{"id":113358,"date":"2024-12-07T05:45:00","date_gmt":"2024-12-07T10:45:00","guid":{"rendered":"https:\/\/www.freethink.com\/?post_type=ftm_article&p=113358"},"modified":"2024-12-06T12:31:19","modified_gmt":"2024-12-06T17:31:19","slug":"obesity-rate-falling","status":"publish","type":"ftm_article","link":"https:\/\/www.freethink.com\/biotech\/obesity-rate-falling","title":{"rendered":"Has the US reached \u201cpeak obesity\u201d?"},"content":{"rendered":"\n

This article is an installment of Future Explored<\/a>, a weekly guide to world-changing technology. You can get stories like this one straight to your inbox every Saturday morning by subscribing above.<\/em><\/p>\n\n\n\n

It\u2019s 2028, and for the first time in living memory, the US obesity rate is trending downward, and more and more Americans are achieving a healthy weight \u2014 potentially signaling the beginning of the end of the obesity epidemic.<\/p>\n\n\n\n

The obesity epidemic<\/strong><\/h2>\n\n\n\n

The US has a weight problem. According to the CDC, the percentage of Americans 20+ years old who classify as obese \u2014 meaning they have a body mass index (BMI) above 30 \u2014 has nearly tripled over the past 50 years, from 14.5%<\/a> in the early 1970s to 40.3%<\/a> in 2023.<\/p>\n\n\n\n

However, that newest figure is slightly lower<\/em> than the rate from 2020 (41.9%<\/a>), causing some speculation<\/a> that we have reached a turning point in the obesity epidemic. To find out whether that\u2019s true \u2014 and, if so, what may be causing the trend \u2014 let\u2019s explore the past, present, and future of obesity in America.<\/p>\n\n\n\n

\"Line
NCHS, National Health and Nutrition Examination Survey<\/figcaption>
Obesity rates for adults 20 years and older in the US. \n<\/div><\/div><\/figure>\n\n\n\n

Where we\u2019ve been<\/h3>\n\n\n\n

Obesity isn\u2019t entirely a new phenomenon \u2014 archaeologists have uncovered sculptures depicting people with obesity dating back 30,000 years<\/a> \u2014 and for much of human history, carrying excess weight was viewed as a sign of fertility and prosperity.<\/p>\n\n\n\n

As far back as Ancient Greece, though, people were already connecting obesity to health problems, including early death, and their ideas for addressing excess weight focused on two things: diet and exercise.<\/p>\n\n\n\n

\u201cIf we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health,\u201d reads the Hippocratic Corpus, written around 400 BC.<\/p>\n\n\n\n

Fast forward about 2,400 years, and in many parts of the world, including the US, food has become both abundant and cheap, leading to unprecedented obesity rates. This, in turn, has led to higher rates<\/a> of diseases and deaths linked to obesity.<\/p>\n\n\n\n

\"Graph<\/figure>\n\n\n\n

Dropping excess pounds by moving more and eating less hasn\u2019t gotten any easier over the centuries, either.<\/p>\n\n\n\n

Despite countless diet and exercise programs designed to simplify the process, it still takes a lot of willpower to hit the gym consistently and eat the right number of calories. Our biology<\/a> can actually work against us in the process, too \u2014 weight loss leads to lower levels of the hormone leptin, for example, and that reduction triggers feelings of hunger.<\/p>\n\n\n\n

In the 20th century, the FDA approved a handful of medications designed to facilitate weight loss, but they haven\u2019t been much help: many were later pulled, usually because they were deemed unsafe<\/a>, and others had side effects<\/a> that prevented them from becoming popular.<\/p>\n\n\n\n

About 50 years ago, bariatric surgery emerged as an option for people with severe obesity or serious obesity-related health issues. It\u2019s considered one of the most effective options, but adoption has remained low \u2014 only about 1% of Americans<\/a> who qualify for the surgery get it, with cost, recovery time, and general fears of surgery contributing to the low rate<\/a>.<\/p>\n\n\n\n

