If the odds were ever in my favour, no one told my grandfathers.

On my mother’s side, my gramps was an avid sportsman. He worked with his hands and captained the St George’s cricket team. Towards the end, he would become a double amputee as a consequence of diabetes. On my father’s side, my nonno was a tradesman and owned his own construction company. He suffered a fatal heart attack in his early forties.

That family history has long lingered in the back of my mind. A couple of years ago, it became central to a frank conversation with my GP about my own health.

But before I get to that, there is something about hunger that is hard to explain to the slim and trim among us. It has a name: food noise.

You might recognise the sharp feedback following a snappy comment to a close friend or spouse when they turn and say: “You’re ‘hangry’, go and eat.”

It isn’t the same noise that you get from a crowd at a football game. It resides in your own head. The nagging, gnawing sensation telling you to eat, thinking about when you ate last, whether you should eat again and if you can trust yourself not to eat something you shouldn’t.

I grew up in a hospitality family; I worked in and eventually ran restaurants, bars and nightclubs. There were days when I worked doubles, or triples during the busy season, when I genuinely forgot to eat. It wouldn’t show up as light-headedness from too few calories, it would appear alongside a short temper and irritability as a loud strong signal to eat, now.

Back to my GP’s office, and considering the genetics I had inherited. Aside from the hairline that seemed to run away one night while I was asleep, diabetes and heart disease are a combination not to be trifled with. My bloodwork showed enzymes and biomarkers consistent with someone who lifts weights and moves but I was also, according to that data, borderline obese, with blood sugar approaching pre-diabetes.

Like many people I investigated what could be done. I had heard enough about Ozempic and Mounjaro as weight-loss drugs used by the rich and famous but it wasn’t until I spoke with friends who had been prescribed them for diabetes and other hormone conditions that I began to think of it as a possible option.

When I began taking Mounjaro, what struck me was that the volume knob on the food noise had been turned down, a lot. Yes, the number on the scale changed. But the desire to gorge myself, overeat or annihilate a pint of ice-cream in a sitting, was more or less removed.

The language matters.

We have a tendency to call these medicines weight-loss drugs. That description isn’t entirely wrong but it can obscure what they are acting upon and seeking to treat. Anti-obesity medication is a more useful and accurate term. It places the focus on the condition, rather than the outcome we can see on the scales.

And this distinction matters. Do we interpret the term obese as a health condition that may require medical intervention or primarily as a consequence of a lack of willpower and discipline?

There is a biological explanation for why the distinction matters. Ania Jastreboff, an obesity specialist at Yale, describes the regulation of fat stores using the idea of a “defended fat-mass set point”.

Think of it like a thermostat – an analogy, not a literal dial, and not a claim that everyone has one fixed weight their body will inevitably restore. When the temperature falls, the system responds to bring it back up. Our bodies also respond to changes in energy stores by cranking up the hunger signal, or food noise. When someone loses weight, appetite can increase and the body can adapt by using less energy. Those dial adjustments can make maintaining weight loss very difficult.

On this model, anti-obesity medicines act on biological pathways involved in appetite and energy regulation. They can help change those responses, making weight loss more achievable for some people. That is a different proposition from saying the medication supplies willpower. They appear to work by lowering where the thermostat is set, which is also why the weight can return if treatment stops.

In Bermuda, the conversation has a practical consequence.

According to local reporting, Allshores covers GLP-1 medication for type 2 diabetes but does not cover it for weight management in the absence of a qualifying diagnosis. The distinction raises an important question: how do we decide which conditions and treatments qualify for coverage?

I am not suggesting that every prescription should be automatically covered. Healthcare costs here are high and rising. These medications are expensive, they carry risks, and insurers have legitimate concerns about appropriate use.

Insurers have to justify a current expense line against a possible future benefit that may be difficult to quantify. A possible reduction in heart disease, kidney disease, or other complications years from now is not necessarily a saving that can be calculated with certainty today.

Obesity is not a problem facing a small sample of the population. Local reporting suggests three in four adults are overweight or living with obesity. Kim Wilson, the Minister of Health, told the House of Assembly in 2022 that we are living longer but living sicker.

The financial toll for kidney dialysis alone puts the annual bill near $29 million and rising every year. Kidney disease has multiple causes and obesity is not the only factor. But the wider burden of metabolic disease is difficult to ignore.

This is not an argument for treating GLP-1 medications as a miracle cure. The side effects and complications can be significant and they are by no means for everyone. The long-term effects of staying on these medications also need further study.

Weight regain after stopping the treatment is a real concern. It is not proof that the treatment has failed, nor is regain guaranteed for every patient. What it does underscore is that obesity often requires ongoing treatment and assessment rather than a short course.

The risks are not confined to medicines dispensed through legitimate channels, either. The Bermuda Health Council has recently warned about unapproved medicines. Counterfeit and improperly sourced products make medical supervision and a legitimate supply chain more important, not less.

Bermuda has already taken a position on the relationship between diet and public health in the form of a sugar tax. A 75 per cent import duty was placed on sugary products, including soft drinks, alongside a healthy-food subsidy. It was a recognition that the food environment matters and that fiscal policy can shape it.

What I have not been able to find is a public evaluation establishing whether it achieved its intended health outcomes, or evidence that the revenue raised was directed towards treating obesity. I would be happy to be corrected on either point. The larger question is whether the prevention strategy has been met with an equally serious approach to treatment.

We appear to have been willing to tax one part of the problem. But have we been as willing to invest in treating people already living with its consequences?

That matters particularly when it comes to children. The childhood weight figures cited in Bermuda’s planning documents are old, some dating to 2006, with adolescent data older still. A public health strategy cannot be properly evaluated if the information needed to measure its impact is missing or out of date.

Ricky Brathwaite, the health council’s chief executive, made a point recently in another context that belongs here: a benefit should not simply exist on paper. If it does not translate into better health, it risks becoming little more than words on a screen.

That is a useful test.

We can acknowledge the health risks, discourage sugary foods and drinks, publish strategies and list benefits on insurance policies. But do these measures translate into access to prevention, diagnosis and treatment? For someone prescribed an appropriate medication, a benefit that excludes it because it is being used to treat obesity may not feel like much of a benefit at all.

I am not a doctor, an endocrinologist or a health insurance expert. I am simply writing as someone who has had to weigh the risks and benefits and made a decision based on medical advice.

When I raised Mounjaro with my GP, he was sceptical at first. I explained the genetic hand I had been dealt and what I wanted to do about it now rather than later. I asked about tirzepatide specifically because my understanding was that it acts on more than one pathway involved in appetite and metabolism. We talked about diet, strength training, what monitoring would look like and how dosage would be assessed over time. It was a medical conversation, not a decision I made on my own. I chose to prioritise the possible short-term effects against the possibility of not being healthy and able to be a resource and not a burden to my children in the future.

I do not offer my experience as a prescription for anyone else; each person’s medical decisions should be made with their own medical providers.

Bermuda has already acknowledged that obesity deserves a public-health response. The question not yet answered is whether we are prepared to address the whole problem, rather than only the parts that are easiest to tax or put in a policy document.

• Paolo Odoli is a former aide-de-camp to two governors of Bermuda and a former government communications officer. He is living in northern Italy with his family