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A new type of drug is generating excitement among the rich and the beautiful. Just a jab a week, and the weight falls off. Elon Musk swears by it; influencers sing its praises on TikTok; suddenly slimmer Hollywood starlets deny they have taken it. But the latest weight-loss drugs are no mere cosmetic enhancements. Their biggest beneficiaries will be not celebrities in Los Angeles or Miami but billions of ordinary people around the world whose weight has made them unhealthy.

一种新型药物在富人和美女中引起了轰动，每周只需注射一次，体重就能下降。埃隆·马斯克对其推崇备至，抖音上的网红大唱赞歌，突然变苗条的好莱坞年轻女星否认注射了这种药物。但是，最新的减肥药物不仅是为美容，最大受益者不是洛杉矶或迈阿密的名流，而是全球数十亿因体重而不健康的普通民众。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处

Treatments for weight loss have long ranged from the well-meaning and ineffective to the downright dodgy. The new class of drugs, called glp-1 receptor agonists, seems actually to work. Semaglutide, developed by Novo Nordisk, a Danish pharmaceutical firm, has been shown in clinical trials to lead to weight loss of about 15%. It is already being sold under the brand name Wegovy in America, Denmark and Norway and will soon be available in other countries; Ozempic, a lower-dose version, is a diabetes drug that is also being used “off label” for weight loss. A rival glp-1 drug, made by Eli Lilly, an American firm, is due to come on sale later this year and is more effective still. Analysts think the market for glp-1 drugs could reach $150bn by 2031, not far off the market for cancer drugs today. Some think they could become as common as beta blockers or statins.

长期以来，减肥疗法要么是善意的无效治疗，要么是彻头彻尾的欺骗。新药物glp-1受体激动剂好像确实有效，临床试验表明，丹麦制药企业“诺和诺德”研制的“司美格鲁肽”能减少大约15%的体重，目前这种品牌名为“Wegovy”的药物已经在美国、丹麦、挪威销售，不久将在其他国家销售。“胰妥赞”是一种低剂量型糖尿病药物，也被用于“仿单标示外”的减肥用途。美国“礼来”公司制造的glp-1竞争药物预计在今年晚些时候销售，效果会更加显著。分析人士预测到2031年，glp-1药物的市场规模可达1500亿美元，与当今的抗癌药物市场相差不远。有人认为，glp-1药物可能会像β-受体阻滞剂以及他汀类药物那样普遍。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处

The drugs could not have arrived at a better time. In 2020 two-fifths of the world’s population were overweight or obese. By 2035, says the World Obesity Federation, an ngo, that figure could swell to more than half, with a staggering 4bn people overweight or obese. People everywhere are getting fatter. The populations putting on pounds the fastest are not in the rich West but in countries like Egypt, Mexico and Saudi Arabia.

这些药物可能恰逢其时。2020年，全世界五分之二人口超重或肥胖。据非政府组织“世界肥胖联合会”预测到2035年，这个比例可能增至一半以上，超重或肥胖人数达到惊人的40亿。全球各地的人都在变胖，体重增加最快的不是西方发达国家，而是埃及、墨西哥、沙特阿拉伯等国家。

These trends are alarming because obesity causes a host of health problems, including diabetes, heart disease and high blood pressure, as well as dozens of illnesses such as stroke, gout and various cancers. Carrying extra weight made people more likely to die of covid-19. And then there is the misery that comes from the stigma associated with being fat, which affects children in schools and playgrounds most cruelly of all.

这些趋势令人担忧，因为肥胖会引起一系列的健康问题，包括糖尿病、心脏病、高血压，以及中风、痛风、各种癌症等数十种疾病。肥胖使人更容易死于新冠肺炎。另外，因肥胖而丢脸会令人痛苦，学校和游乐场上的儿童受此影响是最残酷的。

The consequences of obesity for the public purse and the wider economy are large. According to modelling by academics the annual cost to the world economy of excess weight could reach $4trn by 2035 (2.9% of global gdp, up from 2.2% in 2019). That includes both spending on health care and working time lost to illness and premature deaths tied to obesity.

肥胖给公共财政和整体经济带来了严重后果。学者建立的模型预测到2035年，每年肥胖给世界经济造成的损失可能达到4万亿美元（占全球GDP的2.9%，2019年占2.2%）其中既包括医疗保健支出，也包括与肥胖相关的疾病和过早死亡而损失的工作时间。

The world’s expanding waistlines are not a sign of the moral failure of the billions who are overweight, but the result of biology. The genes that were vital to helping humans survive winters and famine still help the body cling on to its weight today. The superabundance of hard-to-resist processed foods in recent decades has brought greater convenience and lower costs, but also triggered overeating just as lifestyles became more sedentary. Once the fat is on, the body fights any attempt to diet away more than a little of its total weight. Despite the $250bn that consumers around the world spent on dieting and weight loss last year, the battle to get slim was largely being lost.

