Wednesday, December 06, 2023

by Aaron Medaris

Obesity has emerged as a pervasive and pressing global health issue, transcending geographic, economic, and cultural boundaries. The World Health Organization (WHO) defines obesity as "abnormal or excessive fat accumulation that may impair health." The prevalence of obesity has reached alarming levels, posing significant challenges to individuals, healthcare systems, and societies worldwide.

The obesity epidemic has grown steadily over the past few decades. According to WHO, global obesity rates have nearly tripled since 1975. In 2016, more than 1.9 billion adults were overweight, with over 650 million classified as obese. Alarmingly, childhood obesity is also on the rise, affecting 38 million children under the age of five. 

Obesity is a complex and multifaceted condition with a range of contributing factors. While genetics can play a role, lifestyle choices and environmental influences are primary drivers. Sedentary behaviors, high-calorie diets rich in processed foods, and an increase in portion sizes are major culprits. Additionally, socioeconomic factors, such as limited access to healthy foods and opportunities for physical activity, contribute to the epidemic. 

Obesity is not merely a cosmetic concern; it is a major risk factor for a multitude of health problems. Individuals with obesity are at a higher risk of developing chronic conditions, including type 2 diabetes, cardiovascular diseases, certain cancers, and musculoskeletal disorders. The economic burden of obesity on healthcare systems is substantial, with increased healthcare costs and decreased productivity. 

According to a 2022 article titled, “The Economic Costs of Obesity,” there are currently, “236 diseases that are associated with obesity…[putting] medical care costs of obesity at almost $150 billion per year in the U.S. More specifically, the cost of treating the five most common obesity-related conditions (stroke, coronary artery disease, diabetes, hypertension, and elevated cholesterol) resulted in roughly $9,000 to 17,000 in higher costs compared to normal weight adults.” 

Just one year ago, the outlook on obesity was quite dire. How dire? Look at some of these headlines from news agencies around the world, “Obesity ‘epidemic’ leading to 1.2 million deaths a year in Europe, says WHO,” “Study finds childhood obesity occurring at greater frequency,” and “Number of States with High Rates of Adult Obesity More Than Doubles.” 

However, there have been some major developments in the treatment of obesity that have changed headlines from bleak and dire to hope and optimism. “FDA Approves Powerful New Drug to Counter Obesity Epidemic,” “New drugs Could Spell an End to the World’s Obesity Epidemic,” “Doctors Grapple with Patients Demand for Weight-loss Drugs.” 

Drugs such as Mounjaro, Wegovy, and Ozempic are known as incretin medications. Incretins are gut hormones that aid in digestion and blood glucose control. They include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Therefore, incretin medications mimic incretin hormones. They stimulate the release of insulin which helps lower blood sugar as well as slow food passage through the digestive system, making them an effective treatment for those with Type II Diabetes. But how do these medications help people lose weight? Using Ozempic as an example, these drugs often:

1. Mimick GLP-1 Activity: GLP-1 is a naturally occurring hormone in the body that plays a crucial role in glucose homeostasis. It is released in response to food intake and stimulates insulin secretion from the pancreas, leading to reduced blood sugar levels. Ozempic acts as a synthetic version of GLP-1, binding to the GLP-1 receptors on pancreatic beta cells. This stimulates the release of insulin in a glucose-dependent manner, meaning that it primarily acts when blood sugar levels are elevated. 

2. Reduce Glucagon Release: Glucagon is another hormone produced by the pancreas, and its primary function is to increase blood glucose levels. In individuals with type 2 diabetes, there is often an imbalance between insulin and glucagon, contributing to elevated blood sugar. Ozempic helps regulate this imbalance by inhibiting the release of glucagon, leading to a decrease in the production of glucose by the liver. This contributes to improved blood sugar control. 

3. Slow Gastric Emptying: Ozempic slows down the emptying of the stomach, which helps reduce post-meal spikes in blood sugar. By delaying the absorption of nutrients from the digestive tract, it contributes to a more gradual and controlled rise in blood glucose levels after eating. 

4. Appetite Regulation: One of the notable secondary effects of Ozempic is its impact on appetite regulation and weight loss. The medication appears to influence the central nervous system, leading to a reduction in appetite and an increase in feelings of fullness. The mechanisms underlying the weight loss effects are not entirely understood, but they may involve interactions with brain pathways related to food reward and satiety. 

Dr. Cecilia Low Wang, a professor at the University of Colorado School of Medicine who also chairs the committee that advises the FDA on drugs related to endocrinology and metabolism, mentioned that those people who used the largest dose of Mounjaro, 15 milligrams, lost as much as 21% of their body weight. “They were able to achieve unprecedented amounts of weight loss. It was dramatic and exciting…We’ve never had a medication that is so effective for improving diabetes control and weight loss without putting patients at high risk of hypoglycemia,” Low Wang said.

 Dr. Wang’s excitement reflects why these drugs have been changing headlines across the U.S. where an estimated 70% of adults are either obese or overweight. Novo Nordisk, the makers of Wegovy, estimate that if 100,000 people lost 15% of their body weight (which is the average amount lost for their drug), it would cut $85 million from the cost of obesity related conditions over 5 years. Figures like look promising, but how do they compare to the global cost of obesity? In 2020, obesity health issues on a global scale cost over $1.96 trillion or 2.4% of global GDP; and if gone unchecked, is expected to reach $4.32 trillion by 2035. With such a daunting economic and human price ahead of us, can these weight loss drugs really make a difference? I feel the answer is a definite yes. No country has seen a decline in obesity since 1975! What we have with these drugs is an opportunity to use them as a therapeutic option to treat obesity, improve overall health, and slowly cut overall healthcare costs. For instance, in a recent study from Mongan Stanley, “analysts estimate that 24 million people or 7% of the US population will be taking these drugs by 2035.” One of the other interesting facts uncovered in the Morgan Stanley analysis, is that over two-thirds of those who took these drugs cut back on their intake of sugary drinks, baked goods, and other foods high in fat and sugar. Not only are these drugs helping people lose weight, but they are helping them change behavior. I feel that it is reasonable to believe that over the next decade that these drugs along healthier habits we could actually see a decline in obesity trends. 

Time will tell what impact these therapies will have on the obesity epidemic. But I sure hope that 10 years from now, we’re talking about how we’ve seen the first decline of obesity and obesity related health issues in over a half century.

References: 

The Economic Costs of Obesity
https://www.medicaleconomics.com/view/the-economic-costs-of-obesity

What Are Incretin Mimetics
https://www.goodrx.com/conditions/diabetes-type-2/what-are-incretins

What is Mounjaro? And does it work better for weight loss than Ozempic and Wegovy?
https://www.uchealth.org/today/what-is-mounjaro-and-how-does-it-work-for-weight-loss/

Report: Obesity could cost the world over $4 trillion a year by 2035
https://www.statnews.com/2023/03/02/obesity-costs-4-trillion-2035/