Dear Friends, a ton of activity on metabolic and obesity care, with Obesity Care Week, publication of report from the World Obesity Forum, all in advance of World Obesity Day on March 4.
AT A GLANCE…
- Publication of the World Obesity Atlas estimates a $4.32 trillion cost to the global economy, or 3% of global GDP by 2035, with 4 billion people [or 51% of the world population] affected by overweight and obesity.
- Game-changing and more sought after than Taylor Swift tickets, wonder cure, and thin is power are sentiments described this week in the mass media; are GLP-1s the new Viagra and Botox?
- The Economist, my all-time favorite newspaper, disappoints this week with the hype-focused headline ‘Eat, Inject, Repeat.’ with three articles focused upon GLP-1 medications and not much else in the metabolic/obesity care arena.
- Disheartening – but not surprising – news reported by the WSJ yesterday alleges that NextMed, a GLP-1 agonist telehealth company, is relying on false advertising and fake testimonials to push Ozempic as a weight loss drug.
- Today’s obesity problem will not be solved with either/or thinking, in reference to prevention versus treatment of obesity.
EVENTS
- Obesity Care Week, or OCW2023 culminated in a five-day public awareness campaign, to ‘…change the way we care by creating a society that understands, respects and accepts the complexities of the disease of obesity and prioritizes accessible, science-based treatment.’ underpinned by ‘…obesity as a complex, chronic, recurring disease.’
- World Obesity Day, leads with ‘Changing Perspectives: Let’s Talk About Obesity’ further exemplified by ‘Together we can correct misconceptions surrounding obesity, acknowledge its complexities, and take effective, collective action. Because when we all talk, debate and share, we can shift norms and transform health outcomes for everybody. This isn’t going to be easy. But difficult conversations help us to influence and mobilise policy initiatives; to upend misconceptions; to turn words into action.’
NEWS
- On Thursday of this past week, the World Obesity Atlas 2023 was published, providing ‘Global, regional and national estimates for the prevalence of obesity up to 2035 for adults, children and adolescents…’ together with economic impacts and preparedness to address obesity, across 187 countries. Wow! The 232 page report highlights that without action, the economic impact of overweight and obesity is ‘…projected to cost the global economy US$4.32 trillion of potential income in 2035.’ or nearly 3% of current global gross domestic product, doubling from a 2020 rate of US$1.96 trillion. This is the fifth annual World Obesity Atlas, with worrying though well known statements that ‘No country has reported a decline in obesity prevalence across their entire population…’ By 2035, over 4 billion people may be affected with overweight and obesity [BMI>25], compared to just over 2.6 billion today, reflecting ‘…an increase from 38% of the world’s population in 2020 to over 50% by 2035.’ and an increase in rates of obesity [BMI>30] from 14% to 24% of the global population by 2035, or nearly 2 billion adults. If that was not depressing enough, the ‘…rising prevalence of obesity is expected to be steepest among children and adolescents, rising from 10% to 20% of the world’s boys during the period 2020 to 2035, and rising from 8% to 18% of the world’s girls.’
- The press release, a more digestible format of the World Obesity Atlas is here too.
- In STAT News, Julia Belluz references the 3 per cent of global GDP mentioned in the World Obesity Atlas as the same amount of impact that was had by the Covid-19 pandemic in 2020. Johanna Ralston, CEO of the World Obesity Federation is quoted ‘The costs are mind-boggling and a really good reason to make the case that any resources allocated to a comprehensive obesity strategy are investments and not costs.’ In addition, William Dietz, a well known policy researcher at George Washington University with a deep interest in obesity care suggests that ‘…Excess weight isn’t always correlated with poor health…’ though the more important aspect is the definition of excess weight, which is not well captured by BMI. I do like the no-nonsense sentence ‘Whatever the precise economic toll of obesity turns out to be, one thing is for sure: the burden is growing and it won’t be evenly spread around the world.’ followed by ‘This urgency isn’t currently reflected in obesity policy.’
- BBC News led with the headline ‘Half of world on track to be overweight by 2035.’ in reference to the World Obesity Federation report. The president of the federation, Professor Louise Baur referred to the ‘…report’s findings as a clear warning to countries to act now or risk repercussions in the future.’ The article also states that the data in the report will be presented to the United Nations on Monday – watch this space for more!
- Newcomer startup NextMed is featured in The Wall Street Journal this week ‘…trying to capitalize on the craze for drugs such as Ozempic, Wegovy and Mounjaro.’ with growth ‘…primarily from advertising, including ads that health professionals have said are inappropriate.’ The article sadly states that ‘…The company used before-and-after photos showing substantial weight loss by people who weren’t its clients.’ It is unlikely, if verified, that NextMed will be the last of direct-to-consumer companies trying to cash-in on the hype for GLP-1 medications, with some offering medications at half of list price imported from outside of the US, and others providing generic semaglutide or tirzetapide in compounds which are not intended for patient use.
