Obesity and Diabetes — 2

Imagine if the researchers and companies had expedited a longer-lasting GLP-1 drug by experimenting with higher doses from the get-go. This glaring miss might have benefited so many—the millions of people suffering the consequences of obesity, those with increased risk of heart attacks, heart failure, strokes, diabetes, high blood pressure, fatty liver disease and cirrhosis, Alzheimer’s disease, sleep apnea, kidney failure, depression, cancer, severe osteoarthritis requiring joint replacement, and infertility. There aren’t many chronic diseases that are left to put on this list. This breakthrough family of drugs, and future derivatives such as the pills, like orforglipron, or even a vaccine-like version, have extraordinary potential to promote health span beyond what they have already accomplished.

There are about a billion obese people on the planet, comprised of more than 650 million adults and 340 million ages five to eighteen years. That number, as defined by a body mass index (BMI) of more than 30 kg/m2, has been growing for decades. Unfortunately, BMI is a flawed metric that both over- and underestimates obesity. It doesn’t distinguish between muscle and fat, yielding abnormal results in athletes, while one in three people in the normal range is obese when body fat is measured. It is used pervasively, even though the easy-to-measure waist circumference and waist-to-height ratio would be more accurate and are the preferred metrics of obesity experts. We might even go to the technology more precisely measuring body fat percentage from a dual X-ray absorptiometry scan.

Nevertheless, using BMI in the United States in 2023, according to the Centers for Disease Control and Prevention, the prevalence of obesity among adults was above 40 percent and 20 percent in children and adolescents. The increase has been relentless: in 1990, the prevalence was 15 percent in adults and 10 percent in kids. By 1998, when obesity prevalence doubled, deaths from severe obesity-related heart disease tripled. People of color, those with low income, and those who live in rural regions of the country have even higher rates of obesity. It had reached staggering proportions with no potential remedy in sight—until the GLP-1 drugs arrived. If we add that another 30 percent of Americans are merely overweight rather than obese (BMI more than or equal to 25 kg/m2) and may stand to benefit, the transformative implications of this new medical technology become obvious.