Obesity rates are down. Is that because of weight-loss drugs?
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I asked (and fought with my insurance company at length) for a GLP-1 agonist. In about 10 months of use, I have lost just over 105lb (47kg). It wasn’t coupled with anything radical diet or exercise wise, but one of the things my doctor emphasized was relearning how to listen to the cues of hunger my body would produce. That served as really good advice as I’m much more aware of how hungry I am and when and “naturally” eat less. During a six week interruption of the drug caused by my insurance company not understanding kilos, I modestly regained some weight (about 8lb/3.6kg) but even then, I found myself much more aware of how hungry I was.
My drug has an official taper schedule, so once I hit my goal weight, I hope to taper down. Hoping that by the end of next year, I’ll be at my optimum weight, and able to taper. Then we’ll see!
My drug has an official taper schedule, so once I hit my goal weight, I hope to taper down. Hoping that by the end of next year, I’ll be at my optimum weight, and able to taper. Then we’ll see!
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Mine’s because I had a heart attack about three weeks ago, and yes, that was a real wake-up call about my eating habits. They weren’t bad exactly—we definitely eat a lot of fish like salmon, whole grains, vegetables (I mean, steamed broccoli with a light pinch of salt is literally my favorite food), etc.—but I let myself indulge since the pandemic a little too much in the not-so-good stuff. Bacon, french fries, potato chips, fast food, Five Guys’ BLT (which is OMG good).
Anyway, I’ve cut all that stuff and am now down about ten pounds so far, without any weight-loss drugs (not that there’s anything at all wrong with those!).
I think/hope my fear of another heart attack will keep me on course.
Anyway, I’ve cut all that stuff and am now down about ten pounds so far, without any weight-loss drugs (not that there’s anything at all wrong with those!).
I think/hope my fear of another heart attack will keep me on course.
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Oh, I hadn't heard about this.
What? That's not the drug not being effective, that's people not being able to afford it.
... the effect size is 2% smaller in a follow up?
The heck is this article?
ETA: I think I misread the line at the end there. The article remains absurd, though.
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I looked at the study's methodology and I am wondering how representative the sample is. I know they weight it to account for different groups, but the data is capture by home interviews followed by a health examination. That sounds like you are probably getting way more responses for middle and upper middle income folks than lower income folks.
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We're also seeing a reversal in trends where fat was getting pulled out of products only to be replaced with additional sugar. There's also an shift to integrate things like Barley and Oat Beta Glucan into health and nutrition focused food products. Studies have suggested they may have similar effects GLP-1 drugs.
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ColdWetDog
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It isn’t representative and that is clearly pointed out in TFA.
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I'm wondering if a certain US demographic would be friendly towards this kind of study given their propensity to reject medicine and science. They also tend to be the "I'll do/eat what I want" crowd.
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I’ve been tempted to talk to my doctor about something similar as I’m probably double my ideal weight right now. I’ve been trying to exercise more but I know for the last year or so I’ve been eating way too much junk as a coping mechanism. Thankfully I’m starting to get that under control but still struggle at times.
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I’d say it’s more like the effect size is 10-15% with some decent error bars. I suspect, too, that the weight loss effects of GLP-1 agonists differ depending on the “starting point”. Someone who is naturally very lean may not see the same percentage loss in body mass.
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My understanding is that availability of GLP-1 agonist medication to people is heavily weighted towards wealthier people, because insurance really doesn't like to cover the very high costs of those drugs except for a few medical conditions, is that correct?
So, if obesity being down is a function of GLP-1's being available, it seems like a comparative analysis could be done about obesity rates among the poor/lower middle class vs higher income individuals, to see if this is just a phenomenon of the wealthy.
Although even adjusting for wealth might not clarify the issue TOO much, because wealthier people are less likely to live in a food desert, more likely to eat healthier, unprocessed, lower-calorie (and especially lower-HFCS), higher fiber foods. They are also more likely to have time and money to exercise regularly - because poor people are more likely to work overtime, and not be able to afford gym memberships or have home exercise equipment).
