Currently browsing posts about: Obesity

A reader, Maria Birman, alerted me to this new report in Lancet Diabetes & Endocrinology from the 56-member Commission on the Definition and Diagnosis of Clinical Obesity.  The commission recommended shifting the definition and diagnostic criteria for obesity away from the BMI and instead defining obesity in two categories based on health status.

• Clinical obesity: signs and symptoms of organ or other dysfunctions; a disease requiring effective health care treatment
• Pre-clinical obesity: high levels of body fat but no signs of dysfunction but higher risk for chronic disease, requiring support for risk reduction.

Maria writes:

I’m astonished by the full two-page “declaration of interests” (no conflict there, of course not!). Naturally Eli Lilly and Novo Nordisk are very much interested in obesity being considered a disease, and a treatable one at that. And doctors and scientists paid by these companies authored this paper which is posed to be very influential.

I took a look at the conflict-of-interest statement.  It is indeed astonishing as it goes on and on for nearly two pages in four columns.

Maria saved me from having to go through the analysis.  Here are her counts.

• Of the 56 authors, 47 declared conflicts of interest; only 9 did not.
• All 8 authors on the steering committee declare financial ties to drug companies.
• Novo Nordisk (Ozempic, Wegovy) is mentioned 60 times by 38 authors.
• Eli Lilly (Zepbound) is mentioned 39 times by 27 authors.
• Authors report financial ties to other pharmaceutical companies: AstraZeneca, Pfizer, Merck, Johnson & Johnson, Eurodrug Laboratories, Sanofi., and others.
• Authors report consulting fees, fees for educational purposes, research grants, speaker fees, co-authorship of manuscripts, medical writing assistance, and personal honoraria as a consultant and speaker, among others.
• Authors report financial ties to food companies such as Nestlé, which makes the Vital Pursuit line marketed to people on Ozempic.

Comment

No question, the BMI is an imperfect measure of the health risks of obesity, although it works pretty well as a first step.  Defining obesity as a disease may well help get treatment for people who need it.

I wish we had a health care system that could help people with obesity find out whether they have the clinical or pre-clinical form.  In the absence of  a functional health care system, we have drugs—effective and without deleterious side effects for some people, but for the great majority, highly expensive and hard to get.

This commission appears as an arm of the pharmaceutical industry.  Its findings require careful scrutiny.

I saw this on Twitter (X):

For the video, click here.

I’m for all three actions.  I’ve argued for years for getting rid of conflicts of interest and focusing resources on preventing chronic disease.

I can’t wait to find out how the new administration plans to accomplish these goals.   We all need to hold it accountable for delivering on these promises.

What started all this was this graph of obesity prevalence in the US from the Financial Times:

The most complete account of what happened next comes from Helena Bottemiller Evich in Food Fix (a must-read for anyone interested in following the food scene): “Have we passed peak obesity? New data sparks speculation.”

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.”

The original data came from the CDC:

Plotted this way, the decline is not nearly so impressive (and severe obesity is increasing slightly).

As for the effect of the drugs, it’s much too early to say, says the epidemiologist Deirdre Tobias posting on Twitter (X).

The downtick occurred before the drugs were widely used.  Following her thread produces lots more data on that point.

We will have to wait a few more years to know how all this will play out.  I can’t wait!

Susan Greenhalgh. Soda Science: Making the World Safe for Coca-Cola.  University of Chicago Press, 2024.

This terrific book picks up where I left off with Soda Politics: Taking on Big Soda (and Winning) (2015) and Unsavory Truth: How the Food Industry Skews the Science of What We Eat (2018).

Susan Greenhalgh’s focus, however, is on ILSI, the International Life Sciences Institute (now renamed the Institute for the Advancement of Food and Nutrition Sciences).  ILSI is a classic industry front group,  It was created originally by Coca-Cola to make sure science promoted corporate interests.  It is funded by big food companies.  It positions itself as an independent think tank.  Hence: front group.

Soda Science documents how ILSI, working through personal connections (guanxi) at the Chinese Ministry of Health, convinced the Chinese government to target obesity prevention measures at physical activity (“move more”), rather than diet (“eat less,” or “eat better”).

The first half of the book tells the story of ILSI’s role in the Global Energy Balance Network, a group outed as funded by Coca-Cola (I wrote about this in 2015, particularly here, here, and here in The Guardian).

The second half gives an intimate, first-hand account of how science politics works in China.

Greenhalgh is a distinguished anthropologist.  She retired from Harvard as as the John King and Wilma Cannon Fairbank Research Professor of Chinese Society (she is an expert on China).  She uses social science methods—interviews and qualitative research as well as document review—to study this particular example of soda politics.

• The International Life Sciences Institute (ILSI): true colors revealed (October 3, 2019)
• ILSI tracked media responses to my book, Unsavory Truth (February 22, 2023)

The story she tells here is fascinating in its own right and a great read.

It also makes one other point: social science methods are really useful in getting information unavailable any other way.

I say this because bench scientists tend to look down on qualitative research and consider it non-research.  I disagree.  I think qualitative research is essential, and has plenty to contribute.  This book is a great example of why.

I subscribe to Pet Food Industry and greatly admire the superb quality of its reporting.

Here’s an example:

Pet obesity 2023: owners oblivious, vets scared to talk: Pet owners may be largely unaware that there is a problem, especially with their own dogs and cats, despite years of warnings.

Several items in this article got my attention.

A.  It is based on a survey by The Association for Pet Obesity (APOP).  Pet obesity is such a widespread problem that it has induced formation of a society to address it.

B.  Pet owners do not recognize that their pets are overweight.

The survey found only 28% of cat owners and 17% of dog owners to say their pets were overweight.  Instead,  84% of dog owners and 70% of cat owners said their pets’ weights were healthy.

