Dreaming of Long-Term Success in Overcoming Obesity

Right now, the public and policy makers are grappling with innovations in obesity that we already have. But scientists are peering over the horizon. They are dreaming – asking important questions about long-term success in overcoming obesity.

Stat News describes this as a “quest to eradicate obesity” – a frame for this work that misses the mark.

Prevention or Cure?

Just as obesity presents in diverse ways and has quite a diverse range of causes, there are many different ways to think about long-term success in overcoming obesity. Bill Dietz, who leads the STOP Obesity Alliance at George Washington University, cautions that medicines should not be the exclusive focus:

“Medications affect the internal pathways around obesity, but what they don’t do is consider the ambient, external, environmental pathways that predispose to obesity. That’s where I think we have to focus.”

As Novo Nordisk and Lilly are harvesting billions of dollars in profits from new obesity medicines, they are both looking for even more innovative approaches. Lilly’s Chief Scientific Officer, Dan Skovronsky, describes the aspirational goal:

“Can we imagine a world where most cases of type 2 diabetes are eliminated because we’re effectively treating or preventing obesity? Can we imagine a world where cardiovascular disease is cut by a third or more because we’re preventing obesity?”

Both Lilly and Novo have established research programs for RNA and gene therapies that might offer lasting remissions from obesity. The vision is to identify something that is closer to a cure than a maintenance therapy.

Novo has also established a research unit with a mission to prevent obesity. Nadeem Sarwar heads this unit, aimed at asking some fundamental questions:

“How do you really unpack the human biology that predisposes someone to disease, and how do you superimpose upon that the cultural or behavioral considerations that go into that, too? It’s really that kind of combination of human biology in the context of the environment.

“The fundamental thing is, we don’t know. We need to invest the time and effort and energy to understand that.”

With sufficient curiosity, we can find effective strategies for both preventing and curing obesity.

But Eradicate Obesity?

This brings us back to the question of how we frame the vision for these worthy endeavors. Dietz points out the problem with language of eradication:

“What people perceive is that you want to eradicate them.

“Obesity is identified with people, and people are blamed for it. There’s not this vision or recognition that people exist in a broader sphere of influence.”

Moreover, the language of elimination offers a false promise. Even if we have prevention and treatment strategies that overcome the staggering effects of obesity on population health, obesity will not totally disappear like an infectious disease might. This can no more happen than 21st century medicine can eliminate suffering or “eradicate” heart disease.

The realistic promise is to overcome obesity – to eliminate the harm it is doing to our health. This is something we can do.

Click here for the full story from STAT News, here and here for additional perspective.

Dream of Joseph, painting by Alexander Ivanov / WikiArt

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December 29, 2023