Newsletter | An Inoculation Against Modern Life?

We've long argued that it’s too hard to be healthy in our modern world of hyperpalatable ultraprocessed foods, of engrossing, 24/7, screen-based entertainment, and of communities that have been designed around automobiles – the most sedentary form of transportation. That we’ve created a world for which, according to evolutionary biology, humans are genetically maladapted – and epidemics of chronic disease such as type diabetes, obesity, heart disease and depression are the inevitable result.

There are three options for dealing with the mismatch: 1) marshal the resources of our vast health care system to treat all the resulting illness; 2) change the environment such that it doesn’t exploit our genetic misalignment by design; or, behind door number 3 – change the humans so that we are less vulnerable to the toxic environment we’ve created. The first option is essentially the default option that we, as a society, have been choosing all along. The second is what we aim for at Building H. And the third – interestingly enough – is what we might actually be doing with GLP-1s.

Prescribing GLP-1s to people with diabetes and obesity sure sounds like the first option (health care treatment), but let’s look more closely at what’s actually going on. There’s been a lot in the news about GLP-1s recently and one of the best sources is New York Times science writer Julia Belluz, who has written on the new era of GLP-1 experimentation, the role of GLP-1s in combating childhood obesity and who was interviewed on Ezra Klein’s podcast. Unlike many health care treatments, GLP-1s are not used to repair damage so much as to shape the behavior that led to the illness going forward. Diet-related illnesses are complex in the sense that they both arise from diets and then, when established, exert control over those diets as well. GLP-1s wrestle away that control over eating habits – and not in the way they were expected to. Originally imagined as a way to boost the satiety signal, to get the gut to, in effect, shout to the brain that it’s full, the GLP-1 drugs work directly on the brain in a rather astonishing way. As Belluz explains it to Klein, “the theory is that it’s reaching into the part of the brain that usually signals that there’s a toxin in circulation. So that shuts down your appetite, it increases your nausea.” You could argue that this is an evolutionary cheat code – we haven’t had the luxury of a thousand generations to develop an evolutionary response in which our brains recognize today’s unhealthy foods as toxic, so we inject ourselves with chemicals that persuade our brains to see them that way.

It also turns out that working on the brain in this way has triggered a whole host of fascinating side effects, including reductions in a set of addictive behaviors, like substance use, gambling, alcohol consumption, cigarette smoking, doomscrolling and even compulsive shopping. (See GLP-1 drugs may fight addiction across every major substance, according to a study of 600,000 people and Can Ozempic Help With Addiction? New Survey Reveals Promising Signs.) It’s early, the science is still developing and it’s not entirely clear what’s actually happening – human bodies and brains are notoriously complex, after all – but there’s some suggestion that the GLP-1s are working on our reward centers.

There are increasing anecdotes of people feeling emotionally “flattened,” and a bit unmotivated when on GLP-1s (see What is ‘Ozempic personality,’ and why does it make life feel ‘meh’?). Klein spoke of his own experience on tirzepatide, reporting that he felt anhedonic and observed a general lack of desire. It’s not clear if the drugs are reducing dopamine or boosting dopamine such that it doesn’t take much to feel satiated, but the result, for people with this experience, is of a reduced desire for more. To be clear, the anhedonic effects have not yet been shown in a large percentage of users and Belluz for one is skeptical that the anti-addiction properties will hold up after longer scientific studies, but the idea of a class of drugs, which are now taken by one of every eight Americans, having an effect on the brain’s reward center that blunts our desire for more seems, shall we say, rather heretical to our modern consumerist society. In his Drug Storypodcast episode on Ozempic, Thomas frames this conflict: “GLP-1s seem to liberate those areas of our brains that food companies have been exploiting for decades.”

To the extent that GLP-1s might mute compulsive consumption and maybe even just over consumption in general, they could represent something of an inoculation against consumerism. We are essentially changing our brains – at a population scale – to become more resistant to the temptation machine of a capitalist society that has trained its resources on getting us to consume more and more – even targeting the most compulsive among us – in order to maximize profits and shareholder returns.

It all sounds a bit ridiculous, a bit far fetched, but it’s also entirely rational and sound from a public health standpoint. GLP-1s are providing real medical benefits to people with diabetes and obesity and to countless others who are discovering beneficial side effects – and nearly half of the country is living with obesity or diabetes. And all of us are struggling to be healthy in a product environment that is designed to get us to consume at unhealthy levels. So it makes sense to change the humans when the progress on changing the environment is so slow. But changing people’s brains at scale is a massive social experiment and while it’s entirely rational in the short run, it’s not clear that it holds up in the long run. Belluz, in her interview with Ezra Klein, is clearly concerned – she’s worried about the long term effects, given that GLP-1s need to be taken constantly throughout one’s life, especially for children. The tension with consumerism also creates long-term challenges. Because so many industries are dependent on high rates of consumption, they will inevitably up their games, creating something of an arms race to overcome increasingly effective and accessible drugs. (We wrote about this escalation in Big Food and Big Insurance Face Down the GLP-1 Threat.) The companies can't help it – they’re literally following the rules of our economic order.

Since our earliest issues, we’ve included this quote from Buckminster Fuller in our newsletter – "It's easier to reform the environment than it is to attempt to reform people." We’ve learned, in the 6+ years we’ve been at it with Building H, that it’s actually quite hard to reform the environment because the environment results from the economic system we take for granted and its rules that specify to whom corporations must be accountable. A manufacturer of ultraprocessed foods is rewarded if it can create snacks so enticing that people crave them despite the damage they will do to their bodies, and it will be rewarded further if those altered bodies now crave those snacks even more. It will not be punished for the costs of that damage. These are simple rules and changing them could have profound effects on the environment. Mustering the political will even to have that conversation is a challenge, but a willingness to re-examine some assumptions about how our economy should work should be a small price to pay when the alternative is to alter a population so that it is better equipped to respond to the harmful consequences of those assumptions.

Read the full newsletter.