SAN FRANCISCO — Laura Schmidt and Luc Hagenaars authored a perspective piece in Science arguing that the "Ozempic era" should be accompanied by policies aimed at the food environment. The proposed policies include restrictions on marketing, warning labels, and taxation modeled on tobacco regulation.

Schmidt is affiliated with the University of California San Francisco. Hagenaars is affiliated with Amsterdam University Medical Center. Their argument centers on the view that relying solely on medication overlooks systemic drivers of obesity.

"They're not a magic bullet. And we have a history of kind of looking to medications as the magic bullet for problems that are really systemic," Schmidt said. She argued that defining obesity strictly as a medical condition requiring treatment shifts focus away from environmental factors.

"Trying to solve the problem by defining obesity as a medical condition that needs treatment with these medications means that we're taking our eyes off the ball when it comes to really thinking about the food environment as the driver of the problem," she said. This perspective draws on prior research into the connections between the tobacco and processed food industries.

The authors conducted a systems analysis prior to their Science perspective. In 2024, Laura Schmidt and Luc Hagenaars conducted a systems analysis that identified feedback loops entrenching the belief that obesity is an individual failing rather than a societal issue, which underpins their argument for policy reform.

"The primary finding of that was that the biggest impediment to solving the obesity epidemic is the belief that it's the individual's responsibility to solve the problem," she said. This belief system complicates efforts to implement broader regulatory changes.

Schmidt pointed to clinical evidence regarding diet. "We know from clinical trials that ultraprocessed foods cause obesity. They make people overeat and they make people eat more calories than an unprocessed diet," she said. She stated that tobacco-style regulations work well when applied to such foods.

"It should come as no surprise to anyone that tobacco-style regulations -- warning labels, taxation, curbs on marketing -- work really well when it comes to ultraprocessed foods," she said. These measures include school-based interventions to keep products out of children's environments.

The perspective acknowledges the utility of GLP-1 receptor agonists for certain patients. The GLP-1 receptor agonist class includes liraglutide, dulaglutide, and semaglutide. These medications modulate energy intake and promote satiety through agonism of the GLP-1 receptor.

GLP-1 receptor agonists improve glycemic control by suppressing glucagon and stimulating insulin secretion. A meta-analysis reported that GLP-1 receptor agonists led to reductions in major adverse cardiovascular events and mortality. Another meta-analysis showed that long-acting GLP-1 receptor agonists reduced major adverse cardiovascular events and improved a composite kidney outcome in patients with type 2 diabetes.

"We can have GLP-1s for people who already have cardiometabolic disease and they seem very effective," she said. She suggested a dual approach involving treatment for existing conditions and prevention for future cases.

"So we can have that for the people who are already suffering and then we can be preventing at the same time the emergence of more obesity, especially in kids through these food environment reforms," she said. Adverse gastrointestinal effects of GLP-1 receptor agonists include nausea, diarrhea, constipation, and vomiting. Gastrointestinal side effects are among the leading causes of treatment discontinuation for GLP-1 receptor agonists.

Schmidt raised concerns about global equity in access to these medications. "And it sets us up for a situation where if we repeat history where pharmaceutical companies put a lot of pressure on WHO [World Health Organization] and we wind up delivering those medications first and foremost to high-income countries, we're really looking at a situation where we're exacerbating health disparities, she said."

She noted that international health bodies are aware of these challenges. She said she thinks WHO got the memo because they are saying at the same time, they're saying we need to think about equitable distribution of these medications. She described the task facing the organization as difficult but familiar.

She said WHO has a real challenging job ahead of itself. It's been a real leader for many, many decades in thinking about chronic diseases from the standpoint of regulatory reforms, tobacco-style regulations, taxation, warning labels, school-based interventions that keep these products out of children's environments, curbs on commercial marketing, especially targeted children.

Why It Matters

The argument presented by Schmidt and Hagenaars shifts the focus from individual medical treatment to systemic environmental reform. By modeling food regulations on tobacco controls, they propose addressing the root causes of obesity rather than solely treating its symptoms. This approach aims to prevent the emergence of obesity in children while managing existing cases in adults.

The perspective shows potential disparities in access to GLP-1 medications. If distribution favors high-income countries, health gaps could widen. The authors suggest that regulatory reforms in the food environment offer a complementary strategy to pharmaceutical interventions. This dual approach seeks to balance immediate treatment needs with long-term public health goals.

What's New

The perspective piece by Laura Schmidt and Luc Hagenaars is titled "(Un)intended consequences of mass-prescribing GLP-1s."

Luc Hagenaars has published extensively on public health policy, with a focus on the role of economic and regulatory tools in addressing chronic disease, including work on alcohol and tobacco control frameworks. Laura Schmidt has authored or co-authored over 150 scholarly works, with a focus on public health, substance abuse, and obesity, many of which examine the systemic drivers of chronic disease.

GLP-1 receptor agonists modulate energy intake and promote satiety through agonism of the GLP-1 receptor.