Now, millennia after doctors first realized that obesity was a serious health issue, the number of people living with it is the highest it has ever been, and yet treatment options have remained basically the same: move more and eat less.<\/p>\n\n\n\n

Where we are<\/h3>\n\n\n\n

After decades of increases in the obesity rate, the CDC survey showing a small decline is encouraging \u2014 40% is still high (the CDC has set a modest goal of 36% by 2030<\/a>), but perhaps we\u2019ve hit \u201cpeak obesity<\/a>\u201d and will soon see rates of obesity-related diseases also start to fall.<\/p>\n\n\n\n

Unfortunately, it\u2019s too soon to celebrate. Obesity rates in the US have seemingly leveled off before<\/a>, just to start increasing again soon after.<\/p>\n\n\n\n

\u201cI do not think we can make any predictions about obesity levels plateauing by comparing just two points in time,\u201d Peter T. Katzmarzyk, associate executive director for population and public health sciences at the Pennington Biomedical Research Center, told Freethink. \u201cWe need to look at longer-term trends over several time points, which indicate that obesity has been increasing over several decades.\u201d<\/p>\n\n\n\n

\u201cIt appeared that obesity was plateauing between about 2007-2012, but then started to increase again,\u201d he added.<\/p>\n\n\n\n

\"The
NCHS, National Health and Nutrition Examination Survey<\/figcaption>
Obesity rates for adults 20 years and older in the US. \n<\/div><\/div><\/figure>\n\n\n\n

If <\/em>the decline is real, though, a leading theory<\/a> as to why<\/em> is the recent development and approval of the new blockbuster GLP-1 agonist drugs \u2014 medications that mimic the activity of the hormone GLP-1, which is produced after you eat and suppresses hunger.<\/p>\n\n\n\n

GLP-1 agonists were initially approved to treat diabetes, with approvals for weight loss coming later. In recent trials, the latest formulations were found to help people lose as much as 10-20% of their body weight<\/a>, as well as reduce their risk of weight-related health problems<\/a>, such as heart attacks and deaths from cardiovascular disease. <\/p>\n\n\n\n

Between 2019 and 2023, the number of Americans taking a GLP-1 agonist for weight loss has increased by more than 700%<\/a>, and as of May 2024, 6% of adults<\/a> self-reported as taking one of the meds.<\/p>\n\n\n\n

\u201cEven if a notable minority is taking the drugs and losing weight, that\u2019s going to alter the shape of the curve, the prevalence rates, and related statistics,\u201d David Ludwig, an endocrinologist at Boston Children\u2019s Hospital, told the Atlantic<\/a>. \u201cSo it would be surprising, and very depressing, for us not to see any impact of these extremely costly drugs by this point.\u201d<\/p>\n\n\n\n

Where we\u2019re going (maybe)<\/h3>\n\n\n\n

As Katzmarzyk noted, we won\u2019t know for sure that obesity rates are actually leveling off or falling until we have longer-term data. We\u2019ll then need to dig into it to figure out exactly what is behind the trend \u2014 new weight loss drugs seem like an obvious answer, but it\u2019s possible other factors, like fewer people going out to eat<\/a>, could be contributing, too. <\/p>\n\n\n\n

If GLP-1 agonists are <\/em>having a notable impact on America\u2019s collective waistline, though, it\u2019s worth considering whether the medications could be a permanent solution to the problem, and if so, how we could get them into the hands of everyone who could benefit from them.<\/p>\n\n\n\n

\u201cThese are not miracle drugs.”<\/p>A GLP-1 agonist user<\/cite><\/blockquote><\/figure>\n\n\n\n

Losing weight is easier than keeping it off. Aside from our biological drive to regain lost weight, the motivation of seeing positive changes in the mirror, or in our bloodwork, while we\u2019re losing weight can end once we hit our goal weight, making it easy to fall back into old habits.<\/p>\n\n\n\n

