Are drugs like semaglutide a quick fix, or might they be opportunities to practise virtue?
Obesity is thought to affect over 800 million adults worldwide and according to the World Health Organisation, has tripled since 1975. Indeed, estimates are that half of the world’s population will be overweight or obese by 2035 and very few currently have access to long-term treatment to address obesity or the conditions that accompany it. However, the development of several drugs that deliver significant weight-loss have the potential to revolutionise treatment. Semaglutide, for example, better known by its brand name, Wegovy, brings about a reduction in weight of up to 15 per cent in recipients. Given the clinical advantages, not least in the treatment of obesity related conditions such as diabetes or kidney disease, it has been approved for use within the National Health Service, where, in spite of soaring demand, it is prioritised for use by high-risk patients who need to lose weight prior to receiving surgery for cancer or organ transplants. Owing to the potential success of such drugs, pharmaceutical companies are keen find a share of a market that some recent reports estimate will be worth approximately $100 billion, or perhaps $200 billion, by 2030.
Some might argue that since, in most cases, obesity is caused by poor diet and lack of exercise, it a consequence of a failure of self-restraint on the part of the individual. It therefore constitutes a problem of willpower and should be treated as such. However, it can plausibly be argued that the emergence of drugs such as semaglutide, far from being a ‘quick fix’ for those who have failed to take responsibility for their own well-being, in fact represent an opportunity to practise virtues such as temperance.
Virtue Theory and the Question of Character
To adopt the language of the virtue ethics tradition, obesity can be seen as a failure of the virtue of temperance. As a virtue, temperance is recognised by both the ancient Greek philosopher Aristotle and the mediaeval theologian and philosopher St Thomas Aquinas, with Aristotle characteristically identifying it as an ‘excellence’ of character that lies between two vices: the deficiency of insensibility and the excess of self-indulgence. For neither Aquinas nor Aristotle is temperance a virtue that relates purely to the consumption of food and drink. Like the other virtues, it rests on the capacity to correctly apprehend one’s situation and respond appropriately. In Aquinas’ terms, this would mean being informed by ‘right reason’ and having a grasp of the truth. As such, temperance – sometimes better understood by the term ‘moderation’ – is a trait of character that pertains to various areas of life. For instance, it might be applied to the emotions, with the suggestion that someone should temper his anger (which of course is not to say that he shouldn’t ever be angry, but only that in the given situation, his anger is excessive). Temperance, then, helps to produce order and balance – and in connection with the body, this means health. In failing to grasp the truth of his situation, with regard to the order of goods (such as physical health, spiritual wellbeing, food and pleasure) or their respective value, the subject falls into self-indulgence. He fails to control or moderate his natural desires – for food or pleasure, in this case – and his well-being is sacrificed to transient goods. This outlook also reflects the wider teaching of Scripture on avoiding excess, developing character and personal responsibility. From such a perspective, then, one might argue that obesity is indeed a moral problem, or, rather, a problem of character, and must be addressed accordingly, with guidance, education and self-discipline.
Drugs as an Opportunity for Responsibility
This might very well be true in many cases, but it is not clear that the existence of weight-loss drugs does in fact undercut the exercise and training of virtue. Might it rather be the case that such treatments represent an opportunity to exercise moderation in a way that the subject has found impossible of late, his situation having become chronic and his attitude having degenerated into hopelessness? By way of comparison, one might say that smoking can be overcome by willpower alone – and for some people it can. For those who are heavily addicted to nicotine, however, and have been smokers for some thirty years, perhaps this is to expect too much. Nicotine patches, nicotine gum and e-cigarettes are, for some, a necessary aid to enable them to overcome their habit and, hopefully, to give up smoking for good, the idea being that they eventually rely on their own willpower. Obesity resulting from lack of exercise and excess calorie consumption is arguably different with regard to the question of physical addiction – and the cost of weight-loss drugs is far higher than that of e-cigarettes – but a similar principle can still be said to apply: at some point, the patient must rely on strength of will. Indeed, the nature of such treatments suggests as much. They are not to be taken forever; rather, they reduce weight to a certain point, after which it is for the individual to take responsibility. One of the major benefits reported by those researching the effects of the drug orforglipron (a tablet often known as Alii or Xenical) was that once they had lost a certain amount of weight, patients changed the way they thought about food and found that they were no longer constantly feeling hunger or thinking about it. What is this but an opportunity to begin to exercise temperance in a manner that had become impossible?
While there will remain questions about the desirability, costs and effects of an obesity market, it would appear that such a market is not of itself necessarily inimical to the exercise of the self-restraint that is so often central to maintaining health. Based on the indications of what certain treatments can achieve, it might well be the case that the development of weight-loss drugs provides some individuals with the means not only of avoiding some of the worst effects of obesity on their health, but, with judicious use, to regain the responsibility and personal agency which had become difficult for them.
Neil Jordan is Senior Editor at the Centre for Enterprise, Markets and Ethics. For more information about Neil please click here.