Have We Turned The Tide On Obesity?

Why we might be starting to see declines in the rates of obesity.

Obesity is one of the world’s biggest health crisis and only seems to be getting worse.

Or is it?

Maybe we have turned the tide on one of the most pressing health issues of the century.

For over 50 years, the rates of obesity have continued to rise worldwide¹.

That is until now.

The most recent data on obesity has shown a decline for the first time in a very long time.

Between 2020 and 2023, the rates of obesity dropped by about 2%².

Why rates of obesity have dropped is likely due to a combination of factors, but the introduction of weight loss medications such as Ozempic, Wegovy, and Mounjaro could well play a role.

Approximately 1 in 8 US adults have trialled one of the medications for weight loss³.

The question is, are we starting to see individual-level weight loss play out at a population level?

It is hard to say. Only time will tell.

I have written before about the effectiveness of weight loss therapies such as Ozempic.

The intriguing question is whether other factors will improve alongside the reductions in excess weight and whether these changes may be related to the use of GLP1 medications.

What I would like to cover are five things that may also improve with the use of these medications in addition to their primary target, which is weight loss.

1. Alcohol Use

GLP 1 medications appear to act centrally on the brain and largely regulate appetite and hunger.

There are likely to be other mechanisms of action, but most people describe a significant reduction in cravings and hunger.

The question is whether this reduction in cravings extends to things other than food.

The answer, it seems, is yes.

Not exactly a randomised trial, but a study using AI semantic analysis of social media and online commentary on medications such as Ozempic found a significant relationship between the use of these medications and reductions in the cravings or desire for alcohol⁴.

If this turns out to be true, these medications may have a meaningful role to play in the management of many maladaptive craving behaviours.

I wonder if they might even reduce social media use?

2. Inflammation.

Inflammation is a key driver of heart disease, specifically coronary artery disease.

I have covered this topic previously here, but it is clear that inflammation plays a major role in the initiation and progression of coronary artery disease, and the inflammatory biomarker hsCRP is tightly connected to this process.

A recent analysis of one of the original trials on Ozempic for weight loss revealed that levels of hsCRP dropped by 38% regardless of the amount of weight lost⁵.

Reductions in hs-CRP have been linked to reductions in cardiovascular events, and GLP1 therapies have also been linked to reductions in cardiovascular events⁶.

Inflammation is closely linked to many other health conditions, so maybe these therapies may see use in other inflammatory-driven areas of which there are many.

3. Dementia.

Dementia is a leading cause of death and a major concern for most people as they age.

Optimal metabolic health is linked to reduced rates of dementia, but the question again is whether the use of medications such as Ozempic might also delay the onset of dementia.

Recent data on the use of GLP1 therapies in those with Alzheimer's dementia has shown improvements in several cognitive and dementia markers⁷.

These early studies are promising, but larger, more definitive studies are already underway and will hopefully provide more insights and possibly even some tools for tackling the challenge of dementia.

4. Obstructive Sleep Apnea (OSA).

OSA is a common sleep disorder that significantly increases the risk of future heart disease and stroke.

Excess weight and insulin resistance are key drivers of obstructive sleep apnea.

Recent trials of these therapies in those with OSA have demonstrated extremely encouraging results with significant reductions in apnea episodes and severity⁸.

For those with OSA, these therapies could be a game changer for both quality of life and, indeed, future cardiovascular risk.

5. Cancer.

Obesity is the second leading cause of preventable cancers after smoking⁹.

Anything that reduces obesity has the potential to reduce future risks of any associated cancers.

Patients on GLP1 therapies compared to metformin or insulin in those with diabetes had lower rates of certain cancers including¹⁰:

• Oesophageal Cancer - 40% reduction.

• Colorectal Cancer - 46% reduction.

• Kidney Cancer - 24% reduction.

• Liver Cancer - 53% reduction.

• Pancreatic Cancer - 59% reduction.

• Ovarian Cancer - 48% reduction.

While this study is a retrospective analysis and comes with a whole lot of caveats, it does highlight a potentially powerful signal.

The relationship between GLP1 therapies and future cancer risk will need to be formally tested in randomised trials to truly define an answer here, but so far, things appear promising.

You can make a very cogent argument that all of the five benefits seen here are not related to GLP1 therapies such as Ozempic but rather simply down to the reduction in excess weight and all the risks that come with it.

I suspect most of the benefit is indeed driven via the weight change and not simply the GLP1 therapy.

However, we have known this for decades.

And despite our best efforts, we have been unsuccessful at implementing strategies that are sustainable for addressing obesity.

Lifestyle measures, in my view, are the preferred approach to tackling this issue.

But we also have to be realistic that, in many cases, lifestyle measures for the management of excess weight do not have great long-term data.

And because of this, rates of obesity have continued to climb year on year since the 1960s.

Until now.

Maybe.

Just maybe the tide is turning.

Only time will tell.

1. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

2. https://www.ft.com/content/21bd0b9c-a3c4-4c7c-bc6e-7bb6c3556a56

3. https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/

4. Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity. Sci Rep 13, 20998 (2023).

5. https://www.medscape.com/viewarticle/semaglutide-anti-inflammatory-2024a1000c4l?ecd=mkm_ret_240728_mscpmrk_cardio_top-content_etid6700785&uac=182495HV&impID=6700785

6. SELECT Trial Investigators. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023 Dec 14;389(24):2221-2232.

7. https://www.medscape.com/viewarticle/promising-new-data-support-glp-1s-dementia-prevention-2024a1000e0l?ecd=WNL_conf_neuro_AAIC-SPON_240817_MSCPEDIT_etid6752994&uac=182495HV&impID=6752994

8. SURMOUNT-OSA Investigators. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024 Jun 21.

9. Cancer is a Preventable Disease that Requires Major Lifestyle Changes . Pharmaceutical Research, Vol. 25, No. 9, September 2008

10. Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes. JAMA Netw Open. 2024;7(7):e2421305.