Exogenous Willpower: Are Weight Loss Drugs Reshaping Society?

Guest contributor Sean Dudley explores the opportunities and challenges of emerging weight loss drugs

Traditionally, willpower is viewed as a virtue, something to be cultivated and cherished—a part of one's character. It involves making choices that align with long-term goals over immediate gratification. However, if a medication can provide the willpower to resist overindulging in food, or even eating altogether, what does this say about human agency and autonomy? Are we outsourcing self-control to pharmaceuticals? If so, at what cost?

In the vast landscape of human health remedies, a new phenomenon is beginning to deeply disrupt our understanding of appetite and weight loss. Emerging drugs known as GLP-1 agonists represent a significant shift in how we might manage obesity, a challenge that has long perplexed and troubled modern society.

GLP-1, or glucagon-like peptide, is a hormone naturally secreted by the intestines in response to food. It plays a crucial role in regulating blood sugar levels, enhancing insulin production when we eat and suppressing the release of glucagon, which regulates hunger, in between meals. It also slows down the stomach’s natural emptying process, promoting an enduring feeling of fullness. These effects make this molecule a prime solution for both dampening and managing hunger.  Yet the GLP-1 we produce naturally lasts only minutes before getting broken down.

Enter new synthetic GLP-1 agonists such as those within the medications Ozempic and Mounjaro. These perform the same function as natural GLP-1 by influencing insulin response and were initially approved for managing diabetes. Both also enhance the sensation of fullness while suppressing hunger between meals, leading to reduced food intake. This led to Ozempic and Mounjaro becoming FDA-certified for weight loss under the product names Wegovy and Zepbound, which, respectively, contain the novel GLP-1 agonists Semaglutide and Tirzepatide.  As “agonists” these molecules mimic natural GLP-1 by binding to receptors in the brain. After just one injection, the effects last up to a week.

Medical scientists only recently determined how to craft variations of GLP-1 that last much longer in the human body than the version secreted by our intestines. And there is a longer story here on the path to long-lasting GLP-1, involving– quite honestly – giant spotty lizards from the desert that carry a more durable GLP-1 inside enormous venom sacs.  While that is a worthy story for another time, the potency of these medications stems not only from the synthetic molecules’ ability to remain viable in blood but also from each administered dose containing millions of times more of these brain-interfacing peptides than our intestines ever produce. 

The implications of these medications are profound, not only for individual health but for public health at large. The obesity epidemic has been linked to many top problems, including heart disease, stroke, type 2 diabetes, and many forms of cancer. Beyond obesity, clinical trials are beginning to show evidence synthetic GLP-1 treatment can mitigate alcohol addiction, drop systemic inflammation and therefore reduce the prevalence of heart and kidney diseases, and improve sleep apnea, even in studies where researchers control for the beneficial effects of weight loss alone.

Yet the introduction of what we might call "liquid willpower” raises intriguing questions about the future of human behavior and the role of medication in managing lifestyle-related health issues. On one hand, these drugs offer a powerful tool for individuals struggling with weight management, potentially leading to significant improvements in health and well-being.  It is important to emphasize this point by stating that real lives are being improved and extended through these treatments. There is no question. On the other hand, these approaches invite a reflection on the nature of willpower and the degree to which we rely on internal versus externally generated, also known as exogenous, sources to manage our behaviors.

This transition to pharmacological solutions for self-control mirrors a broader shift toward medicalizing behaviors that some might argue should be managed through personal care and societal support, not just clinical intervention. GLP-1 agonists complicate this further. Individuals struggling with obesity might feel compelled to use these medications as a first resort rather than pursuing sustainable changes in diet and lifestyle or seeking to resolve underlying personal causes. In effect, this medical advance threatens to overshadow the importance of comprehensive strategies that include addressing associated aspects of physical and mental wellbeing.

As these drugs reduce interest in food, fewer calories are eaten than expended, and this in turn causes weight loss. This familiar underlying process is the same among all diet programs ranging from ketogenic to Weight Watchers. This means traditional understandings of dieting behavior apply. Here we understand that most individuals who lose weight through dieting will regain it. Those who avoid regaining weight have often benefited from additional care activities that allow them to identify and remediate causes behind obesity, such as abuse, trauma, or inherited eating habits. These individuals have strengthened their natural willpower through new understanding and personal growth. 

As we look to navigate our way forward, it is essential to foster dialogues between patients, healthcare providers, policymakers, and the public to help ensure the deployment of these medications aligns with society’s evolving goals and ethical standards. How we handle the introduction of such powerful tools will say much about our values and our vision for the future.

In the end, the rise of synthetic GLP-1 invites us to reflect deeply on the nature of health and the mechanisms we employ to enhance it. These medications hold promise, and they also compel us to think carefully about the balance between intervention and autonomy, between injections and enduring solutions, and between individual benefits and longer term societal well-being. As pharmaceutical corporations work rapidly to unleash stronger and even more effective medications, we have an opportunity to commit to maintaining a holistic view of health—one that respects both the complexity of human biology and the depth of human experience.

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Sean Dudley has served at Arizona State University, the largest university in the U.S., for over twenty years, and as Chief Research Information Officer, he also teaches and conducts research while leading the Research Technology Office.