The Merger of Obesity and Diabetes

This is a merger that has taken decades – the merger of obesity and diabetes. Ethan Sims first coined the term diabesity in 1973. Even five decades ago, the coincidence of diabetes and obesity was unmistakable, but the standards of care for obesity and diabetes did not reflect the recognition of obesity as anything other than evidence of poor lifestyle choices. In fact, into the early 2000s, treating obesity with drugs that caused weight gain was not uncommon.

The Beginning of Profound Changes

Not long after that, the tide began to shift. We noted a decade ago that massive changes were already under way. Drugs like Actos and Avandia, which both cause weight gain, came off the market in some countries and faded from their market-leading positions. Newer drugs like GLP-1 agonists and SGLT2 inhibitors gained favor because they yielded some weight loss in addition to control of blood sugar.

Even more important, these weight-sparing drugs were also life-sparing. Cardiovascular outcome studies showed that people had fewer heart attacks and deaths if they received them. The shift accelerated.

Ozempic, Mounjaro, and Diabesity

Today, the merger is nearly complete. In a recent editorial titled simply “Diabesity,” Stephen Brunton explains:

“Strong, consistent evidence shows that managing obesity can delay progression of prediabetes to type 2 diabetes. Obesity management is also highly beneficial in treating type 2 diabetes, based on the degree of weight loss achieved. Losing excess weight improves glycemic control, reduces the need for glucose-lowering medications, can substantially reduce A1C, and can even promote sustained diabetes remission.”

Thus the existence of separate brands for semaglutide in diabetes (Ozempic) and in obesity (Wegovy) has become ridiculous. Scan the headlines and you’ll see that the Wegovy brand name crops up less and less. Just about all the buzz is for Ozempic – whether that buzz is about diabetes or obesity. It’s all diabesity.

Likewise, look at the new consumer advertising for Mounjaro (tirzepatide). Lilly takes pains to say that it’s “not a weight loss drug.” But they also make it quite clear that people eat less and lose weight when they are taking it for diabetes. In truth, it’s all part of the same metabolic problem for most people.

In short, the makers of Mounjaro want people to “do diabetes differently.” Increasingly, this will mean that the sharp line between diabetes and obesity is going to blur. Because these two diseases are merging and for good health outcomes, they both need attention.

There’s no going back.

Click here for the Brunton editorial and here for more on the new Mounjaro advertising.

Pair of Mandarin Ducks, photograph by Francis C. Franklin, licensed under CC BY-SA 3.0

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

April 3, 2023