Medical News

The irony undergirding the new wave of obesity drugs is that they initially weren’t created for obesity at all. The weight loss spurred by Ozempic, a diabetes drug in the class of so-called GLP-1 agonists, gave way to Wegovy—the same drug, repackaged for obesity. Zepbound, another medication, soon followed. Now these drugs have a new purpose: heart health.

On Friday, the FDA approved the use of Wegovy for reducing the risk of heart attack, stroke, and death in adults who are overweight and have cardiovascular disease. The move had been anticipated since the publication of a landmark trial in the fall, which showed the drug’s profound effects on cardiovascular  health. The decision could usher in a new era where GLP-1 drugs become mainstream, opening up access to millions of Americans who previously didn’t qualify for Wegovy.

Some of the obstacles stopping people from getting the drug may also begin to crumble. Insurance companies commonly deny coverage of Wegovy because obesity is seen as a cosmetic concern rather than a medical one, but that argument may not hold up for cardiovascular disease. “This new FDA indication is HUGE,” Katherine Saunders, an obesity-medicine physician at Weill Cornell Medicine, told me in an email. Wegovy may soon be within reach for many more Americans—that is, if they can find it.

In practice, Wegovy is maddeningly hard to get hold of. Shortages of injectable semaglutide, the active ingredient in Wegovy and Ozempic, have been ongoing since March 2022; currently, most doses of Wegovy are in limited supply. As the popularity of semaglutide has skyrocketed, demand has completely outstripped the capacity of its manufacturer, Novo Nordisk. The drug comes in injection pens containing a glass vial; “these are not easy products to make,” Lars Fruergaard Jørgensen, the CEO of Novo Nordisk, said in August. In response to the shortages, the company withheld its supply of lower Wegovy doses last year. Because treatment on the medication must begin in low doses, this meant that new patients who wanted to start on Wegovy functionally couldn’t. In January, the company began “more than doubling the amount of the lower-dose strengths” of the drug, a Novo Nordisk spokesperson told me, and it plans to gradually increase overall supply throughout the rest of the year.

The ongoing shortages have left providers and patients feeling stuck. “It is devastating to prescribe a lifesaving medication for a patient and then find out it’s not covered or we can’t locate supply,” Saunders said. Doctors are scrambling to make do with what’s available. Ivania Rizo, an endocrinologist at Boston Medical Center, told me she has had to turn to older GLP-1 drugs such as Saxenda to “bridge” patients to higher doses of Wegovy, although now that is in shortage too. Patients can spend each day calling pharmacy after pharmacy in search of one with Wegovy in stock, Rizo said. In desperation, some have turned to versions of the drug that are custom-made by compounding pharmacies with little oversight, despite the FDA expressing concerns about them. The shots are supposed to be taken weekly, but others have attempted to stretch their doses beyond that.

That the new FDA approval could very mainstream obesity drugs may create long-needed pressure to help resolve these shortages. It makes clear that Wegovy is a lifesaving medication not only for people with obesity but also for those with cardiovascular disease—the leading cause of death in the U.S.—putting the impetus on Novo Nordisk to ramp up production. But in the short term, the access issues may persist. “The new approval is very likely to worsen shortages, because the demand for Wegovy will continue to climb—now at an even faster pace,” Saunders said.

If patients think they’re stuck now, they’re about to feel entrenched. Wegovy is the only obesity drug that has been approved to reduce the risk of heart attacks, but none of its competitors is easily available either. Supplies of certain dosages of Eli Lilly’s Mounjaro, a diabetes drug whose active ingredient is sold for obesity as Zepbound, are limited, and shortages are expected later this year. “We need supply to increase dramatically,” Saunders said. Both Novo Nordisk and Eli Lilly have invested heavily in expanding production capacity, but some of the new plants won’t open until 2029.

For all of its advantages, the FDA approval has a sobering effect on the unrelenting hype around GLP-1s. So much of the excitement around obesity drugs has focused on the future, as dozens of pharmaceutical companies develop more powerful drugs, and commentators imagine a world without obesity. In the process, the issues of the present have gone overlooked. More drugs won’t make much of a difference if the drugs themselves are out of reach.

Recently, a photo of rice left me confused. The rice itself looked tasty enough—fluffy, well formed—but its oddly fleshy hue gave me the creeps. According to the scientists who’d developed it, each pink-tinged grain was seeded with muscle and fat cells from a cow, imparting a nutty, umami flavor.

