How Ozempic Will Change Cities

More than weight will be lost -- and gained

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Ozempic and other forms of semaglutide (Wegovy, Mounjaro, etc.) are going to change life in America, big time. Consider that nearly 3 out of 4 Americans over 20 years old are either overweight or obese. It’s not hard to imagine that a large portion of Americans will be taking semaglutide in the coming years as the medication becomes more affordable and available through insurance. The resulting shift in eating habits will have ripple effects on countless other aspects of society.

When urbanists think about obesity, it’s often from the perspective of the built environment’s impact on people’s eating habits. Researchers have tried to understand how factors such as walkability or sprawl, the availability of fast food restaurants or farmers markets, affect people’s body weight. There’s tantalizing evidence that safe, walkable, and bikeable neighborhoods with quality food options help people to maintain healthy body weights — but even an umbrella review of 1,850 articles on the association between obesity and the built environment can’t prove a definite causal relationship. Perhaps that’s because, as semaglutide shows, weight gain has a lot more to do with dopamine than anything else.

While semaglutide is going to reduce the obesity epidemic to some degree, it will do nothing to address the root causes of obesity, and this is really unfortunate. It will not get rid of predatory marketing of unhealthy foods, lower the sugar content of packaged foods, un-process much of the American diet. It will not make healthy foods as inexpensive as unhealthy foods. It will not address poverty or neighborhood violence — both of which reduce people’s access to safe places for physical activity. It will not provide the time or structures that kids — or parents — need to engage in exercise or physical recreation. And so it will be just one more bandage on a broken society, much like anti-depressant medications have been for the past 25 years.

Still I can’t help but wonder how these drugs will affect our cities, reversing the old question about how the built environment effects our eating habits and physical activity: how would a population with less obesity and lower food consumption change everything from restaurants and transportation, to parks and employment? I’ve gone down a rabbit hole, looking at obesity research and speculating on the biggest winners and losers in cities as a result of the coming semaglutide revolution. What’s clear: new eating habits and physical mobility habits are going to be just two more issues that will call for a new urban order in American downtowns.