Veterinarians say 59% of dogs and 61% of cats are overweight or obese, and percentages are rising.

C.  Veterinarians are reluctant to discuss obesity with pet owners.

Although the survey found 84% of veterinarians to report encountering “pet owners who appeared embarrassed or angry when told their pet was overweight,” only 4% of owners thought their veterinarian would be uncomfortable discussing the issue.

Comment

None of this should be surprising, as I think about it.  Doctors avoid discussing obesity with human patients (embarrassment, stigma, and lack of time, empathy, or satisfactory treatment approaches).  Obesity has become the “O” word.

An astonishing 75% of U.S. adults are overweight or obese, and children are also getting there.

We, as a society, need to prevent this kind of weight gain for ourselves, our kids, and our pets.

How to do this requires policies, and lots of them, all at once.  Policies require politics.  Politics requires advocacy.

We need all of these, and right away.

Resources

Sunday’s New York Times has an entire section on pets.

Information about my book with Malden Nesheim on pet food issues, Feed Your Pet Right, is here.

As I keep saying, eating less is bad for business.

If you need proof, just look at how the food industry is scrambling to figure out what to do in response to the effects of GLP-1 drugs in decreasing appetite and food “noise.”

Here are a few examples.

The threat

Weight loss drugs may be melting US ice cream demand: Demand for frozen dairy products in the US has been declining for decades. Consumers’ growing interest in GLP-1 weight loss products is putting further pressure on demand…. Read more

Ozempic’s Effect on Food Innovation: Anti-obesity drugs have dropped on the food business in the last year like ChatGPT has dropped on the world. And according to experts assembled for a recent Mattson webinar on the topic, the effects of new appetite suppressants including Ozempic, Wegovy, and Zepbound have only begun to be felt among American consumers and the food industry that sells to them.

The promise

Nestlé introduces Vital Pursuit brand to support GLP-1 users in the US: Nestlé is introducing Vital Pursuit, a new line of foods intended to be a companion for GLP-1 weight loss medication users and consumers focused on weight management in the US. The products are high in protein, a good source of fiber, contain essential nutrients, and they are portion-aligned to a weight loss medication user’s appetite. The new line is also well-suited to support a balanced diet for anyone on a weight management journey. Vital Pursuit is the first food brand from Nestlé intended for GLP-1 users with the goal of complementing the eating habits of millions of Americans who are currently prescribed a weight loss medication or actively working to manage their weight.

Food Companies Want a Piece of the Ozempic Pie, Too: Last fall, word of a looming existential threat to the packaged food industry began to bubble up in earnings calls and among analysts. Drugs such as Ozempic, Wegovy and Mounjaro, experts feared, could be a little too effective at curtailing people’s cravings for snacks and sweets, and if too many people got on the drugs, their changing habits could eventually do the industry real harm. Could buyers begin to forsake Doritos and Oreos and Pizza Bagels?

Danone Targets Health, Nutrition as Food Industry Braces for Ozempic Era: The food company is targeting like-for-like sales growth of 3%-5% for the 2025 to 2028 period, with operating income rising at a faster pace than sales. Danone plans to double down on health and nutrition in the coming years as food companies seek to tackle the effects of Ozempic and other blockbuster weight-loss drugs on eating habits.

Supergut’s Marc Washington on ‘Ozempic era’ opportunity: The IPA World Congress + Probiota Americas 2024 in Salt Lake City highlighted many of the innovations happening in the prebiotics space, including how GLP-1s are impacting the category…. Watch now

There is much discussion these days of the complexity of causes and consequences of excessive gain body fat.  This review addresses the history of what is known—and not known—about obesity., by someone who has been studying it for decades.

Bray GA. Obesity: a 100 year perspective. Int J Obes (Lond). 2024 May 7. doi: 10.1038/s41366-024-01530-6.

His conclusion:

Obesity is both a public health issue and an individual challenge
As noted during the discussion of the Fogarty Center Conference in 1973, the public health community was already aware of the health-related risks associated with obesity even before the explosion in prevalence occurred after 1975. The ensuing pandemic of obesity with some people developing obesity, but not others, challenges modern medicine and public health. As Hippocrates said more than 2500 years ago: “Life is short, art long, opportunity fleeting, experience treacherous, judgment difficult.” The challenge for those of us working in the field of obesity is that there is more to uncover to fully understand and be able to effectively treat people with obesity.

The paper has 137 references.  If you want to learn what the debates are about, this is a great place to begin.

I was thrilled to be invited to be on Oprah last week to discuss the influence of the food environment on obesity.  Alas, I was disinvited when the topic switched to fat shaming.

While recovering from the disappointment, I ran across this article in FoodDive: The Ozempic effect is real: Study zeroes in on GLP-1 users’ food needs.

A study found people taking anti-obesity medications such as Ozempic, Wegovy and Zepbound to be looking for:

• Foods packed with protein
• Smaller portions
• Foods that help quell nausea
• Foods that help reduce gastrointestinal side effects

The potential size of this market is impressive:

Manufacturers looking to create products that cater to this growing market segment – which according to recent research from Goldman Sachs could be as much as 15 million people, or 13% of the U.S. population, by 2030 – should focus on creating products that meet their new needs.

The research group used “its proprietary AI to generate food concepts that it had panel participants evaluate and several were appealing including:

• Pre-portioned grilled chicken strips
• 2-ounce portions of Greek yogurt in pouches
• Electrolyte-enhanced fruit popsicles
• Mini meal cups

Hey—this is a win-win.  First the food industry makes products that people can’t resist eating and make them gain weight.  Then the industry creates products that help them take drugs more easily.

A marketing opportunity for all