In the February 4, 1735 issue of the Pennsylvania Gazette, Benjamin Franklin wrote that “an ounce of prevention is worth a pound of cure.” Though he wasn’t referencing health, the adage has frequently been applied to disease prevention.
The advent of effective therapeutics for weight loss is heralded as momentous, particularly in light of the fact that more than 40% of the U.S. population is considered overweight or obese. More widespread use of these drugs could have a positive impact on population health and the economy. But policies aimed at obesity prevention may yield a more sustainable path towards improvement in health and economic growth.
The more Americans take semaglutide- and tirzepatide-based drugs such as Ozempic, Wegovy and Zepbound, the more likely the economy is to grow, according to Goldman Sachs. The investment bank estimates that there could be as many as 70 million users of weight loss drugs by 2028. And based on Goldman Sachs calculations, even if the actual figure winds up being closer to 35 million, this could boost productivity sufficiently to increase gross domestic product by 0.4%.
There are more than 100 million adults in the U.S. living with conditions approved to be treated with glucagon-like peptide 1 or GLP-1 drugs. These include diabetes and obesity. So perhaps it’s not far-fetched to imagine that within four years 35 million people may be on these and other weight loss therapeutics.
As the Harvard T.H. Chan School of Public Health reminds us, obesity increases the risk of developing conditions such as diabetes, heart disease, osteoarthritis and some cancers, to name just a few. In turn, these diseases reduce the life spans of those affected by them. Furthermore, obesity-related conditions cost several hundred billion dollars to treat every year, which include both direct medical expenditures and indirect costs associated with diminished work productivity (more absenteeism and disability among the obese) and higher health insurance premiums. According to a 2021 peer-reviewed article, the aggregate direct costs of obesity in the U.S. are $260 billion annually. Goldman Sachs suggests there is a potential reduction in healthcare spending as a result of uptake of weight loss drugs that could be as high as $300 billion.
The financial burden coupled with the toll that excess weight takes on health and well-being imply that more needs to be done to stem the “rising tide of obesity.”
Undoubtedly, GLP-1 drugs represent a breakthrough. They help patients stabilize blood sugar levels and reduce weight. In turn, this has proven benefits that extend beyond shedding pounds. For example, SELECT trial data show that for people with high body mass indices and at severe risk for cardiovascular disease taking semaglutide can lead to a reduction in the risk of having a cardiovascular event such as a stroke or myocardial infarction.
But several caveats are worth making which may rein in some of the unbridled enthusiasm for the GLP-1’s. First, currently the evidence supportive of positive indirect effects, such as cardiovascular risk reduction, is confined to a select group of patients with severe preexisting cardiovascular risks in addition to high BMI. This data can’t (yet) be extrapolated to the general obese population. Second, we can’t ignore the safety signals that have been cited in connection with the use of GLP-1’s, including severe stomach disorders, hair and muscle mass loss. Third, real-world studies suggest that up to 72% of folks stop taking the meds, even when fully insured, within one year. In turn, this leads to weight rebound.
What’s also worth mentioning is that these injections are not a panacea. They’re not a magic bullet that when taken on their own will lead to the desired results. The label for Wegovy, for example, explicitly states it should be used in conjunction with increasing physical activity and being on a significantly reduced-calorie meal plan.
What About Obesity Prevention?
There is a different way of framing the obesity problem. And it’s one which emphasizes prevention, as an Organization for Economic Cooperation and Development analysis lays out.
The OECD report describes the negative impact obesity has on “societies and the economy,” mainly through the causal link to chronic diseases, such as diabetes, cardiovascular conditions and cancer. It estimates that obesity reduces life expectancy in OECD countries by 2.7 years on average. Additionally, the report stipulates that 8.4% of the healthcare budget of OECD countries will be spent to treat the consequences of obesity over the next three decades. And like the Goldman Sachs analysis, the OECD points to diminished productivity as yet another fall-out from an overweight population.
But the OECD draws policy implications in the realm of “public health actions to promote healthier lifestyles.” Analysts argue that such initiatives are “excellent investments for countries.”
In fact, over the next three decades several million cases of newly diagnosed non-communicable chronic diseases could be avoided across 36 OECD countries by implementing a broad range of public health interventions, including a comprehensive “communication package” that provides information to the public from a young age on the importance of diet and exercise, an increase in the availability of healthy nourishment choices as well as an expansion of physical activity options and a modification in prices and availability of unhealthy food and drink through taxation and regulation. For each dollar invested in preventing a person from becoming overweight, up to $5.60 will be returned in economic benefits, according to OECD modeling.
What appears to be missing in some of the current discussions in the media and elsewhere on obesity is prevention. As a British Medical Journal article from 2006 explains in great detail, despite some individuals being genetically predisposed to unhealthy weight gain, the majority of folks can “modify the vectors of obesity” by incorporating healthier eating habits and more daily physical activity.
Fast forward to 2024, this doesn’t mean that GLP-1 products have no value. Some would still need these drugs, even with changes in diet and exercise. But for many individuals such changes can prevent obesity-related problems from happening.
As STAT News reported, the World Health Organization views weight loss drugs as an important tool, but not as a solution to the problem of worldwide obesity. Rather, the solution lies in “transforming food systems and the environment, such that obesity can be prevented.”
GLP-1 drugs have a role to play as treatments for certain people with diabetes, obesity and perhaps other diseases as well. But more resources could be spent on prevention to avoid having to treat obesity and diabetes in the first place.