Freethink spoke with three people currently using GLP-1 agonists for obesity, and all three reported feeling like they were in a much better position to maintain their weight loss on the drugs than they had been after losing weight through other methods in the past.<\/p>\n\n\n\n

\u201cEvery diet that was available, I tried, and while I lost weight initially, it was really hard to sustain being on these diets for a long period of time,\u201d a 38-year-old woman told Freethink. \u201cEventually, I got either bored of doing it or I wasn’t able to stick to it, and I ended up just gaining the weight back.\u201d<\/p>\n\n\n\n

\"Box
Novo Nordisk<\/figcaption><\/div><\/figure>\n\n\n\n

Two years ago, she started taking a GLP-1 agonist and lost about 60 pounds in 10 months. Since then, she\u2019d been focused on maintenance, which has been going better than it had in the past.<\/p>\n\n\n\n

\u201cI’ve been a little up and down with weight within 10 pounds,\u201d she said. \u201cSome of it has been due to an injury that I’ve had which prevented me from doing some of the physical activity I wanted. It also does get a little more tricky around the holiday season \u2014 I think that everybody struggles with that.\u201d<\/p>\n\n\n\n

This idea that the drugs alone aren\u2019t enough to ensure permanent weight loss was another common thread in Freethink\u2019s discussions with GLP-1 agonist users \u2014 all three emphasized that they also needed to (you guessed it) eat less and exercise more to reach their goals. The medications just made doing that easier.<\/p>\n\n\n\n

\u201cThese are not miracle drugs,\u201d the 38-year-old woman emphasized. \u201cYou don’t just give yourself an injection and poof, you lose weight. I started working out way heavier, doing a lot more cardio, and I started to change the foods that I ate.\u201d<\/p>\n\n\n\n

\n

“The overwhelming majority [of patients] will need ongoing and chronic therapy.”<\/p>\nA Novo Nordisk spokesperson<\/cite><\/blockquote>\n\n\n\n

Aside from sticking to a diet and exercise plan, people who lose weight with GLP-1 agonists typically need to stick with the drugs, too \u2014 patients tend to regain their lost weight<\/a> if they stop taking their meds.<\/p>\n\n\n\n

\u201cObesity is like other chronic cardiometabolic diseases which require ongoing treatment,\u201d a spokesperson for Novo Nordisk, maker of the popular GLP-1 agonists Ozempic and Wegovy, told Freethink. \u201cJust like hypertension, high blood pressure, or high cholesterol, you would never just stop your medicines.\u201d<\/p>\n\n\n\n

\u201cThere are always exceptions to the rule, as there are patients who lose weight with medication and then come off of it and keep the weight off, but the overwhelming majority will need ongoing and chronic therapy,\u201d they continued.<\/p>\n\n\n\n

Not only did the GLP-1 agonist users that Freethink talked to seem OK with the idea of being on the drugs indefinitely, two of them expressed trepidation at the thought of not<\/em> taking them. <\/p>\n\n\n\n

A 36-year-old woman who has lost 84 pounds on one of the meds said she was \u201cscared\u201d at the thought of quitting the drugs because she didn\u2019t think she\u2019d be able to maintain the weight loss on her own. A 63-year-old man who has lost 80 pounds said he was \u201ca bit worried\u201d about what might happen if he stopped.<\/p>\n\n\n\n

\u201cIf my insurance was to stop covering it, then I won’t be able to afford it every month.”<\/p>A GLP-1 agonist user<\/cite><\/blockquote><\/figure>\n\n\n\n

While the three patients Freethink spoke to might want<\/em> to stay on their meds longterm, there\u2019s no guarantee they\u2019ll be able to.<\/p>\n\n\n\n

Right now, they\u2019re each paying between $25 and $50 per month for their prescriptions through their health insurance plans. If insurance doesn\u2019t cover it, though, the out-of-pocket costs for the meds can be as high as $1,300 per month, and about 55 million Americans living with obesity don\u2019t have insurance that covers anti-obesity drugs, according to Novo Nordisk.<\/p>\n\n\n\n