In one sense, this “beef rice” was just another example of lab-grown meat, touted as a way to eat animals without the ethical and environmental impacts. Though not yet commercially available, the rice was developed by researchers in Korea as a nutrition-dense food that can be produced sustainably, at least more so than beef itself. Although it has a more brittle texture than normal rice, it can be cooked and served in the same way. Yet in another sense, this rice was entirely different. Lab-grown meat aims to replicate conventional meat in every dimension, including taste, nutrition, and appearance. Beef rice doesn’t even try.

Maybe that’s a good thing. Lab-grown meat, also widely known as cultivated meat, has long been heralded as the future of food. But so far, the goal of perfectly replicating meat as we know it—toothy, sinewy, and sometimes bloody—has proved impractical and expensive. Once-abundant funding has dried up, and this week, Florida moved toward becoming the first state to ban sales of cultivated meat. It seems unlikely that whole cuts of cultivated meat will be showing up on people’s plates anytime soon—but maybe something like beef rice could. The most promising future of lab-grown meat may not look like meat at all, at least as we’ve always known it.

The promise of cultivated meat is that you can have your steak and eat it too. Unlike the meatless offerings at your grocery store, cultivated meat is meat—just created without killing any animals. But the science just isn’t there yet. Companies have more or less figured out the first step, taking a sample of cells from a live animal or egg and propagating them in a tank filled with a nutrient-rich broth. Though not cheaply: By one estimate, creating a slurry of cultivated cells costs $17 a pound or more to produce.

The next step has proved prohibitively challenging: coaxing that sludge of cells to mature into different types—fat, muscle, connective tissue—and arranging them in a structure resembling a solid cut of meat. Usually, the cells need a three-dimensional platform to guide their growth, known as a scaffold. “It’s something that is very easy to get wrong and hard to get right,” Claire Bomkamp, a senior scientist at the Good Food Institute, a nonprofit supporting meat alternatives, told me. So far, a few companies have served up proofs of concept: In June, the United States approved the sale of cultivated chicken from Upside Foods and Good Meat. However it is virtually impossible to come by now.

The basic science of lab-grown meat can be used for more than just succulent chicken breasts and medium-rare steaks. Cells grown in a tank function essentially like ground meat, imparting a meaty flavor and mouthfeel to whatever they are added to, behaving more like an ingredient or a seasoning than a food product. Hybrid meat products, made by mixing a small amount of cultivated-meat cells with other ingredients, are promising because they would be more cost-effective than entire lab-grown steaks or chicken breasts but meatier than purely plant-based meat.

Already, the start-up SciFi Foods is producing what has been described as a “fatty meat paste” that is intended to be mixed with plant-based ingredients to make burgers. Only small amounts are needed to make the burgers beefy; each costs less than $10 to make, according to the company—still considerably more than a normal beef patty, but the prices should come down over time. Maybe it sounds weird, but that’s not so different from imitation crab—which doesn’t contain much or any crab at all. A similar premise underlies the plant-based bacon laced with cultivated pork fat that I tried last year. Was it meat? I’m not sure. Did it taste like it? Absolutely.

Meat can be so much more than what we’ve always known. “We don’t have to make meat the same way that it’s always come out of an animal,” Bomkamp said. “We can be a little bit more expansive in what our definition of meat is.” Beef rice, which essentially uses rice as a miniature scaffold to grow cow cells, falls into this category. It isn’t particularly meaty—only 0.5 percent of each grain is cow—but the scientists who developed it say the proportion could change in future iterations. It’s framed as a way to feed people in “underdeveloped countries, during war, and in space.”

Eventually, cultivated meat could impart a whiff of meatiness to blander foods, creating new, meat-ish products in the process that are more sustainable than regular meat and more nutritious than plants. Beef rice is one option; meat grown on mushroom roots is in development. Even stranger foods are possible. Bomkamp envisions using the technology to make thin sheets of seafood—combining elements of salmon, tuna, and shrimp—to wrap around a rainbow roll of sushi. In this scenario, cultivated meat probably won’t save the planet from climate change and animal suffering. “It wouldn’t serve its original function of being a direct replacement for commercial meat,” Daniel Rosenfeld, who studies perceptions of cultivated meat at UCLA, told me. But at the very least, it could provide another dinner option.

Of course, it’s in the interest of the cultivated-meat industry to suggest that cultivated meat isn’t just outright doomed. No doubt some vegetarians would cringe at the thought, as would some dedicated carnivores. But considering how much meat Americans eat, it’s not hard to imagine a future in which cultivated cells satisfy people searching for a new kind of meat product. Imagine the salad you could make with chicken cells grown inside arugula, or bread baked with bacon-infused wheat. But should those prove too difficult to produce, I’d happily take a bowl of beef rice, in all its flesh-tinged glory.