like gastric bypasses are highly effective, but far more invasive than injections and carry risks of infection and other complications. The obesity drugs have their own set of side effects, but they’re less significant—nausea, vomiting, and diarrhea—and tend to be most prevalent when patients first begin taking the medication.

Several of the drugs recently approved by the Food and Drug Administration—or seeking approval in the near future—are essentially identical to Type 2 diabetes treatments, but administered in higher doses. The FDA approved Novo Nordisk’s semaglutide treatment for diabetes four years before it cleared the drug for treatment of obese adults in 2021. The agency approved a similar drug from Indiana-based Eli Lilly, tirzepatide, for Type 2 diabetics in 2022, and it will likely expand its usage to treating obesity this year. In a recent trial, participants lost an average of about 22 percent of their body weight in 72 weeks or less. 

“We should treat obesity as we treat any chronic disease—with effective and safe approaches which target underlying disease mechanisms,” said Dr. Ania Jastreboff, an obesity medicine specialist at the Yale School of Medicine who serves on scientific advisory boards for a number of pharmaceutical companies, including Eli Lilly and Novo Nordisk. “These results underscore that tirzepatide may be doing just that.”

Market analysts expect widespread interest in the new treatments. A Morgan Stanley report predicted obesity drugs will “become the next blockbuster pharma category,” and estimated global sales could grow from their current $2.4 billion annual rate to $54 billion by 2030. 

Skyrocketing demand, slow FDA approval processes, and manufacturing hiccups have already led to shortages. If the FDA approves a drug for one use, like Type 2 diabetes, doctors can then begin prescribing it “off label” for other purposes—and they have been. When a Novo Nordisk manufacturing problem limited supply of its semaglutide weight-loss drug, Wegovy, for example, physicians switched many patients seeking obesity treatment over to the company’s diabetes-targeted version, Ozempic, leading to further shortages. The scarcity has also been exacerbated by celebrities and social media influencers recommending Ozempic as a Wegovy substitute.

But not everyone who has been seeking out the medications as they’ve gained popularity truly needs them. “These drugs are approved for obesity, meaning a [body mass index] greater than or equal to 30. The more severe that obesity is, the more important is the use of these drugs,” Dietz said. “When we talk about cosmetics, we’re talking about people who lose weight for appearance purposes, rather than for medical concerns.” That, he said, is not their intended use—and such misuse has likely contributed to the shortages.

That said, plenty of would-be patients probably won’t be able to afford the drugs even once the backlogs are resolved: The medications typically cost more than $1,000 a month. Many insurance plans don’t cover the cost of weight-loss drugs given their dodgy past, and a bill that would remove a prohibition on Medicare coverage for such medications has languished in Congress for years. The federal government’s Office of Personnel Management, though, said recently that insurers can’t exclude anti-obesity medications from coverage for federal employees. Pharmaceutical companies have also made an effort to help patients affordably access the drugs, with Novo Nordisk, for example, providing instructions on requesting insurance coverage and offering up to $500 a box off Wegovy for patients who pay cash or aren’t covered.

Some questions remain about the medications, including who they’ll work best for and whether patients will have to take them for life to maintain weight-loss. But Dietz feels the latter concern is overblown, pointing out that people with diabetes, hypertension, and similar chronic conditions take medicines indefinitely. Understanding obesity as a disease, he argued, means recognizing the importance of pharmaceutical interventions in treatment alongside lifestyle changes. “For the first time we have drugs that are approaching the effectiveness of bariatric surgery,” Dietz said. “These new drugs bring us to a new place.”

Another Day, Another Stalemate

For more on the speakership drama, be sure to check out our latest update over on the site. Audrey, Price, Haley, and Harvest have been on Capitol Hill all week and have a great sense of the state of play.

McCarthy has pledged to stay in the race as long as it takes for him to become speaker, but his opponents have shown few signs of moving toward supporting him. He did obtain one slim victory Wednesday: After three votes and several hours of closed-door meetings with his critics, McCarthy successfully pushed for a motion to adjourn the House Wednesday night. Members are scheduled to return Thursday at noon.

“Leadership doesn’t want this to stay on the floor,” said Tennessee GOP Rep. Tim Burchett, who supports McCarthy but often sits next to Freedom Caucus members in the chamber during votes, including this week. He acknowledged that McCarthy’s opponents “have very dynamic speech-makers.”

“They literally kick their butts on the floor,” he said.