So, if obesity being down is a function of GLP-1's being available, it seems like a comparative analysis could be done about obesity rates among the poor/lower middle class vs higher income individuals, to see if this is just a phenomenon of the wealthy.
Although even adjusting for wealth might not clarify the issue TOO much, because wealthier people are less likely to live in a food desert, more likely to eat healthier, unprocessed, lower-calorie (and especially lower-HFCS), higher fiber foods. They are also more likely to have time and money to exercise regularly - because poor people are more likely to work overtime, and not be able to afford gym memberships or have home exercise equipment).
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Let’s do some math. 38% of 15.5 million active users of the drug is 5.89 million. That’s the number said to be taking it to treat obesity.
The US population is about 345 million.
The obesity rate reported in this article is 40.3 percent, down from 41.9%. A shift of 1.6 points.
1.6% of 345 million is 5.5 million.
The severe obesity rate reported in this article is 9.7%, up from 7.7%, a shift of 2 points.
2% of 345 million is 6.9 million.
So:
So: Did all 5.5 million who lost weight take the drug? If so, that's a grand slam. The epidemiologist quoted said 15.5 million is an “optimistic upper bound,” so they sound unconvinced that as many patients were taking it as the article's source claims.
Drug companies are required by FDA regulation to report to the FDA how much drug they sold into the commercial market each year. Is this data public? If so, that's a way to check. (I am well outside my area of expertise here – I have no idea where even to start looking.)
I came in truly expecting Betteridge’s Law to apply. I had to run the numbers myself to see that nope, it does not. The answer is genuinely unclear. :-/
I’d feel better if Dr Beth Mole looked into this.
The US population is about 345 million.
The obesity rate reported in this article is 40.3 percent, down from 41.9%. A shift of 1.6 points.
1.6% of 345 million is 5.5 million.
The severe obesity rate reported in this article is 9.7%, up from 7.7%, a shift of 2 points.
2% of 345 million is 6.9 million.
So:
- 5.9 million patients were treated specifically for obesity, of 15.5M patients
- Of the total US population, 5.5 million are no longer obese
- Of the total US population, 6.9 million are more obese
So: Did all 5.5 million who lost weight take the drug? If so, that's a grand slam. The epidemiologist quoted said 15.5 million is an “optimistic upper bound,” so they sound unconvinced that as many patients were taking it as the article's source claims.
Drug companies are required by FDA regulation to report to the FDA how much drug they sold into the commercial market each year. Is this data public? If so, that's a way to check. (I am well outside my area of expertise here – I have no idea where even to start looking.)
I came in truly expecting Betteridge’s Law to apply. I had to run the numbers myself to see that nope, it does not. The answer is genuinely unclear. :-/
I’d feel better if Dr Beth Mole looked into this.
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It could be the error bars, or it could be slightly less effective in the general population. The effect size in the general population is USUALLY lower than in a study group - study groups have all kinds of exclusion criteria including (as you say) that you probably wouldn't include somebody who's actually thin but 'feels fat' and can convince a doctor to prescribe it.
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This could have been the whole article:
"In addition, the recent dip in the overall obesity rate was not statistically significant. In other words, the numbers are “small enough that there’s mathematical chance they didn’t truly decline,” according the same article from the Associated Press."
Or, better yet, a good reason not to write an article at all, since there is literally nothing to see here.
"In addition, the recent dip in the overall obesity rate was not statistically significant. In other words, the numbers are “small enough that there’s mathematical chance they didn’t truly decline,” according the same article from the Associated Press."
Or, better yet, a good reason not to write an article at all, since there is literally nothing to see here.
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I don't know if GLP-1 is right for you but if you're worried about your health you should absolutely talk to your doctor sooner rather than later. There is no downside to a conversation about your concerns.
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This illustrates a separate but very related problem of mental health support in the USA. Too often it is not covered / under-covered by health insurance. I remember when my son was diagnosed on the Autism spectrum having to jump through hoops with his therapist because our insurance wouldn't cover Autism therapy, but would cover anxiety support. Certainly support for people (including myself) who self-mediate through eating would improve overall health outcomes.