While some companies are adding GLP-1 coverage<\/a> to their health insurance plans, others are going in the opposite direction and dropping it<\/a> due to the high cost<\/a> of the meds, meaning some people are being forced to stop taking the drugs even when they don\u2019t want to.<\/p>\n\n\n\n

\u201cIf my insurance was to stop covering it, then I won’t be able to afford it every month,\u201d the 36-year-old woman told Freethink.<\/p>\n\n\n\n

The bottom line<\/h3>\n\n\n\n

GLP-1 agonists aren\u2019t going to be the answer for everyone with obesity. An estimated 20% of users<\/a> don\u2019t respond to the medications, and many can\u2019t tolerate them \u2014 17% of people who received Wegovy<\/a> in one large trial quit due to the medication\u2019s unpleasant side effects, which can include vomiting and diarrhea.<\/p>\n\n\n\n

However, they are the most effective weight-loss medications available today, and even if it\u2019s too soon to note any impact they\u2019re having on obesity rates in the US, millions more Americans could potentially benefit from the drugs if <\/em>we can increase access to them, which means addressing the cost issue.<\/p>\n\n\n\n

The most straightforward solution there would be for pharma companies to lower the price. Pressure from policy makers<\/a> could encourage this in the US, as could competition from new GLP-1 agonists<\/a> and other types of obesity treatments<\/a> \u2014 many are now in clinical trials, and some are even oral meds, which could be preferred over the currently weekly shots. <\/p>\n\n\n\n

Further down the line, the patent for the drug<\/a> in Ozempic and Wegovy will expire in 2032, after which cheaper generic versions will hit the market.<\/p>\n\n\n\n

\n

“Obesity is a complex disease that requires complex solutions.”<\/p>\nPeter T. Katzmarzyk<\/cite><\/blockquote>\n\n\n\n

Pharmacological treatment alone might never be enough to lower America\u2019s obesity rates, though \u2014 Katzmarzyk told Freethink he expects we\u2019ll need to attack the problem from multiple angles.<\/p>\n\n\n\n

\u201cThe reliance on individual-level treatment approaches is very time-consuming and expensive,\u201d he said. \u201cIt is also questionable if we really can address the broader obesity epidemic by using approaches that affect one individual at a time.\u201d <\/p>\n\n\n\n

\u201cObesity is a complex disease that requires complex solutions,\u201d he added. \u201cWe will need coordinated obesity treatment and prevention programs at the community and at the individual level.\u201d<\/p>\n\n\n\n

These community-level initiatives<\/a> could include things like the creation of more bike paths and parks or supermarkets in places that are currently food deserts \u2014 basically, anything that lowers barriers to eating healthier and moving more.<\/p>\n\n\n\n

“It really has been life-changing.”<\/p>A GLP-1 agonist user<\/cite><\/blockquote><\/figure>\n\n\n\n

Regardless of what it takes to get there, if the US can lower its obesity rate, the benefits could be wide-ranging: a healthier military<\/a>, higher fertility rates<\/a>, and huge economic savings<\/a> \u2014 right now, obesity is costing the US healthcare system $173 billion a year.<\/p>\n\n\n\n

For now, though, all we know for sure is that at least one approach to treating obesity is having a major impact on the lives of millions of individuals, helping them make the changes needed to lose weight, keep it off, and improve their overall health.<\/p>\n\n\n\n

\u201cWhen you start to see your cholesterol come down, when you see your blood pressure is under control, when you\u2019re able to cut back on your other medications \u2026 it really has been life-changing,\u201d the 63-year-old man told us.<\/p>\n\n\n\n

We\u2019d love to hear from you! If you have a comment about this article or if you have a tip for a future Freethink story, please email us at <\/em>tips@freethink.com<\/em><\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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