OPINION
- An article in Fast Company written by a physician trained in obesity medicine who is also chief clinical officer for D2C healthcare company Ro, refers to thousands of people asking the question ‘…where can I get it?’ in reference to GLP-1 agonists, rather than the much sought after Taylor Swift tickets! Once again, whilst GLP-1 medications are defined as ‘…game-changing’ the author importantly does take time to highlight ‘…the legacy of weight bias and the failure to recognize obesity as a complex chronic condition.’ I do like the paragraph in the text that the ‘…uncomfortable truth is that the advice to change one’s diet and exercise habits alone does not help most people lose weight or keep it off. This is due to powerful biological signals from the brain that work to maintain our body weight. Most patients living with obesity are motivated to address it, so it’s high time we put aside weight bias and support them with the most effective means of weight loss.’ Hear hear! And in addition, there is mention that ‘…positioning obesity as somehow less deserving of treatment than diabetes—is another sign of weight bias. It is also shortsighted, considering obesity’s role as a risk factor for many other diseases, including heart attacks, strokes, mental health conditions, and some types of cancer.’ Great article and worth a deeper dive.
- In THE Healthy, a Reader’s Digest brand, Dr. Kumar begins her article with ‘A new class of drugs seems to be the wonder-cure for obesity…’ And continues that ‘…most physicians default to recommending that a patient should eat less and move more.’ Most importantly, we need multimodal, whole-person care that is individualized and delivered in a dynamic manner, aligned with the final sentence in the narrative that ‘Medication may help, but it’s just one piece of the puzzle.’
- In THE HILL, two scientists Anthony Biglan and Diana Fishbein write to acknowledge ‘…genetic roots…’ in the rising rates of obesity over the past forty years, though focus upon ‘The glaring oversight in these assertions is the failure to describe the huge influence of the food industry on the obesity epidemic and the dire need to halt the harmful marketing of unhealthful foods’ stating that ‘We cannot treat our way out of the obesity epidemic.’ This is a strong view, with additional statements that first, genes could not have changed in the past forty years, second, optimism about new drugs is not warranted, and third, there is no evidence that bariatric surgery produces long-term reductions in obesity. I respectfully disagree, though do believe that more can be done in the longer term to inform and educate society on healthy eating; it is just that we are way beyond that point in the US [and likely globally] where an ‘ounce of prevention’ is better than the ‘pound of cure’, and as such need to focus energies on approaches that can impact the current and onward state of the chronic disease of obesity.
- In reference to the above article, Dr. Ted Kyle responds in the bluntest manner ‘That ship has already sailed. The plane has left the gate. Obesity is endemic in the U.S.’ and ‘…the most generous description we can offer for the Biglan-Fishbein strategy of relying exclusively on primary obesity prevention is that it is unwise.’
- US News & World report weighs in on the mechanism of action, efficacy, safety supply shortages and users of Ozempic, quoting four clinicians with expertise in primary care, regenerative medicine, endocrinology and gastroenterology.
- The cover story in The Economist this week focuses upon obesity and medication therapy, with the somewhat flippant title of ‘Eat, inject, repeat.’
- The leader article begins with a click-bait opening: ‘A new type of drug is generating excitement among the rich and the beautiful. Just a jab a week, and the weight falls off.’ And to appease readers from a financial perspective, the article states ‘Analysts think the market for GLP-1 drugs could reach $150B by 2031, not far off the market for cancer drugs today,’ and that the ‘…market capitalization of Novo Nordisk, the firm at the front of the gold rush, has doubled in two years, to $326B, making it the second-most-valuable listed drugmaker in the world.’
- The next article in the three-part series is somewhat fairytale-like, titled ‘A new class of drugs for weight loss could end obesity.’ What follows is a terrific summary subtitle: ‘They promise riches for drugmakers, huge savings for health systems and better lives for millions.’ Whilst we have already heard this in other reporting this week, it is worthwhile to repeat ‘…the annual cost of humanity’s growing paunch will reach $4Tr in 2035, of 2.9% of global GDP, in the form both of spending on health care and of working time lost to illness and premature deaths. That is the equivalent of another Covid-19 pandemic every year.’ The author adds ‘A good indication of how desperate so many people are to lose weight is the nearly $250B the world spent on dieting last year, even though it tends not to work.’ I do disagree with the mention of bariatric surgery as ‘…a drastic response to the problem, and is limited by the number of surgeons’ … a statement that would never be said of the need to treat a patient with breast cancer, knee osteoarthritis, or gallbladder disease [and by the way, bariatric surgery is now as safe, or safer than all of the above]. On the issue of the need for lifelong pharmacotherapy, ‘In the first year after stopping a 2.4mg dose of semaglutide, people regain two-thirds of the weight they lost.’ Which is not such a good thing in terms of costs, access and medication adherence.