Not suggesting that there is a once size fits all solution. I would see mental health assistance, GLP-1 blockers, and improved exercise/diet as complementary paths to health -- one that would need to be very personally tailored to an individual's situation.
(There is also a high correlation between the "you can't lose weight 'cause y'all suck at self control" and "only wimps need to talk to therapist" crowds).
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What all this seems to tell me is that we know very little about obesity, its causes, or its treatment.
It also tells me that while a lot of American diet is shit, human behavior is not entirely to blame in this weight question.
It also tells me that while a lot of American diet is shit, human behavior is not entirely to blame in this weight question.
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Writing about null results is still important, since it's important to know what doesn't work so that people don't keep wasting effort on them. This article, though, is a little too casual about explaining the results for this audience.
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As an anecdotal sample set, approximately half of the people that I know that have started Mounjaro or Wegovy have quit. In all cases they stated that they missed the aspect of their life that included dining. They didn't quit because it was unaffordable. Their insurance (like mine) was covering it with a $0 co-pay.
Admittedly, my dining habits with respect to enjoyment of food have changed over the last year and a half that I have taken Wegovy (and lost > 100 lbs), but the overall metabolic benefit has been tremendous.
For decades I have eaten reasonably well, with moderate exercise. The only time I have truly lost weight was when I was heavily involved in athletics and exercising > 6 hours per day. That ended with grad school and full time jobs.
There certainly are side effects, and it hasn't been easy, but tolerating the side effects and having a normalish metabolism has made it worth it.
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The cheapest I could find without it being a literal back alley deal was about $300/month. Not sure how overweight you have to get insurance to cover it, but I'm at the high end of Overweight and they said "naw."
A friend of mine has lost 25 LB, ~12%, while taking it for a few months so I am tempted. But I have yet to see if there is a bounceback for him once he stops now that he is at his target weight.
A friend of mine has lost 25 LB, ~12%, while taking it for a few months so I am tempted. But I have yet to see if there is a bounceback for him once he stops now that he is at his target weight.
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With Blue Cross / Blue Shield you have to pursue it a bit and have the support of your doctor, but they have been good on covering my wife's, mine, and other people I know. At least one of the covered people I know is Tricare (retired military).
I don't think I'd call the extents I had to go to a fight, but it did require a little pursuit between calls to Express Scripts and BCBS. My 1 year renewal wasn't without issue, but it was handled by the doctor's office with a little back and forth on their part.
I think part of it is the doctor knowing how to word things.
In my situation they provide a 3-month supply at a time with $0 co-pay via Walgreens.
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Absolutely fair point. I should have been more general. People have many reasons to discontinue use.
I think we both agree, though, that this has nothing to do with the drug's effectiveness at lowering weight.
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I wonder if part of it is just people eating less fast food. Prices for fast food are up so much that one of the main appeals to it (that it used to be cheap), is no longer true. Now it's fast and expensive while still being low quality. I haven't had fast food in decades now and just that 1 change caused me to lose about 40 pounds.
Back when I was in college, I could get 5 burgers from a fast food joint for about $5. It was fast, and it was cheaper than making my own food. So that was my most common lunch option. Now fast food costs about the same as a superior casual restaurant. It's slower but the food is a lot better, and if I want something cheaper I just have to make it at home.
I've made other changes that allowed me to lose even more but cutting out the fast food was something that didn't require any sacrifice. I could still eat whatever I wanted and didn't have to pay anything more than what I did before, but I generally ate healthier because non fast food restaurants just have generally healthier food and the food I make at home is also healthier.
Back when I was in college, I could get 5 burgers from a fast food joint for about $5. It was fast, and it was cheaper than making my own food. So that was my most common lunch option. Now fast food costs about the same as a superior casual restaurant. It's slower but the food is a lot better, and if I want something cheaper I just have to make it at home.
I've made other changes that allowed me to lose even more but cutting out the fast food was something that didn't require any sacrifice. I could still eat whatever I wanted and didn't have to pay anything more than what I did before, but I generally ate healthier because non fast food restaurants just have generally healthier food and the food I make at home is also healthier.
