Twenty years ago, the headlines were grim. It was common for studies to warn: “Rising childhood obesity will decrease life expectancy.” In large part, those predictions came true. The rise in obesity – both in children and adults – has correlated to a catastrophic rise in chronic disease that continues to affect life expectancy, cost of care, and quality of life.
But take a look at the health news headlines now, and a more hopeful picture starts to emerge: “Weight-loss drugs lead people to buy less food,” “Weight-loss drugs estimated to save airlines millions,” “Clothing stocks set to gain from weight-loss drugs.”
Incretin medications, which include prescription diabetes or obesity drugs such as Mounjaro, Wegovy, and Ozempic, can help people lower their blood sugar and lose weight. They stimulate the release of insulin, which helps lower blood sugar, and slow food passage through the gut.
As these medications gain popularity for weight loss, we’re starting to see a shift in the decades-long rise in obesity and diabetes. Wall Street has already gotten wind of what this could mean for the economy. But what could it mean for health? Perhaps incretin medications and the awareness of them can finally achieve the impossible and change the course of our country’s wellbeing.
That was certainly the message touted by drug manufacturers in nine industry-sponsored studies presented at the recent Obesity Week conference in Dallas. Makers of incretin medications predicted seismic economic and health care shifts.
One of the studies from Novo Nordisk, for example, estimates that if 100,000 people lost 15 percent of their body weight — the average weight loss for the company’s Wegovy drug — it would cut the cost of obesity-related conditions such as hypertension, type 2 diabetes and sleep apnea to the tune of $85 million over five years.
Jason Brett, executive director of medical affairs for Novo Nordisk, told Stat News, “The overarching message is around the clinical or medical burden and economic burden of obesity and how that’s growing, and then also how we can use weight loss as a therapeutic strategy to improve health and to reduce costs ultimately downstream to the health care system.”
Obesity to overtake tobacco
Critics of the manufacturer-sponsored studies pointed out that much of the research into economic savings doesn’t take into account the high price tags of the medications themselves. And others warn of the drugs’ side effects, such as malnutrition, nausea, and facial aging.
But the prevalence of obesity, and the impact it has had on people’s health and quality of life, is too great to ignore. According to the CDC, 42 percent of adults and 20 percent of children and adolescents have obesity as measured by BMI, and a 2019 New England Journal of Medicine study warned that 50 percent of U.S. adults will have obesity by 2030.
Obesity contributes to eight of the ten leading causes of death in the U.S. It also increases the risk of mental health disorders. People who are obese are also routinely left out of clinical trials, leading to a potential gap in safety and efficacy of new drugs for this population.
Incretin medications help patients shed their weight, control their diabetes and have been shown to reduce atherosclerotic cardiovascular risk in patients with type 2 diabetes. Early studies even suggest that these medications could reduce alcohol intake and protect brain health in diabetes patients as well.
While incretin has much-publicized negative side effects and is not on its own a magic bullet, it does represent the most significant remedy to obesity in a generation. And given that obesity is expected to overtake tobacco as the leading preventable cause of death in the U.S., the stakes for halting the rise of obesity simply couldn’t be higher.
Improvement in healthy habits
There is another side to these new weight-loss drugs that is hard to overlook: the way they could potentially reset societal norms. Never in the evolution of humanity has food been this calorie-rich and plentiful. And never have we been a more sedentary, safe-from-harm species. As a result, we actually have to put effort into the healthy habits that our bodies still think are part of our daily lives (namely, a healthy diet and regular exercise).
By reducing food cravings, incretin medications help people eat less. According to one report: two-thirds of patients reported eating three or more snacks per day before starting the drugs, while 74 percent reported eating two snacks or less after starting the drugs. And more hearteningly, they appear to be eating better. The advent of these medications has meant that ultra-processed food is out, and fruits and veggies are in.
It is hard to predict what a national drop in weight will mean to our collective attitudes toward exercise, smoking cessation, alcohol restriction and other healthy habits. But as people lose weight and overcome related chronic conditions, it is reasonable to believe that we could see a rise in the kind of healthy habits that negate the need for these drugs in the first place.
Maybe 20 years from now, we will be able to reassess those dire predictions from 20 years ago. Maybe all those babies born at the turn of the century will grow to be the first generation expected to live – healthily – well beyond 100. I can just see the headline now: “Due to weight loss drugs, people live longer, healthier.”
David Ahn is an endocrinologist and chief of diabetes services, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.