“Fighting Fire with Fire: GLP-1s and the Political Economy of Population Health,” written by Iliya Gutin, research assistant professor in the Center for Policy Research, was published in the Milbank Quarterly. Following is an excerpt:

Glucagon-like peptide-1 (GLP-1) receptor agonists have been adopted faster and more widely than any anti-obesity therapy prior. Within a few years of approval, nearly 1 in 5 US adults report having used one, and 1 in 8 is currently using it, with these numbers only likely to increase. Notably, these drugs produce average weight loss of 15% to 21% of body weight, a magnitude comparable only to bariatric surgery. While their broader health impact remains unknown, their potential to reduce obesity, and numerous other morbidities, at the population level is seemingly unprecedented.

The natural question, in turn, is what about this GLP-1 era feels different, or, to put it another way, what is the cause for optimism after decades of losing the “war on obesity”? The superficial answer is that we finally have drugs that work, but many interventions that succeed at the individual level fail to live up to their population-level promise. The fuller story — and the argument advanced here — is that they are poised to succeed because they operate within the same structural logic as the industries that engender obesity and so much chronic disease in the United States: profit-seeking, scalability, and reprogramming individuals’ default decisions and behaviors.

In a sense, GLP-1s are fighting fire with fire, which presents a dilemma for those concerned with population health. If the most promising solution succeeds because it leverages market logic, the more pressing concern for population health shifts from prevention alone toward intervening in how this market distributes GLP-1s to maximize population benefit. That is, left to its own devices, we have every reason to believe that a solely market-driven approach to GLP-1s as a population health intervention would fail to live up to the promise and potential of these transformative medications.