On Wednesday’s first ballot—and the fourth overall—the roughly 10 percent of the Republican conference who defected from McCarthy united around second-term Rep. Byron Donalds of Florida. It was a switch from Tuesday’s nomination of Ohio Rep. Jim Jordan, who has endorsed McCarthy.

Texas Rep. Chip Roy, who had voted for Donalds on the first ballot on Tuesday, formally nominated him on Wednesday, noting that for the first time in history, two black Americans were up for speaker of the House (the other being the Democrats’ candidate, Hakeem Jeffries of New York).

For the rest of the day, Donalds remained the default anti-McCarthy vote—though Indiana Rep. Victoria Spartz voted “present” repeatedly, telling reporters she still supports McCarthy but wants to see movement on the speakership race and he needs “to be able to address the concerns of other people.”

While she and others grew weary of the stalemate, McCarthy’s allies argued for him to remain in the race. “This is going to be an incredibly difficult place to lead over the course of the next two years,” GOP Rep. Dusty Johnson of South Dakota told reporters Wednesday. “Kevin McCarthy is so much better positioned to be able to do that than anyone else. If it’s not Kevin McCarthy, I wouldn’t wish that job on any single human being in that chamber. Full stop.”

Worth Your Time

• The Wall Street Journal’s latest Weekend Interview—with social psychologist Jonathan Haidt on what he sees as the “national crisis” facing Gen Z—is well worth the read. “When you look at Americans born after 1995,” he tells Tunku Varadarajan, “what you find is that they have extraordinarily high rates of anxiety, depression, self-harm, suicide and fragility.” There has “never been a generation this depressed, anxious and fragile.” The cause? A combination of social media and a culture that emphasizes victimhood. “Haidt’s research, confirmed by that of others, shows that depression rates started to rise ‘all of a sudden’ around 2013, ‘especially for teen girls,’ but ‘it’s only Gen Z, not the older generations,’” Varadarajan writes. “If you’d stopped collecting data in 2011, he says, you’d see little change from previous years. ‘By 2015 it’s an epidemic.’”
• Chuck Rosenberg is no Donald Trump fan—he resigned as acting head of the Drug Enforcement Administration largely in protest of the former president—but he’s concerned about congressional Democrats’ move last week to release six years worth of Trump’s tax returns. “The committee report recommends ways to fix the structural failures at the IRS, going forward. That seems valuable. And that strikes me as a sufficient reason to obtain and examine Trump’s returns,” he writes in Politico. “But publication of his returns is different. How does publication advance the otherwise valuable findings of the committee? Couldn’t the committee highlight the IRS’ failures in a report and keep Trump’s returns private? I believe so.” Democrats’ decision to publish the returns, he continues, was unfair to Trump. “Why do I worry about being unfair to Trump?” he writes. “Because principles of fairness should matter to all of us, all the time, and apply to all of us, all the time, even if they do not matter to Trump.”

Presented Without Comment

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Toeing the Company Line

• In this week’s Capitolism (🔒), Scott shares his outlook for the direction of economic policy in 2023. Are we headed for a recession? Will supply chains return to some semblance of normalcy? Is remote work here to stay? “If the last few years have taught us anything, it’s that we should expect the unexpected when it comes to the global economy,” he writes.
• Republicans’ inability to elect a speaker? That’s democracy, baby! “We have elected officials obeying the rules to empower a different person and a different party to take control of the House,” Jonah writes in Wednesday’s G-File (🔒). “It’s taking longer than it usually does, but we’re probably only talking about a few days. But even if it’s a few weeks, what’s the big deal?”
• Nick has complicated feelings as he watches Kevin McCarthy twist in the wind—but not all that complicated. “I relish his personal embarrassment,” he writes in Wednesday’s Boiling Frogs (🔒). “To watch him stymied and embarrassed repeatedly on the House floor by the Trump acolytes he courted at the brink of achieving his life’s ambition is justice too sweet for my weak prose to capture. We’d need a poet for the occasion.”
• On today’s episode of The Remnant, Chris Stirewalt joins Jonah for a discussion of the ongoing debacle that is Kevin McCarthy’s bid for House speaker. What do McCarthy’s opponents hope to gain? Does opposing him actually make someone more conservative? Plus: Has wokeism passed its peak? And why is scripted comedy in such a strange position?
• On the site today, Harvest takes an in-depth look at the life and work of Bob Woodson, founder of the Woodson Center and one of the country’s most recognized black conservatives today.

Let Us Know

Do you think “eat less, exercise more” will become “eat less, exercise more, take semaglutide” from now on? Do you share the optimism of the anti-obesity researchers?