Uncertain Future Date

Ten Big Stories to Watch in 2020

We’re launching a whole new decade on Wednesday. So it makes sense to step back for a moment and think about what the coming year will bring in obesity, nutrition, and health. We’ll be ready for surprises. Those are unpredictable. But we’re pretty sure that these big stories – already in play – will grab headlines for good reasons in 2020.

Do you see other trends in play? Use the comment function below to add your own two cents.

1. Tailored Dietary Guidelines

Every five years, whether we need it or not, we get new Dietary Guidelines for Americans. So sometime around the end of the year, the 2020 edition will land. Even before that, we’ll get the report of the expert advisory committee. It’s well into its work and pelted with passionate, conflicting viewpoints.

Setting all the conflicts aside, one thing is clear. They’re working on tailored recommendations for children under two and for pregnant women. The 2014 Farm Bill requires it. The group has a dedicated subcommittee working on these topics. This is new and it’s important. Because when it comes to nutrition, one size does not fit all.

2. Ketogenic and Low-Carb Diets

It would be hard to find a more dominant story of 2019 than keto. Paul John Scott calls it the “health story of the year.” In 2019, The American Diabetes Association decided keto is a viable option for people with type 2 diabetes. Die hard advocates have formed a political-style lobbying group to insist that the 2020 guidelines make space for low-carb and keto diets. This story will be as strong as ever in 2020.

What does scientific data say about these miracle diets? Don’t annoy us with pesky facts.

3. Intermittent Fasting

The science of IF is hot right now and you can be confident that there’s more to come in 2020. Three of the top ten papers in the Obesity journal for 2019 focused on this topic. In the latest issue of the New England Journal of Medicine, Rafael de Cabo and Mark Mattson tell us:

Preclinical studies and clinical trials have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders. Animal models show that intermittent fasting improves health throughout the lifespan, whereas clinical studies have mainly involved relatively short-term interventions, over a period of months.

In other words, everything we know points to great promise for this dietary strategy. But there’s a whole lot that we don’t yet know. So you can be sure this will be in the news. Perhaps with some surprises.

4. Serious Pediatric Obesity Care

If you have any doubt that pediatricians are getting serious about obesity care, give it up. For years, all they would talk about was healthy eating and active living. God, mother, and apple pie, but it isn’t much help for kids who are severely affected. No more. A big clue is the AAP’s new position recommending better access to bariatric surgery for adolescents with severe obesity. Better drugs for youth with obesity are coming, too. But perhaps most important is the opening of new centers offering fellowships and stage-four, comprehensive obesity care for youth and children.

If you lead a children’s hospital that only offers token care for obesity, you’d better adapt. Fast. Or your institution will be left in the dust.

5. Better Anti-Obesity Meds

The day is coming when anti-obesity meds will match the effectiveness of bariatric surgery. The new year will bring important progress toward that goal. Semaglutide is one promising option. Huge phase three studies will begin to deliver results this year. In addition, Rhythm will be submitting a highly targeted obesity drug, setmelanotide, for FDA approval early in the year. And then, there’s the intriguing promise of bimagrumab. In a phase two study, it delivered a 21 percent reduction in fat mass while bringing an increase in lean muscle mass. That’s a stunning and unique result.

6. Body Positivity

The long-term trend in explicit weight bias is down. Even though implicit weight bias is still going strong, this is progress. As more and more of the population – now almost 40 percent in the U.S. – is living with obesity, fat shaming is no longer OK. People of all sizes want and need to feel good about themselves. That has nothing to do with whether or not obesity is a problem. So people who fret about “normalizing” unhealthy weights will find themselves on the wrong side of history. They’re promoting the dehumanization of people with obesity.

We have no doubt that body positivity, already evident in popular culture, will grow stronger in the coming year.

7. Plant-Based Nutrition

This one is coming at us from every direction. Vegans are on a mission with big claims about how going vegan will save your life and your soul. The Lancet EAT commission and its obesity commission are both singing from the same hymnal. According to them, eating more plants will save the planet and turn around the excess of obesity. And then you have the entrepreneurs. They know a good thing when they see it. Beyond Meat and Impossible Foods are making gobs of money on their stock offerings by selling ultra-processed, plant-based fake meat. Underneath all that hype are some good reasons to favor more plants in our diets. This trend might be a bit overblown. But we doubt the bubble will pop anytime soon.

8. Clean Processed Food Labels

This is a story with a long arc. Remember the manifesto from Michael Pollan? More than a decade ago, he told us to “eat food” first and foremost. What that meant was to shun ultra-processed foods. The definition might be a little squishy, but it’s not bad advice. So for years now, the food industry has been reformulating. They’ve been cutting the number of “industrial ingredients” in their products. The goal is “clean labels” that will make their products seem more wholesome. Less highly processed.

Then there’s the whole added sugar disclosure thing. That goes into effect this year. So big food has been working hard to cut the amount of added sugars that will appear on their new labels.

We have more and more reason to believe that ultra-processed foods are problematic. So this is a robust trend.


