On September 24, 2024, the CDC released a report showing an obesity prevalence of 40.3 percent among American adults as a whole. This publication was greeted with much fanfare by some commentators. Quartz’s Brian Gil wrote that “Obesity is falling for the first time.” Reason’s Billy Binion took it one conclusion further: “Obesity in the U.S. Is Finally Declining. You Can (Probably) Thank Ozempic.”
But is obesity really declining? That’s not what the actual CDC report said: “From 2013–2014 through August 2021–August 2023, the age-adjusted prevalence of obesity did not change significantly, while severe obesity prevalence increased from 7.7 percent to 9.7 percent.”
The small decrease in obesity between 2017-2020 and 2021-2023 was not even statistically significant! A more accurate headline could have stated, as The Washington Post did, that “The obesity rate might have stopped growing.”
Even this lesser claim is still a victory worth celebrating. The United States of America, like most countries on Earth, has experienced a drastic increase in obesity over the past fifty years. Obesity has tripled from 13 percent to 40 percent between 1960-1962 and 2021-2023, with the most rapid rate of increase occurring between the 1970s and 1990s. This prolonged trend of increasing obesity has many likely root causes, including lack of exercise, calorie-dense foods, excessive portion size, ultraprocessed foods, altered gut microbiome, stress, and sleep deprivation.
So even if obesity isn’t going down, just staying the same, it would be fantastic news. And the 2024 CDC report suggests that this may in fact be the case. But can this fortunate turn really be credited to Ozempic?
Well, Ozempic is one of several drugs in the category of GLP-1 agonists. GLP-1 agonists were first developed as a treatment for diabetes, with the 2005 FDA approval of Byetta (exenatide) in April 2005. Many diabetic patients enjoyed significant weight loss while taking these drugs, leading to clinical trials of GLP-1 agonists for weight loss in non-diabetic individuals. As of October 2024, there are seven GLP-1 drugs approved in the U.S. for diabetes. Two are approved for weight loss, with FDA labels awarded to Wegovy (semaglutide) in June 2019 and Saxenda (liraglutide) in December 2020.
GLP-1 agonists appear to have better efficacy and more tolerable side effects compared to older weight loss drugs, many of which contained stimulants or antidepressants that could cause insomnia, rapid heart rate, heat intolerance, mood changes, even seizures.
However, many patients who use GLP-1 agonists report some amount of gastrointestinal side effects such as nausea or diarrhea. A very small minority can develop severe toxicities like gastroparesis, paralysis of the stomach that can persist even after stopping the drug.
Perhaps an even greater problem with GLP-1 drugs is their cost. Many patients in the U.S. pay hundreds of dollars a month for GLP-1 agonist drugs. Americans pay far higher rates for the same drug than our European counterparts, sometimes over 10-fold more. One estimate released by Senator Bernie Sanders stated that if half of all obese Americans were to pay list price for Wegovy, it would cost more than the U.S. spends on all retail prescription drugs combined.
In one recent study, 50 percent of U.S. patients taking GLP-1 agonists for weight loss discontinued use within one year, whether due to side effects or cost. The overwhelming majority of patients who discontinue GLP-1 agonists regain all of the weight that they lost while on the drug. This means GLP-1 drugs on their own are not sufficient to reverse the obesity epidemic. Drugs can only be one tool in the toolbox, albeit a potent one.
What else can we Americans do to help fight obesity? There are many policy changes that could be made. An improved youth sports ecosystem could encourage healthy habits at a young age. Walkable urban design can encourage people to walk rather than drive to destinations. We can discourage ultraprocessed foods, address the problem of food deserts, and remove perverse subsidies such as food stamps for soda pop.
So, is obesity declining? Not yet, but there are reasons to hope that it will do so soon.
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Comments
That opening picture is disgusting David, sorry, but still not as much as Ozempic otherwise from everything I’ve heard. By that, admittedly, I’m referring to the commercials I’m bombarded with, with all of the terrifying side effects. One of the worst things the bio-pharmaceutical complex has come out with yet!
Also, that song ‘Magic’ by Pilot was a favorite when new and for quite a few after that. Now I NEVER want to hear it again. Ozempic is just the latest in a long number of commercials to use this now destroyed song in place of an original ad jingle. I do believe the last ad series to use such a jingle were those European Mentos ads in the 90’s.