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Helena
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Have we passed peak obesity? New data sparks speculation
Obesity has been back in the news over the past couple of days – and it’s good news, for a change!
The Financial Times was the first to pick up on new data from the Centers for Disease Control and Prevention showing that the obesity rate for U.S. adults declined two percentage points between 2020 and 2023. The headline from across the pond was upbeat: “We may have passed peak obesity.” Soon, a couple of other news outlets followed, including Axios: “Americans are getting healthier by some key metrics.” The Washington Post editorial board jumped into the fray this week as well: “The obesity rate might have stopped growing. Here’s what could be working.”
All of these outlets were quick to note that there would be massive benefits if this trend is real and continues. Obesity and other diet-related diseases are extremely costly, ranging from the direct costs to the health care system to quality of life for millions of Americans.
“In America and beyond, the dividends will be enormous,” wrote John Burn-Murdoch, a columnist and the chief data reporter for the Financial Times. “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.”
What’s driving the decline? The CDC report doesn’t look at what might be driving this, but Burn-Murdoch and others have speculated in recent days that the adoption of GLP-1 drugs like Ozempic, Wegovy and Zepbound might help explain the decline. It’s too soon to know, but it certainly seems possible. These drugs have been adopted much more broadly than many folks realize. As WaPo’s ed board noted this week: “KFF, a nongovernmental organization that tracks health trends, reported in May that 12 percent of respondents to its annual survey said they have taken one of the drugs at some point in their lives; 6 percent are currently doing so.” The FDA first started approving these GLP-1 drugs for weight loss in the summer of 2021. Ozempic has been approved for diabetes since 2017. It really has not been very long.
Other experts cast doubt on GLP-1s being the big factor here. Deirdre Tobias, an obesity and nutritional epidemiologist at the Brigham and Women’s Hospital and Harvard Medical School, cautioned against leaping to such conclusions.
While it’s true that the overall rate went down between 2020 and 2023, Tobias noted that this is far from the first time CDC data has shown declines or flat trends in recent decades – each time giving epidemiologists false hope that maybe the tide had finally turned. “It never lasted,” she noted. She also thinks it’s unlikely the surge in weight loss drugs explains the dip. (Definitely go read her chart-filled thread if you want to wonk out on this.)
Patience, patience: Voice of America quoted Samuel Emmerich, the CDC official who led the latest study, acknowledging that we don’t yet know what’s going on here vis a vis the GLP-1 boom. “We simply can’t see down to that detailed level to prescription medication use and compare that to changes in obesity prevalence,” Emmerich said. He added, “Hopefully that is something we can see in the future.”
It seems wise to take this fresh batch of data with a grain of salt. It’s good news, but too soon to know just how good.
Setting the numbers aside, however, something else struck me about the coverage of all this. I noticed in a few places there were references to public health campaigns and policies in the U.S.
From the Financial Times: “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.”
WaPo’s ed board writes: “public health campaigns might have had their intended effects: increased awareness, promoting healthier food choices and more opportunities for physical activity.”
Reality check: I think there are some misconceptions about what the U.S. has and hasn’t done to try to tackle our obesity crisis. There’s broad recognition that obesity is a major problem, so I understand why one might assume Washington has tried everything. But we actually haven’t had major public health campaigns, nor have we had warnings, tax incentives (nor disincentives, save for a couple cities with soda taxes), and certainly, we haven’t seen any bans. (Tbh, it feels very European to even think this is in the realm of possibilities.)
We didn’t have a national strategy aimed at diet-related diseases until President Joe Biden held a White House conference on hunger, nutrition and health in 2022 – the first such gathering since the Nixon administration. Back during the Obama administration, first lady Michelle Obama launched a strategy for tackling childhood obesity, which was a big deal at the time. That campaign did not reduce childhood obesity, but it did result in a meaningful improvement to the health profile of school meals and WIC (the Supplemental Nutrition Program for Women, Infants, and Children). Obama no doubt also raised a lot of cultural awareness, but this is harder to measure.
Washington tends not to put any real firepower behind public health messaging aimed at addressing diet-related diseases. The Obama administration scrapped the food pyramid and replaced it with MyPlate, a much simpler nutrition message, but USDA has spent very little promoting this. Most Americans have never heard of it. Under Obama, FDA also revamped the Nutrition Facts label to mandate added sugars labeling, which some in the food industry fiercely opposed, but there wasn’t a massive corresponding PR campaign. (The agency actually did have some ads, but I’ve never seen one in the wild.) The U.S. updates the Dietary Guidelines every five years, but spends little promoting these messages (especially compared to industry marketing) and most people don’t heed the advice. There’s a relatively small budget at CDC dedicated to obesity prevention.