Right now, the mainstays of bariatric surgery are the gastric sleeve and gastric bypass. Duodenal switch is an uncommon procedure that can be highly effective in certain situations. Now it seems that a variation on the switch, known as SADI-S, is moving into the spotlight. The promise is a safer and more effective option. So, many surgeons are quite enthusiastic about it. ASMBS remains cautious about adopting this procedure because many questions and concerns remain. We need better long-term data to be confident of the place this procedure will find in the practice of bariatric surgery.

Despite – or perhaps because of – these unresolved questions, you can expect to hear a lot about the SADI-S bariatric surgery.

10. More Inclusive Fitness

With good reason, the public’s focus on fitness will remain strong. Physical activity has a profound effect on long-term health outcomes. But for too long the image of the fitness industry was very exclusive. In a bad way. The image of the fitness industry has long been young, slender, and white. But no more. Body inclusivity is now a thing that’s gaining momentum in the fitness industry. Racial, cultural, ethnic, and gender diversity are getting attention, too. And finally, the special needs of seniors are getting attention from the fitness industry. Bring it on.

Uncertain Future Date, photograph © Erin Nekervis / flickr

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December 30, 2019

8 Responses to “Ten Big Stories to Watch in 2020”

  1. December 30, 2019 at 6:58 am, Mary-Jo said:

    Thank you, Ted, this is quite informative on what to look out for. I Hope to also look for increased medical insurance coverage to treatment options for Obesity and comprehensive nutritional care.

  2. December 30, 2019 at 8:56 am, AER said:

    “People who fret about “normalizing” unhealthy weights will find themselves on the wrong side of history.” Unfortunately statements like these are problematic. You cannot normalize obesity and at the same time empower the populous to change the behaviors that lead to obesity.

    • December 30, 2019 at 11:05 am, Ted said:

      AER, thanks for sharing your view. Mine is quite different, as you noticed.

      IMHO, “normalizing” obesity is a non-issue that exists in the minds of people who don’t live with this chronic disease. Who ever worries about “normalizing” cancer … or diabetes? No one. People with a chronic condition need a sense of normalcy as we cope with our health challenges. Normal comes in many sizes, shapes, and contexts. What’s normal for me is not normal for the next person. And my health is my business alone. Not the business of someone who doesn’t even know me but pretends to be “concerned” about my health. Respect is essential.

  3. December 30, 2019 at 10:58 am, David Brown said:

    Treating obesity with a drug, surgery, intermittent fasting, or the keto approach has it’s merits. However, adopting a plant-based approach may be superior because it prevents the cause. An important, overlooked difference between plant and animal sources of protein is the arachidonic acid content. Except for infants with developing brains, the daily requirement for arachidonic acid is in the 10s of milligrams. Exceeding the daily requirement results in accretion (gradual accumulation) of arachidonic acid in fat stores, red blood cells, and cell membranes. One of the benefits of exercise is that it accelerates utilization and excretion of arachidonic acid such that higher intakes do not result in accretion. This is what researchers have observed: “In multivariate models adjusted for age and gender, the red blood cell (RBC) proportions of dietary polyunsaturated fatty acids were unrelated to leukocyte telomere length (LTL). In contrast, the RBC proportion of arachidonic acid was inversely related to LTL.” https://www.sciencedirect.com/science/article/abs/pii/S0261561418300748 What this means is that increased accretion of arachidonic acid in ted blood cells is associated with accelerated aging.

    • December 30, 2019 at 11:12 am, Ted said:

      David, thanks for sharing your view. Regarding the possibility that a plant-based diet “prevents the cause” of obesity, that’s quite unlikely. Scientists are pretty clear that obesity has more than a single cause and it can be radically different in different people. A plant-based diet might be quite helpful for some people and completely ineffective for others.

  4. December 30, 2019 at 6:26 pm, David Brown said:

    Ted, I agree. I didn’t mean to convey the idea that a plant-based diet is appropriate for everyone. Sorry that I didn’t make that clear. What I did mean to say is that a reduction in linoleic acid and arachidonic acid intake IS appropriate for anyone with an arachidonic acid accretion problem. Reducing meat intake is an effective way to address the arachidonic acid aspect of the problem. Another is to eat animals that have been allowed to forage in a forest or pasture. Both the linoleic acid and arachidonic acid content will be lower than CAFO animals. Of course, if grass-fed is not available, a reduction in meat intake is a viable option.

  5. December 31, 2019 at 6:19 am, AER said:

    ‘Who ever worries about “normalizing” cancer … or diabetes?” Ted clearly there aren’t marketing campaigns aimed at seducing people to believe that its ok to have cancer and diabetes because all that matters is that you feel “comfortable in your own skin” and you should “love your body” and you can be healthy regardless the type of cancer or diabetes you have. This would be madness. This is exactly what’s happening with people who make such statements about obesity. The idea that you can be obese and healthy rejects mountains of empirical evidence and epidemiological findings. People deserve respect regardless of what condition they have so this is a straw-man argument. We have an obligation to make sure people understand the clinical risks and the reputable behaviors that will empower people to make changes.

    • December 31, 2019 at 6:47 am, Ted said:

      AER, thank you for making your feelings so clear.

      Your comment seems to reflect a feeling that the concept of body positivity is a “marketing campaign” to persuade people that they should not worry about obesity. I disagree. It’s all about loving and caring for your body. Nothing more. Nothing less. It’s not a political statement about obesity.