BLOG

Obesity has long been one of the most pervasive health challenges in the United States, with rates steadily climbing for decades. In a recent post, I wrote about some troubling report published in the medical journal, The Lancet.

“As of 2021, 15.1 million children (5–14 years), 21.4 million adolescents (15–24 years), and 172 million adults in the U.S. are overweight or obese. This amounts to a 75% rate of overweight and obesity in the adult US population.” The authors stated, “Forecasts suggest these numbers will further rise, with obesity affecting one-third of adolescents and two-thirds of adults by 2050.”

Were these pessimistic projections wrong?

The Decline of Obesity in the United States: A Turning Point?

Recent data published in the United States, the prevalence of obesity in adults remains above the Healthy People 2030 goal of 36.0%, but from 2013–2014 through August 2021–August 2023, the age-adjusted prevalence of obesity in adults plateaued and did not increase significantly according to a report from the US Center for Disease Control. The key findings of the report indicate that during August 2021–August 2023, the prevalence of obesity in adults in the United States was 40.3%. While the prevalence of severe obesity has increased from 7.7% in 2013–2014 to 9.7% in 2021–2023, the adult obesity has not changed significantly over the past decade.

Do these findings suggest a significant and unexpected shift marking a potential turning point in the country’s battle against one of its most persistent public health crises? What is driving this trend? And what does it mean for the future of health in America?

A Longstanding Epidemic

For years, the United States has been an outlier among developed nations when it comes to obesity. When it comes to life expectancy rates, a measure closely associated with obesity, the U.S. ranked a shocking 49th in the world in 2022. With rates nearly 50% higher than those in Europe, obesity has been a leading contributor to the chronic noncontagious disease epidemic including diseases such as diabetes, heart disease, brain disorders and certain cancers. These conditions not only reduce life expectancy but also strain healthcare systems and economic productivity. Efforts to curb obesity have included public health campaigns, changes in nutritional guidelines, and increased awareness of the importance of physical activity—but the results have mostly fallen short.

The Role of GLP-1 Drugs

One of the most widely discussed contributors to the stabilization of the obesity rates is the increasing use of GLP-1 receptor agonists, a class of drugs originally developed to treat diabetes but now widely prescribed for weight loss. Medications like Ozempic and Mounjaro have gained popularity for their ability to suppress appetite and promote significant weight reduction. According to a survey conducted by the health nonprofit KFF, approximately one in 16 Americans is currently using a GLP-1 drug, while one in eight has tried them.

It is currently assumed that these medications work by mimicking the hormone glucagon-like peptide-1, which regulates hunger and glucose levels, while additional mechanisms are being explored. Clinical trials have shown that they can lead to weight losses of up to 15% or more of total body weight. With their growing accessibility and acceptance, it seems inevitable that GLP-1 drugs will continue to play a significant role in reducing obesity rates. There will be considerable public pressure to cover GLP-1 costs by Medicare and health insurance programs on the one side, and political pressure from the incoming administration to emphasize food and lifestyle changes over expensive medications.

The Obesity Plateau Hypothesis

Another theory posits that the stabilization of obesity rates may signal the beginning of a natural plateau. A 2023 study by Greek researchers suggested that obesity rates in developed nations might stabilize as they reach a biological or societal saturation point. This concept implies that there may be a natural limit to the proportion of a population that can become obese, influenced by genetics, environmental factors, and social norms. Supporting this idea is evidence that childhood obesity rates have stabilized in many economically advanced countries since 2000.

Lifestyle and Behavioral Shifts

While pharmaceutical interventions are a critical factor, lifestyle and behavioral changes are likely to play a crucial role. The COVID-19 pandemic disrupted routines but also sparked renewed attention to personal health. For some, the lockdown periods provided an opportunity to focus on cooking at home, engaging in outdoor activities, and reevaluating dietary habits. Additionally, public health campaigns emphasizing the importance of managing weight to reduce the severity of COVID-19 outcomes may have had a lasting impact.
Economic and Policy Influences

Economic and policy changes may have indirectly influenced obesity trends. The expansion of telehealth services has made it easier for individuals to access medical advice and weight-loss support. Meanwhile, some local governments have implemented measures such as soda taxes, restrictions on junk food marketing to children, and incentives for healthier school meals. While the direct impact of these limited measures on the national obesity rate is difficult to quantify, they contribute to a broader cultural shift toward healthier living. However, major political changes will be required to cut back the massive lobbying efforts by the agricultural and food production companies which is one of the root causes of the obesogenic US diet.

Challenges and Criticisms

Despite the promising data, some experts urge caution in interpreting the results. Obesity rates have temporarily declined in the past, only to rebound in subsequent years. Moreover, the reliance on GLP-1 drugs raises questions about equity, long-term sustainability and long term negative side effects. These medications are expensive, and access remains limited for uninsured or underinsured populations. Critics also worry about the potential for over-reliance on pharmaceutical solutions at the expense of addressing systemic issues like industrial food production and processing, food deserts, income inequality, and sedentary lifestyles.

The Way Forward

If the recent stabilization in obesity rates is confirmed and is to be sustained and translated into a significant decline towards levels in other industrialized countries, a multi-faceted approach will be essential. Policymakers must address the underlying drivers of obesity, in particular food production and processing, poor access to nutritious foods in disadvantaged neighborhoods, limited opportunities for physical activity, and socioeconomic disparities. Expanding insurance coverage for GLP-1 drugs and other weight-loss therapies is essential to make these tools more accessible to underserved communities.

Bipartisan public health campaigns should also emphasize prevention, encouraging healthy behaviors from an early age. Schools can play a pivotal role by incorporating nutrition education and physical activity into their curricula. Simultaneously, community-based initiatives, such as farmers’ markets and urban gardening programs, can help make healthy choices more accessible and affordable.

Turning Point or a Temporary Dip?

Whether the recent stabilization of obesity rates represents a turning point or a temporary dip remains to be seen. What is clear, however, is that the United States has a unique opportunity to build on this progress. By combining pharmaceutical advancements with major systemic changes in food systems, healthcare access, and lifestyle norms, the nation can take meaningful steps toward the goal of Make American Healthy Again.

In the words of one public health official, “We may have passed peak obesity.” If this is true, the challenge now is to ensure that this peak becomes a sustained decline rather than a new summit. The recent findings are a promising sign, but it is just the beginning of a much larger journey toward better health for all Americans.