Could we have hit “peak” obesity?

I am stunned. The Financial Times reported today that there’s been a dip in obesity rates this year, indicating that we may have already hit the peak and could see a slow and steady decline from here.

What’s driving that? Data columnist John Burn-Murdoch suggests that it might very well be the GLP-1 medicines, given that 1 in 8 members of the public have now tried these drugs per data from KFF. Moreover, he noted, that the drop off seems to be most steep when it comes to younger adults (college graduates), and that’s the group using medications like Ozempic at the highest rate.

We can’t be certain this is the most important factor, but there is some compelling evidence. For those who didn’t catch it, I’ll drop the tweet storm here for reading pleasure. As you can see, the tweet is already taking off in a big way.

So how enthusiastic should we be? For context, I asked the go-to obesity medicine experts in my network to weigh in. And unsurprisingly, I got very mixed opinions.

Some say that it is a big deal. Dr. Jonathan Slotkin, a neurosurgeon who’s been closely tracking all the relevant studies, described the outcome as “remarkable and unprecedented.” He went as far as to suggest that it may even be worth adjusting the CDC’s 2030 Healthy People goal for reducing obesity in our population to be even more aggressive.

“The U.S. government underwrote our COVID medication response,” he said. “With this data, maybe the Feds should heavily support medical obesity efforts. Let’s have an Operation Warp speed around oral GLP meds.”

Others I spoke to cautioned that obesity is a complex issue, and there are other contributors that need to be taken into account. Ozempic isn’t the only intervention out there for obesity. There’s surgery; there’s other therapeutics; and there’s the role of fitness and lifestyle. Sometimes these interventions will complement each other, and the outcomes considered in a more holistic way.

My friend Dr. Nisha Patel, who’s a physician specializing in weight loss, stresses that obesity is a complex chronic disease and oftentimes that requires multiple interventions. She also noted that Body Mass Index, often used as the metric for obesity, has its limitations.

For instance, patients can have a normal BMI and still have obesity because of elevated body fat percentage, notes Dr. Patel. “I track body composition in my clinic and I do see this.” Likewise, there are famous examples of body builders with BMI’s that technically fall in the obese range.

“Even if people’s body mass index falls into the normal range, it doesn’t mean the underlying disease goes away,” she explained.

Another expert, Dr. Michael Albert, who’s also the chief medical officer of the obesity medicine startup Accomplish Health, said he’s also seen data that indicates the opposite. In fact, he’s been directly involved with a study that is pending publication that is far more sobering in its conclusions.

He agrees that BMI isn’t the right measure for obesity prevalence across a broad population; instead it’s a “directional” signal of weight health.

Lastly, there are also still big problems related to these medications, related to the lack of insurance coverage, cost and supply issues. All of that is changing in real time, with WSJ now reporting that pharmacy companies are increasing supply.

What we may need to be looking into here is what is going on from a metabolic level, noted Dr. Disha Narang, an endocrinologist and obesity medicine specialist based in Chicago. Is there still insulin resistance? How are cholesterol levels tracking? How about the leading factors associated with cardiovascular disease risk?

Beyond BMI, “it’s also important to consider the degree of chronic illness, food environment and education around weight,” she said.

So there you have it: Big, big news today. But with a sprinkling of caution.