全人类的腰围都在变粗，这不是几十亿超重者道德沦丧的标志，而是生物机制造成的。帮助人类度过寒冬和饥荒的关键基因至今仍在帮助人类维持体重。近几十年来，大量令人难抵诱惑的加工食品带来了更大的便利和降低了开销，但随着生活方式变得更加久坐不动，也引发了暴饮暴食。一旦脂肪堆积起来，身体会抵制一切大幅度减肥的企图。去年，全世界的消费者在节食减肥上花费了2500亿美元，但这场减肥战争基本失败了。

The new obesity drugs arrived by serendipity, after treatments meant for diabetics were observed to cause weight loss. Semaglutide mimics the release of hormones that stimulate a feeling of fullness and reduce the appetite. They also switch off the powerful urge to eat that lurks inside the brain, waiting to ambush even the keenest dieter.

新型减肥药物的出现纯属巧合，人们观察到针对糖尿病患者的疗法会导致体重下降。“司美格鲁肽”模拟释放的荷尔蒙使人产生饱腹感和减少食欲，它们还会关闭潜伏在大脑中的强烈食欲，就连最积极的节食者也难逃这种欲望的伏击。

With the jabs already in high demand, investors are nearly as giddy as newly slim users. The market capitalisation of Novo Nordisk, the firm at the front of the gold rush, has doubled in two years, to $326bn, making it the second-most-valuable listed drugmaker in the world. Analysts expect half of obese Americans who seek help to be on glp-1 drugs by the turn of the decade. But, as with any new medicine that holds so much promise for so many, there are uncertainties. Two big ones will be safety and affordability.

由于这种注射药物的需求量已经很大，投资者几乎和减肥的新用户一样激动不已。 “诺和诺德”公司站在这场淘金热的前沿，其市值在两年内翻了一番，达到3260亿美元，成为世界第二大最具价值的上市制药企业。分析人士预测，到本十年结束时，美国将有一半的肥胖者求助于glp-1药物。但任何新药给许多人带来希望的同时也存在不确定性，两大不确定因素是安全性和经济性。

Consider safety first. The newness of these drugs means that their long-term consequences are not yet known. For the lower-dose forms prescribed for diabetes, the side-effects, such as vomiting and diarrhoea, have been mild. But others could crop up as the drugs are used more widely and at higher doses. Animal studies have shown a higher incidence of thyroid cancer, and semaglutide is associated with a rare pancreatitis. Little is known about the effects of using them during or just before pregnancy. All this will require careful analysis through controlled longitudinal studies.

首先说安全性。这些药物新问世，意味着长期影响尚不明确。用于治疗糖尿病的低剂量药物的副作用比较轻微，例如呕吐和腹泻。但随着药物得到更广泛和更高剂量的使用，其他副作用可能会显现。动物实验表明甲状腺癌的发病率升高，“司美格鲁肽”与一种罕见的胰腺炎有关联。妊娠期间或妊娠前服用这些药物的影响尚不明确，所有这些都需要通过纵向对照研究进行仔细分析。

Understanding these risks will be important, because many patients who take the drugs may need them for the rest of their lives. As with ditching a diet, stopping a high dose of semaglutide is associated with much of the lost weight piling back on. Some people even gain more weight than they lost in the first place.

了解这些风险很重要，因为许多服用这种药物的患者可能需要终身服用。正如停止节食一样，停止服用高剂量的“司美格鲁肽”与体重大幅反弹有关，有些人反弹的体重甚至超过当初减少的体重。

Another preoccupation for policymakers is cost. In America the bill for Wegovy runs at around $1,300 a month; for Ozempic about $900. Judged by such prices, lifelong prescxtions look forbiddingly expensive. The longer view, however, is more encouraging. In time, companies may strike deals with governments and health providers to cover the whole population, ensuring high volumes in return for low prices. The prospect of profits is already luring competition and spurring innovation. Amgen, AstraZeneca and Pfizer are all working on rival drugs; Novo Nordisk has a full pipeline of follow-on drugs. Further ahead still, patents will expire, enabling the development of lower-priced generics.

决策者关注的另一个问题是成本。在美国，Wegovy每个月药费约为1300美元；“胰妥赞”每个月药费约为900美元。从价位上看，终身服用极其昂贵。但从长远来看更令人振奋，制药企业可能迟早与政府和医疗保健供应商签订全民覆盖协议，确保以高产量换取低价位。利润前景已经在吸引竞争和刺激创新。安进、阿斯利康、辉瑞都在研发竞争药物；诺和诺德有一整套后续药物。在更遥远的未来，专利将会失效，从而开发价位较低的仿制药。

The shape of things to come

未来发展方向

What to do in the meantime? Governments must ensure that those who most need the drugs get them, leaving those taking them for cosmetic purposes to pay out of their own pockets. The long-term effects must be carefully studied. States should keep pressing other anti-obesity measures, such as exercise, healthy eating and better food labelling, which may help prevent people from getting fat in the first place. But spare a moment to celebrate, too. These new drugs mean that the world’s fight against flab may eventually be won.

在此期间应该做些什么？政府必须确保最需要这种药物的人得到它们，让那些以美容为目的的人自掏腰包。药物的长期影响必须得到仔细研究，各国应该不断推行其他的抗肥胖措施，例如运动、健康饮食、改善食品标签，有助于从一开始就防止人们变胖。但也要花点时间庆贺一下，这些新药物意味全世界最终可能打赢这场减肥战争。