Trying to tackle diet-related diseases has simply not been a priority in Washington – a reality that was laid especially bare during the first years of the pandemic (something I wrote about for Politico). The fact that Americans are living shorter, sicker lives has not been a pressing political priority. If we have passed peak obesity (TBD), we’re likely not going to be able to credit public health campaigns.
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What I’m reading
US consumer prices rise on food; Hurricane Helene muddies labor market picture (Reuters). “U.S. consumer prices rose slightly more than expected in September amid higher food costs, but the annual increase in inflation was the smallest in more than 3-1/2 years,” writes Lucia Mutikani. “Food prices jumped 0.4% after rising 0.1% in August. Grocery store food prices increased 0.4%, lifted by higher costs for meat, poultry, fish and eggs. Fruits and vegetable prices rebounded 0.9% after dropping 0.2% in August.”
Georgia’s farmers suffer devastating crop losses after Hurricane Helene (FOX 5 Atlanta). “Georgia’s farmers are still assessing the extensive damage left behind by Hurricane Helene. The severe flooding and high winds destroyed large portions of Georgia’s cotton, peanut, and pecan crops, causing significant losses across the state,” reports Rob DiRienzo. “According to the Georgia Department of Agriculture, one-third of the state’s cotton crop is considered a total loss. Nearly 30% of the peanut crop has been destroyed, and 50,000 pecan orchards have suffered serious damage. Additionally, over 200 chicken houses were affected, and roughly four million acres of timberland have been impacted.”
Hurricane Milton disrupts phosphate industry at ‘critical time’ (FarmWeek Now). “The widespread impact of Hurricane Milton across Florida will reverberate throughout the Corn Belt this fall,” reports Daniel Grant. “Phosphate mines and other associated infrastructure in the path of the storm were shut down prior to the storm’s arrival. And, it’s unclear when operations will resume. Farmers typically apply various phosphates in the fall after harvest or in the spring. And, while there is supply on hand in many areas, just-in-time deliveries will be disrupted moving forward.”
In 2024, bird flu posed big risks — and to far more than birds (Science News Explores). “News reports of bird flu striking huge flocks of birds — including farmed poultry — have been ongoing for more than two years,” write Tina Hesman Saey, Erin Garcia de Jesús and Janet Raloff. “Since the current outbreak emerged in Europe three years ago, bird flu has shown up in at least 50 mammal species around the globe. That’s far more than the dozen or so kinds of mammals that bird flu is known to have sickened during previous outbreaks.”
For contract farmers, the election could change everything—or nothing at all (Civil Eats). “Over the past three decades, under both Democrat and Republican administrations, concentration across the meat industry has accelerated,” writes Lisa Held. “Now, as the election approaches, many experts and farmers say the outcome could determine whether the farm economy continues toward consolidation and monopoly, or whether—if the next administration enacts policies to restore a more competitive marketplace—it shifts power away from corporations and toward farmers.”
‘Should I be worried about my cat?’ Answering your questions about bird flu (The Washington Post). “Many readers had questions about the Missouri patient who tested positive for the illness without any known interactions with livestock as well as the state of bird flu in general. I address them here,” writes Leana S. Wen. “Earlier this year, the Centers for Disease Control and Prevention reported cases of domestic cats drinking raw milk from infected cows and contracting H5N1. People working on farms should heed the CDC’s guidance to prevent H5N1 from spreading to themselves and domestic animals. They should also refrain from drinking raw milk and from giving raw milk or raw meat to pets.”
Welcome to Consumed! (Substack). Veteran journalists Jane Black and Liz Dunn this week launched a new newsletter focused on helping eaters make more informed choices about the food they buy. “It is, frankly, a very chaotic time to be an eater in the United States!” they write. “Using in-depth research, data, and decades of journalistic experience, we strip away the noise to help you make confident, informed decisions about what and how you eat. We also share broader insights and analysis when it comes to what’s happening in the food industry, from whether you should be freaking out about bird flu to why a green salad at your favorite date night spot suddenly costs $22.”
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