- The final article focuses upon the ‘Dos and don’ts on how to handle a gold rush’ with sage advice for executives at Novo Nordisk ‘…to avoid a political backlash, it is important that those who need them most can access them’ … which is not the Hollywood celebrity clique.
- In THE CUT, Matthew Schneier writes ’Thin is power.’ retelling the stories of countless individuals who have lost weight on GLP-1 medications, including Adele, Elon Musk and Kim Kardashian. The sentence ‘Not since Botox, and before that Viagra, has a drug brand become so well known so quickly’ is telling and worrying in the same. I am not sure this article does much more than hype the hype around GLP-1 medication for lifestyle users, and unfortunately reminds me of the reputed quote from Wallis Simpson in that ’no woman can be too rich or too thin.’
- Samhita Mukhopadhyay writes a personal piece in THE CUT this week, with real world insights including powerful narratives, ‘I could write books, run a newsroom, provide for my family, be a good friend, and be on time for anything, but I couldn’t be thin or get thin – and, somehow, that felt like it negated everything else. What was the point of all this success if I’m still fat?’ followed by ‘We live in an anti-fat culture where weight gain is, on its own, seen as a personal failure.’ The author continues in one of the best sentences I have read on the topic in recent times, ‘…having a medication that can regulate my hormones is teaching me that when I eat compulsively, it is not just about internal willpower or self-control.’ Thank you for sharing your experiences which I am sure will resonate with many others too.
- An area that has perplexed me is summarized very well in STAT News by Nicholas Florko, on ‘food is medicine’ with a definition of ‘…anything that recognizes food as a way to address health.’ Or to be more specific, food as medicine may comprise three specific interventions, i.e. medically-tailored meals [dietician-designed meals for certain conditions], medically-tailored groceries [meal boxes for certain conditions] and produce prescriptions [vouchers for unprepared fruits and vegetables]. Whilst I am still unclear on the approach and interventions, the data on medically-tailored meals for Medicare and Medicaid beneficiaries reports ‘…70% fewer emergency room visits and 52% fewer hospital inpatient admissions.’ I think I still need convincing and whilst a good idea, the implementation seems hard.
DATA
- In the American Journal of Health Promotion, the Editor-in-Chief Dr. Paul Terry reviews the American Academy of Pediatrics recent clinical practice guidelines for evaluation and treatment of children and adolescents with obesity, with the sub-title of ‘…Medicalizing Obesity or Acquiescing to Our Obesogenic Culture?’ An important sentence in the midst of the general commentary over the past few weeks is on ‘…critics worry that medicalizing obesity will inexorably lead to the expedient routes that hurried clinicians take with other conditions, that is, an over-reliance on medications and surgery.’ which is further potentiated in health care delivery systems that are remunerated on a fee-for-service rather than value-based model of care. While the following might be a non-sentence for sure, I think it summarizes the general mood pretty well right now… ‘Today’s obesity problem will not be solved with either/or thinking. There will be those who want to reframe obesity as something to be accepted and those who want to fight it with more aggressive treatment. Neither are wrong…or right.’
- In peer-reviewed Journal, Lancet Diabetes & Endocrinology, world renown researchers in the science and care of patients with metabolic/obese disease launch the ‘Commission on the Definition and Diagnosis of Clinical Obesity.’ The authors drive straight into the meat of the topic, stating that ‘…the question of whether obesity is a disease or merely a condition conveying risk for future ailments is ill conceived because it presumes an implausible all-or-nothing scenario, in which obesity (ie, excess adiposity) is either always or never a disease. Logic and evidence suggest that obesity can be both a risk factor and, sometimes, a disease in and of itself.’ The Commission ‘…aims to identify clinical and biological criteria for the diagnosis of clinical obesity.’ through engaging sixty experts from across the globe, importantly with inclusion of ‘…people with lived experience of obesity.’
- The Editorial concomitantly published in Lancet Diabetes & Endocrinology refers to World Obesity Day on March 4, the projections of global ecumenic impact to be over $4B, and the main drivers of weight-related stigma. The final paragraph is powerful, timely and exceedingly important… ‘Obesity is complex. The causes are varied and multidimensional so management must be too. Evidence shows that obesity stigma and misconceptions about the condition only worsen health and wellbeing. A person-centred approach is important for tackling the obesity crisis and is needed in all areas, from medical guidelines to media reporting.’
Kind regards, Raj
