In late October 1999, leaders at the CDC published an article in JAMA warning that obesity had become a national crisis.
The CDC Director at the time, Jeffrey Koplan, wrote this in a press release:
“Overweight and physical inactivity account for more than 300,000 premature deaths each year in the U.S., second only to tobacco-related deaths. Obesity is an epidemic and should be taken as seriously as any infectious disease epidemic.”
Back then, about 30% of U.S. adults had obesity and about 14% of children and adolescents had obesity.
More than 25 years later, obesity remains one of the most challenging public health issues of our time.
@dr..eeks In this version of public health is weird… By the late 1990s, leaders at the CDC were warning that obesity had become an epidemic. At the time: • About 30% of U.S. adults had obesity • About 14% of children and teens had obesity Today, those numbers are even higher. Which raises an important question: If we've been talking about this for decades, why does it keep getting worse? 🧐🧐 And why have the solutions we’ve tried over the years failed to make a dent? 🧐 It’s kinda weird… But I suspect it's because the problem is tangled up with modern life itself…and it’s not like we can just get up & “quit”modern life. It’s the food we eat. How we move. How we sleep. Our devices. How we work. How stressed we are. The connections (and disconnections) we feel. GLP-1 meds may help some people. But it’s also true that a high percentage of people stop taking them & the weight comes back on…and large public health problems rarely disappear because of a single intervention. Especially when the problem is woven into the fabric of everyday, modern life. Which is why this issue deserves science, compassion, and far more CREATIVITY. No matter the level of nostalgia, we're not going back to hunting and gathering.🦕🦖 (At least the majority isn’t.) But we may need a lot more imagination when it comes to helping humans thrive in this modern world we've gone ahead & built ourselves. As always, happy to hear your thoughts. 😊 #obesity #obesityepidemic #health #publichealth ♬ original sound – Dr. EeKS
This raises an interesting question:
If we’ve been talking about this for decades as an “epidemic level” problem…, why has it gotten so much worse?
And why have so many of the solutions we’ve tried struggled to make a meaningful dent from a prevention standpoint?
I mean, that’s kinda weird. (Public health is weird…?)
But I suspect it’s because obesity is tangled up with modern life itself, and we can’t just up and quit the modern world, as tempting as that is sometimes.
It’s definitely the food we eat.
One of my more popular podcast episodes, and one that should probably make you mad, is with Dr. Tera Fazzino, whose research explores how, from 1988 through 2000, major tobacco companies owned leading food giants like Kraft, Nabisco, and General Foods, helping create and market hyper palatable foods designed to keep us coming back for more.
And of course, it’s also how we move, sleep, work, and commute.
It’s how we interact with technology.
How we manage stress.
And the connections, and disconnections, we experience.
I don’t think the situation is hopeless.
In fact, a recent Gallup analysis suggested that adult obesity rates may finally be declining. Maybe.
Many people speculate that GLP-1 medications are driving that trend. Others say it’s changes in food policy, nutrition awareness, or broader shifts in health behavior.
Personally, I think it’s a silly debate.
From both a treatment and prevention standpoint, we’re probably going to need multiple approaches if we’re serious about getting ahead of obesity. That is, if we’re serious about stopping it before it starts.
But it’s also worth noting that Gallup’s estimates are based on self reported height and weight, whereas CDC estimates rely on measured data and have been more cautious. Last I checked, CDC data suggested adult obesity rates may be stabilizing rather than clearly declining.
And to my knowledge, no one is reporting a meaningful decline in childhood obesity.
Personally, that’s where I think we need to focus much of our attention, because once obesity develops in childhood, it can become much more difficult to get ahead of later in life.
And that brings me to another public health question:
If obesity prevalence declines, that’s great news.
But what about obesity incidence?
Think of obesity like water in a bathtub.
Prevalence tells us how much water is currently in the tub.
Incidence tells us how much new water is flowing in.
If obesity prevalence declines, it could mean fewer people are developing obesity.
It could also mean we’re getting better at treating people who already have obesity. (The GLP-1 Effect.)
Both outcomes matter.
But they’re not the same thing.
The bathtub draining is good news.
But from a prevention standpoint, I’m also curious whether we’ve slowed the faucet.
Because those may be two very different public health stories.
GLP-1 medications may prove to be one of the most important obesity treatments we’ve ever developed. But they are not without limitations.
A substantial percentage of people eventually stop taking them, and when they do, weight regain is very common.
Researchers are also paying close attention to another issue: GLP-1 medications can lead to the loss of lean body mass alongside fat loss. Since maintaining muscle is important for overall health, mobility, and healthy aging, many scientists are looking for ways to preserve muscle while still achieving meaningful weight loss.
In fact, some researchers are already working on potential solutions. Dr. Richard Pratley recently studied whether adding an antibody to Zepbound treatment could help patients maintain more of their lean muscle mass during weight loss.
Of course, that would mean adding yet another medication to the medication designed to help manage the condition that developed in the modern world we’re trying to navigate in the first place. Just sayin.
(And yes, he came on Causes or Cures to discuss. I really encourage you to listen to the episode here, because it is excellent on why lean mass matters…and he even discusses how muscle differs from lean mass, something a lot of people miss.)
Point being…large public health problems rarely disappear because of a single intervention.
Especially an intervention that has not yet fundamentally changed the childhood obesity picture.
And especially when the problem is woven into the fabric of everyday life.
Which is why I think this issue deserves science, compassion, and a lot more creativity.
No matter the level of nostalgia, most of us aren’t going back to hunting and gathering.
But we may need a lot more imagination when it comes to helping humans thrive in the modern world we’ve gone ahead and built for ourselves.
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