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I find it fascinating that statistically representative decrease in obesity rates is first associated with big pharma and we have to wait a few paragraphs to think maybe about progress on healthier lifestyle.
Fascinating and maybe also a tad cynical?
Fascinating and maybe also a tad cynical?
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Problem is the data is backwards looking (2021-2023) where supply constraints of GLP-1 drugs didn't ease until after then (sales essentially doubled in 2024 since people could get the drugs). Then it takes 6-12 months to see benefits once taking the drugs, so probably most of those several million people wouldn't show up in this survey anyway. We'd have to wait for the next one to see an impact.
May just be statistical noise (they're not statistically significant) and the data is too early to catch most of the effect from new drugs. But with that grain of salt, lifestyles have not become markedly more healthy in the last few years (quite possibly the opposite given the pandemic), so no reason to think the steadily climb in obesity would suddenly reverse direction.
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Fuzzypiggy
Ars Scholae Palatinae
People can't afford rent let alone "3 squares" a day, also maybe we now have generations coming up that do take their health more seriously than we older folks ever did.
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I used to eat a lot of fast food. Like 2 to 3 times a week. Covid slowed it down, mainly because I was working at home but because of prices increasing and quality decreasing I've gone from a 2 to 3 times a week guy to a 3 to 4 times a year guy. I honestly can't say I miss it though. Whenever I eat it now I always regret it and ask myself why I did it for so long.
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Fair, but at the very least, the headline shouldn't start with "Obesity rates are down."...when the date doesn't support that conclusion.
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I hope not, that would mean it'd be a widespread adoption of the drug. It'd be treating the symptoms of obesity and not the root cause.
These drugs aren't supposed to be used as a magical "you can continue to eat what you want and the food industry can continue to put sugar in everything" antidote. They're for people looking to correct with proper dieting and/or have specific conditions.
These drugs aren't supposed to be used as a magical "you can continue to eat what you want and the food industry can continue to put sugar in everything" antidote. They're for people looking to correct with proper dieting and/or have specific conditions.
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Feels more like we're hitting a ceiling in health-related damage done, at least in the US. The amount of people with new GI issues seems to be skyrocketing. When your body becomes intolerant to foods, weight-loss is the result. Intended or otherwise.
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Came here to say basically the same thing. The cost of fast food is approaching (or depending on what you eat, exceeding) that of sit down restaurants. The only difference for some between fast food and sit down is the extra cost of a tip plus the food (depending on where you would have eaten) is more likely to be fresh and not frozen/microwaved.
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icebergFromLaputa
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Why so many downvotes? If I said something utterly stupid , then I would appreciate if someone englightened me about my errorMaybe because coronavirus is more likely to kill obese people and a lot of Americans died from the virus
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Both the US and Canada have similar obesity rates and Canada doesn't subsidise corn production; e.g. in things like coke, etc, you'll usually see glucose-fructose and/or real sugar rather than the US-style high fructose corn syrup.
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ColdWetDog
Ars Legatus Legionis
Because we've been harping on 'healthier lifestyle' for decades. If it actually worked, we would not be having this conversation. As a society in general and medicine in particular, we're figuring out that obesity isn't 'just' a healthy lifestyle. Further, the conversation is ingrained at this point. Even the patient info for GLP-1 agonists starts with admonitions to not use the next US president as a lifestyle mentor.
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This is a classical case of speculation around, and over interpretation of, a weak signal. If GLP-1 drugs are going to have a profound effect on overall obesity rates, we need them to be available to, and used appropriately by, a large percentage of the obese population. If we have say 15% penetrance, and only half of those have used the drug in a meaningful way, one can take the average weight loss, and divide it by 13-14, to bet about 1% global effect for a 14% loss of weight. AS the numbers are somewhat variable to begin with, and lots of things may be altering on the periphery, a 1% global effect is probably meaningless, and from that data one would conclude there is no evidence of an effect. If you extracted from the same data set all of the people who had taken the drug as prescribed for a year, and their average weight loss was 10%, one would conclude that the drug was highly active. Do stupid analyses, get stupid results.
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