Beginning of the End

OCW2023: The End of Obesity? Not Exactly

An interesting collision of stories is playing out in the media today. It comes at the end of Obesity Care Week and on the eve of World Obesity Day. On one hand, the Economist proclaims that “new drugs could spell an end to the world’s obesity epidemic.” On the other, hand the World Obesity Federation is out with a new report prompting more dire headlines. More than half the world will be living with overweight and obesity by 2035 and it will cost the global economy more than four trillion dollars annually.

So is this a good news day or a bad news day for obesity? Maybe it’s a bit of both. A glass half full, so to speak.

“The Excitement Is Justified”

While we don’t agree with the primary claim of the Economist, their subhead is correct – “the excitement is justified.” But even this requires a little definition. By excitement, we are referring to the enthusiasm of medical experts about the prospect of truly effective drug therapies for obesity. (In contrast, the Hollywood weight loss buzz is absurd and unhelpful.) Semaglutide and tirzepatide are already making a big difference in the lives of people who have been trying to cope with the health effects of severe obesity for a long time without success.

Of course, semaglutide is the only one of these two drugs fully approved by FDA for treating obesity. Presently, the sole indication for tirzepatide is treatment of type 2 diabetes. But the results to date with tirzepatide suggest that it may very well be equally or more effective than semaglutide. Eli Lilly is waiting for the results of an FDA review, expected later this year.

On balance, this is good news, suggesting obesity medicines are on track to deliver effectiveness comparable to bariatric surgery in the near future. But it does not mean an “end to obesity.”

Costly Mistakes

The new report from the World Obesity Federation also points to important truths. Obesity prevalence continues to grow, even in countries like Chile and Mexico, which have been touted as models for obesity prevention.

Clearly, though some folks say they know the “root cause” of obesity is unhealthy food, they’ve had a hard time using their insight to prevent obesity and reduce its prevalence. The truth is closer to scientific insights that Julia Belluz reported recently. It’s complicated.

We have only fooled ourselves by thinking that public policy can reverse the growth in obesity by nudging, educating, urging, or taxing people into eating more healthfully. In some quarters, it remains an article of faith that “big food” is making us sick. So some folks suggest we can succeed where we have failed before by mounting a grand battle with the food industry. It feels good to call out an enemy.

But it doesn’t do much to reduce the harm of obesity to public health. For that, we need to urgently pursue evidence for prevention strategies that actually work. Not programs that merely feel like they should.

Curiosity about what works for preventing obesity is essential for overcoming it.

Click here and here for more from the Economist, here and here for more from the World Obesity Federation.

The Beginning of the End, poster for a 1957 science fiction movie / Wikimedia Commons. More about the movie here.

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March 3, 2023