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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
The year 1963 was surely one of the most significant of the 20th century. President John F Kennedy was assassinated, Martin Luther King delivered his “I have a dream” speech, and the Beatles recorded and released their debut album. But for all the huge political and cultural events, it was arguably an even more momentous year for public health: 1963 was the year cigarette sales peaked and began to fall in the US.
A generation from now, we may look back on 2020 in a similar way. Yes, there was the small matter of a global pandemic, but this may also have been the year obesity levels ceased their inexorable rise and began to descend.
Around the world, obesity rates have been stubbornly climbing for decades, if anything accelerating in recent years. But now newly released data finds that the US adult obesity rate fell by around two percentage points between 2020 and 2023.
We have known for several years from clinical trials that Ozempic, Wegovy and the new generation of diabetes and weight loss drugs produce large and sustained reductions in body weight. Now with mass public usage taking off — one in eight US adults have used the drugs, with 6 per cent current users — the results may be showing up at the population level.
While we can’t be certain that the new generation of drugs are behind this reversal, it is highly likely. For one, the decline is steepest among college graduates, the group most likely to be using them.
Crucially, the US National Health and Nutrition Examination Survey, which reported the unprecedented decline in obesity levels, uses weight and height measurements taken by medical examiners, not self-reported values. This makes it far more reliable than other surveys. American waistlines really do seem to be shrinking.
What makes this all the more remarkable is the contrast in mechanisms behind the respective declines in smoking and obesity. The former was eventually achieved through decades of campaigning, public health warnings, tax incentives and bans. With obesity, a single pharmaceutical innovation has done what those same methods have repeatedly failed to do.
If you take a step back, this is an astonishing achievement. Weight gain has proved far harder to combat than almost any other public health issue in history. Obesity has been such a formidable foe because everything is stacked against those trying to lose weight.
We’re surrounded by tantalising tastes, our bodies try hard to maintain our current weight even when we manage to cut back, and maintaining a large enough calorie deficit over the sort of timescale required to shift serious weight is incredibly hard.
But almost by magic, these new drugs remove the requirement for superhuman willpower, making us feel fuller, reducing our appetite and alleviating cravings.
More likely than not, this will prove another case of “where the US leads, others will follow”. In Denmark, home of Ozempic and Wegovy creator Novo Nordisk, 3 per cent of adults were using the new drugs by the end of 2023. The decades-long climb in the obesity rate slowed to a crawl that same year, and declined among several age groups.
The US leading the descent is a beautiful twist. Its unparalleled consumer culture sent its obesity rate rising faster and further than almost anywhere else. When the solution was regulation or moderation, America was at a disadvantage. But when procuring and distributing large quantities of pharmaceuticals is the name of the game, the US is unrivalled. These drugs are more widely available there than anywhere else.
In America and beyond, the dividends will be enormous. After smoking rates began falling, rates of lung cancer promptly peaked and then dropped precipitously, saving millions of lives. If obesity curves do now descend, rates of cardiometabolic disease and death should follow. More promising still, a growing number of trials find the addiction-suppressing mechanism of the same drugs can also reduce rates of alcohol misuse and even avert opioid overdoses.
There has been a tendency in some quarters to view taking drugs to lose weight as cheating, not virtuous, not the way it’s meant to be done. But here’s the thing: it works. And I suspect that when we look back at charts of obesity rates in generations to come, there will be inflection points in the 2020s to prove it.
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