A shift to office work has reduced our energy use. Technology advances, automation, urbanization, cars and other energy-saving changes have also contributed. During the 1960s, half of all jobs required moderate intensity physical energy expenditure, whereas in 2010, fewer than 20% did.
Trends in Obesity: 1963 to 2018 (CDC)
Corpulent Costs
Obesity not only increases health risks and reduces quality of life and mobility; but also produces a significant economic impact. Two primary drivers behind this cost burden include medical care and productivity.
A 2021 study found that obese adults were burdened with medical costs $2,505 greater than individuals of normal weight. It found that obese individuals covered by public health insurance programs incurred more costs than average, adding $2,868 per year. Overall health care costs attributed to obesity in the United States were an estimated $261 billion in 2018 and 2.2% of gross domestic product in 2019.
Annual Health Spending: Obese vs. Not
Obesity is associated with lower work productivity and absenteeism. Research has identified material health-related productivity losses. Obese workers are overall less likely to be employed and suffer from other challenges that impair work efficiency. There is also an association between obesity and reduced motivation. Depression, poor self-image, loss of enjoyment and other related factors are all more common in obese persons compared to normal-weight counterparts.
Obesity Death Rate/100,000 Individuals (IHME)
Reclaiming the Spotlight
The search for an effective weight loss product has followed a winding path throughout the decades. Regulators have added and deleted products based on developing information. However, the rapidly-growing obese population demands robust solutions.
Glucagon-like peptide (GLP-1) agonists were first approved for Type 2 diabetes in 2005. They stimulate insulin production and inhibit glucagon release from the pancreas. GLP-1s also delay gastric emptying, which limits blood sugar volatility. Other GLP-1 agonists were later approved to address type 2 diabetes including semaglutide, liraglutide and dulaglutide. Researchers found that GLP-1 patients reduced food intake and lost weight. This led to additional studies and the 2014 approval of liraglutide for weight loss; however, its effectiveness was mediocre. In 2021, semaglutide (Wegovy) produced better outcomes, generating impressive results in a clinical study, angling the spotlight towards weight loss and GLP-1s. A recent Goldman Sachs report estimates the market could reach $100 billion by 2030.
Obesity Treatment
The first prescription to achieve weight loss is a change in diet and exercise. Avoiding high-sugar foods and consuming fresh fruits and vegetables are other interventions. Evidence shows regular physical activity can also be an effective complement.
For many, medicines may be necessary as diet and exercise are not enough. These are generally recommended for people with a BMI over 30 (obesity) or a BMI over 27 (overweight) with weight-related health conditions like diabetes or hypertension.
While the weight loss benefits of GLP-1s have attracted the eye of dieters, so has their burdensome price which can range from $800 to $1,350 per month. Except for the occasional billionaire, most patients are not able to afford the product without insurance. And many insurers have been reducing coverage due to cost. Combined with the shortage of GLP-1s, the need for alternatives becomes clear.
While recent interest in GLP-1 agonists such as Wegovy and Zepbound has rallied interest in the whole group and captured the limelight, there are many therapeutics available. Other prominent options include orlistat, phentermine hydrochloride & topiramate, and deoxycholic acid.
A literature review by Mital and Nguyen [1] found that, of the four leading anti-obesity drugs approved for pediatric use, phentermine-topiramate (Qsymia) was most cost effective. All [2] demonstrated similar, mild to moderate, adverse events. Of the four, only Qsymia generated an incremental cost effectiveness ratio (ICER) under payors’ standard threshold. Over a 30-year horizon Qsymia’s ICER advantage was even greater.
Summary
There is much to consider when addressing obesity. The health risks are well documented and can dramatically affect quality of life and wealth. While obesity’s solution is sometimes simplified to exercise and diet, these are frequently inadequate and further intervention is needed. Surgery or medications can help achieve weight loss but bear significant costs and side effects which must be balanced against outcomes. With the additional healthcare burden of obesity exceeding thousands of dollars per year, a balance between treatment cost and benefit is needed. This requires alternative approaches and comprehensive efforts that combine cost-effective medications with diet and exercise to reduce excessive obesity rates.
Extended version of article here with references.
[1] Mital, S., Nguyen, H. Cost-Effectiveness of Anti-obesity Drugs for Adolescents With Severe Obesity. JAMA Network. October 2023.
[2] Other medicines: orlistat, liraglutide & semaglutide
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