The Star of the Kings

The Best and Worst of 2023 in Obesity and Health

This was a year of great progress in obesity, and with that progress came frustrations and angst. So finding the best and worst of 2023 in obesity and health is actually quite an easy and interesting task. Let’s dig right in.

#1 Best: Cardiovascular Outcomes Benefit Data for Semaglutide

Above all else the landmark findings of the SELECT trial will make 2023 stand out as a pivotal moment in obesity and health. For the first time ever, we have evidence that with sufficient efficacy, treating obesity can prevent strokes, heart attacks, and cardiovascular deaths. It will take time for some people to accept it, but this should resolve any lingering doubt about the medical value of obesity treatment.

2. More and Better Options for Obesity

Semaglutide is the beginning, not the end, of the story for more effective obesity treatment. Tirzepatide gained FDA approval for this indication in November. Many people are already saying that this drug will surpass semaglutide in the marketplace. But there is still more to come. The ADA Scientific Sessions this year were something of a coming out party for a whole host of advanced obesity medicines in development. The future is very bright indeed

3. Broad Awareness That Obesity Is a Medical Problem

Seeing that medical treatment can reliably yield impressive results for people living with obesity settles an important question. Obesity is definitely a concern that deserves serious medical attention – not just a lifestyle or cosmetic concern.

4. Pediatric Obesity Care Guidance

This was good and unsettling news. When the American Academy of Pediatrics published new guidance for obesity treatment, it was a breath of fresh air for families struggling with a severe medical problem and unable to get serious medical attention for it. But it will take time for people to get over deep seated convictions that obesity is merely a lifestyle problem. Or it’s no problem at all – nothing more than a manifestation of “diet culture.”

5. Moving Beyond Weight to Define Obesity

We are leaving behind a flawed definition of obesity that once relied exclusively on BMI. The Lancet Commission on the Definition and Diagnosis of Clinical Obesity will formalize this in the coming year. But the world is already moving beyond overemphasis on weight and BMI.

#1 Worst: Drug Shortages

This is the flip side of semaglutide success in obesity. The manufacturer of Ozempic and Wegovy was utterly unprepared for the revolution it started. Six years after the first approval of semaglutide in the U.S. and two years after approval for obesity, Novo Nordisk still cannot meet the medical need for this drug. That causes a host of problems and keeps the price high. This is a persistent man-made disaster.

2. The False Line Between Obesity and Diabetes

Everybody seems to be adding to this problem – reserving second-class status for obesity in contrast to other cardiometabolic diseases. Manufacturers use branding to keep obesity separate from diabetes indications. Insurers say it’s fine to use these drugs for diabetes, but if a patient has obesity without diabetes, too bad. Let’s hope they get diabetes and then we’ll pay for treatment. It is absurdity we have a hard time bearing.

3. Fear Mongering

The was a year with too many examples of ridiculous fear-mongering. WHO told the world that sweeteners have “deadly long-term consequences.” Roughly three-quarters of the U.S. food supply fits a definition of ultra-processed foods, but many people are pushing the questionable idea that dietary guidelines should warn people away from all that bad stuff. Some people with books to sell pitched the idea that evidence-based guidelines for pediatric obesity care should “terrify” parents. Terror is not a good tool for prompting sound decisions about health.

4. Confusing Obesity Care with Weight Loss

Let’s keep it simple. Obesity is a chronic disease. Weight loss is a short-term thing. So treating obesity is not merely about losing weight weight, and obesity drugs like semaglutide have long-term benefits that go far beyond weight loss. But confusion about obesity care is persistent, perhaps because people often have a hard time thinking into the future.

5. Prices, Insurance, and Access to Care

It is beyond frustrating to have new and better treatments for obesity drugs and then face a healthcare system that makes these drugs impossible for many people to access. There’s plenty of blame to go around. Drug companies set list prices that are too high. PBMs play a shell game to obscure their profiteering. Health insurers do their best to discourage people from getting good care. Then all of these entities try to blame to the others for the problem instead of fixing it. A pox on all of them.

The Future Is Bright

To be clear, the good in 2023 outweighed the frustrating low-points in news about obesity and health. Because of advances in understanding and treating obesity, the future is quite bright.

The Star of the Kings, etching by Rembrandt / WikiArt

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December 28, 2023

One Response to “The Best and Worst of 2023 in Obesity and Health”

  1. December 28, 2023 at 9:01 pm, Allen Browne said:

    But Ted, what about the children with obesity?

    The best:
    The AAP recognizes obesity as a chronic disease

    The worst:
    The AAP restricts effective, physiologically based treatment by age.