Obesity rates have fallen slightly in the US and while it’s too early to say whether the trend will continue or what’s causing the change, experts believe weight-loss drugs could play a role in further reducing obesity and reducing associated health risks .
These medications – Ozempic, Wegovy, Mounjaro and others – are called GLP-1 agonists and were originally developed to treat type 2 diabetes. But they also show promise for treating obesity and other health problems heart disease, kidney And liver problems, sleep apnea, asthma, Covid complications And canceramong others.
“Everything related to obesity is getting better,” says Rozalina McCoy, an associate professor of medicine at the University of Maryland and lead author of a Nature study demonstrating the benefits of GLP-1s on the cardiovascular health of people with type 2 diabetes.
The drugs “transformed” diabetes care because they actually improved health outcomes — a first for type 2 diabetes, she said. They can help prevent heart attacks, strokes, kidney disease and death. Other conditions, such as metabolic dysfunction-associated steatotic liver disease (formerly known as fatty liver disease), have also previously had no effective treatment.
“Most of the time I think nothing works, everything is overplayed,” says Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and an assistant professor at Harvard Medical School. But “I’m really excited about the possibilities here.”
The obesity rate among US adults over the age of 20 was 41.9% in 2017-2020, but fell to 40.3% in 2021-2023. according to to the National Center for Health Statistics. Severe obesity simultaneously rose from 9.2% to 9.7%.
This is not the first time the overall rate has fallen. Obesity has been rising fairly steadily in the US over the past few decades, but that was the case small drops for example, increases followed in the years 2007–2008 and 2011–2012.
The increase in severe obesity is concerning because that is the group most at risk for poor health, McCoy said. “I don’t find that research reassuring. I think it’s a sign that we’re still going in the wrong direction.”
But “at least it’s not going up,” says John Morton, an obesity physician and vice chairman of bariatric surgery at the Yale School of Medicine.
It typically takes years of data to establish trends, and peaks are usually not visible until long after they are reached, he said. “I think we still have a lot of work to do, but there may be a faint glimmer of it reaching a plateau.”
It’s “certainly a possibility” that the GLP-1s are responsible for the slight decline in obesity, Morton said, but he cautioned that other factors were also at play.
“Another possibility could be Covid. The two main risk factors for Covid-19 mortality were age and weight,” he said. “So I don’t know what to think yet.”
He also pointed out that obesity rates among young people were unusually high, so “a new epidemic is coming.”
But he welcomes the interest – and research – around treating obesity. “It’s really been a struggle to get attention to the problem,” he said.
He is “grateful” for GLP-1 drugs for giving patients more options and for sparking conversations about the health effects of obesity.
He believes they could play a role in improving obesity and other health problems, especially if there is a formulation of the drugs that can be taken orally instead of injected. “It will really be a population benefit,” he said.
“What surprised me was how quickly it worked – how early the mortality benefit showed up,” Faust said. He compared having high-risk conditions, such as obesity, to being closer to the edge of a cliff. The drugs seem to help patients pull back from the brink. “Suddenly someone who was ‘expected’ not to die for a year is dying, and I think that’s remarkable,” he said.
Faust even hypothesized that the increase in severe obesity could reflect the fact that high-risk patients are living longer thanks to better treatments. If a greater number of people enter this category than those who leave, the rate would rise, he theorized.
About one in eight (12%) American adults participation they have used a GLP-1 agonist at some point, with 6% saying they are now taking one of the medications. About half of them say it is difficult to pay for the medicines.
Since 2018, the company that offers Ozempic and Wegovy, Novo Nordisk, has achieved $50 billion in sales – 72% of which from the US.
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This high cost is one reason why McCoy does not believe GLP-1s will affect obesity rates in much of the population.
“Medications that cost $1,000 a month and are accessible to a select few — that is not the way we solve public health problems like obesity,” McCoy said. “They are effective treatments that we need to have access to and use. But if we really want to tackle the problems of obesity, diabetes and cardiovascular disease, we must first tackle the underlying cause.”
Still others are more optimistic about the role GLP-1s can play in reducing obesity in the population.
“We have turned obesity into a kind of moral sin, instead of what it is: a metabolic problem,” Faust said. Paying attention to nutrition and healthy practices is admirable, he said, but “we’ve been trying to do that for a long time. Let’s play on the board we have, and not on the board we would like to have.”
Prevention is important, “but you have to have both,” Morton said. “You need both prevention and treatment to really fight this, just like we did with heart disease and cancer.”
People who stop taking the medication usually come back two-thirds of their weight. But it is not uncommon for people with chronic conditions such as asthma, high cholesterol or high blood pressure to take medications for extended periods of time, even for the rest of their lives.
“We don’t jump into treating other health problems by saying, ‘We don’t know if we should treat your high blood pressure because we may have to stop taking this drug in the future,'” McCoy said. “I think these questions are related to obesity in part because of the stigma that obesity carries… It is a serious chronic health condition that we need to treat.”
The side effects include nausea and vomiting, and rare side effects include gastric paralysis, small intestinal blockage and pancreatitis. Given these potential risks, the drugs should only be given to those who need them, the experts said.
“Frankly, it’s going to be both obese and diabetic patients — those are the patients who are most at risk for adverse health problems and they’re going to benefit the most,” Morton said. For these patients, the benefits often outweigh the potential risks.
“The GLP-1 drugs have actually been around for over twenty years,” Morton said. “If we saw a lot of complications, we probably would have seen them already.”
As the benefits for related health conditions become clearer through research, it’s possible that insurance will cover more of the treatments — because insurance plans like Medicare don’t cover obesity treatments, but they can pay for treatments that reduce the risk of cardiovascular disease, sleep apnea and other conditions.
Researchers are too look into the treatment options for these medications substance use disorderAlzheimer’s, Parkinson’s, mental health and other issues. But those links are not yet as well established as other health benefits.
“We have to be careful because there could very well be a whole host of other diseases, ranging from addiction to mental health, for which these drugs could be just as great,” Faust said. “But I don’t think we want to get ahead of ourselves.”