Off the Scales summary

Individuals bear the burden of excess weight and obesity, along with the Type 2 diabetes, high blood pressure or heart disease that often accompany it. But the causes of obesity are far more collective. Social and cultural factors, governmental legislation, corporations and lobbyists all conspire to create the perfect conditions to produce obesity on a global scale.

Starting in the 1980s, there was an intentional effort on the part of large brands like Kelloggs and Kraft to embrace the trend of abundance in their marketing efforts. With the rise of households in which both parents worked, and the widespread adoption of the microwave oven, industrial food producers recognized the growing need for convenience foods. Households had less and less time to cook meals from scratch.

When Svetlana Mojsov stepped off a plane at JFK Airport in 1972, she was coming to New York to pursue her PhD in biochemistry fresh from the University of Belgrade. She’d learned about Rockefeller University, a private postgraduate institution for biochemical research in New York, from a former professor who’d taken a sabbatical at Columbia University. Young and full of optimism for her future, she was eager to make her mark in research.

Raised in the former Yugoslavia, she was astonished at the portion sizes in America. Having rarely seen meat growing up, the average T-bone steak served in New York restaurants was more meat than she’d seen in her lifetime. She couldn’t remember seeing an obese person growing up, but she saw many on her campus at Rockefeller University participating as research subjects.

In the decades following Mojsov’s breakthrough in peptide synthesis, research into this area exploded. Mojsov’s synthesized peptides drove research at her new position as an associate in biochemistry at Massachusetts General Hospital. She was initially hired by Michael Rosenblatt, the head of the endocrinology unit, to synthesize proteins for other researchers. But by the Fall of 1983, she was director of the Peptide Synthesis faculty at Mass General, and appointed an associate of the Howard Hughes Medical Institute. This gave her funding and time to pursue her own research.

There she continued her work on glucagon and spent years doing animal studies attempting to establish its forms and effects in animals. Her former mentor at Rockefeller, Bruce Merrifield, with whom she shared her preliminary results, strongly urged her to document her experiments in laboratory notebooks. Advice that turned out to be essential in years to come. 

Four years after the GLP-1 breakthrough by Mojsov and others in Massachusetts, biochemist John Eng at the Veterans Affairs Medical Center in the Bronx was pursuing similar research into gut hormones. Remembering a paper by a Belgian scientist who noted that the Gila Monster, a lizard living in harsh desert environments, had remarkably stable blood sugar despite eating only a few times a year. In 1990 Eng isolated a molecule in reptile venom that worked very much like GLP-1 but had more long-lasting effects. 

This was important because with GLP-1’s role confirmed in blood sugar regulation, drug companies faced another problem. The human body has enzymes that chop up the peptide when it is encountered outside the pancreas. This means that ingesting or injecting GLP-1 is useless. Biochemical researchers around the world were trying to be the first to create a viable GLP-1 drug that would evade the body's defense mechanisms long enough to provide lasting stability for sugar levels

Soon after the launch by Novo Nordisk, other drug companies followed suit with their own versions of GLP-1 agents, like Tirzepatide and Dulaglutide. As manufacturers struggled to keep up with demand, social media began to explode with weight loss stories from those who had struggled their entire lives.

Semaglutide drugs began bringing in billions for drug companies, too. The estimated market share for drugs like Ozempic rose to almost 25 billion between 2018 and 2025, with 2026 projected to raise that number to over 28 billion. With millions of individuals now on these drugs, it was only a matter of time before the news of side effects began appearing