Beyond MAHA: Defeating obesity requires a new strategy
Obesity is a major health problem facing our country. According to the CDC, more than 40 percent of the U.S. population is obese, defined as having a body-mass index above 30. As astounding at that number is, it is perhaps even more surprising that nearly 20 percent of children in the U.S. are obese.
Obesity leads to significant health challenges, including diabetes, stroke, cardiovascular disease and liver disease. It is clear that as a nation we must face this crisis on multiple fronts. Diet and exercise certainly help, and it's critical to ensure that people of all socioeconomic backgrounds have access to healthy foods (free of preservatives, unnecessary dyes, high fructose corn syrups etc.) and are educated in making healthy lifestyle choices.
The MAHA or 'Make America Healthy Again' movement has highlighted this as one of its key objectives, and if it is successful, we should see an impact on obesity — especially in children, where diet and exercise have a huge impact on weight-related health outcomes.
Obesity in adults, however, is often more challenging. Many adults with obesity struggle to lose weight, despite considerable efforts to modify their lifestyle through diet and exercise. This is because our metabolism changes as we age, and many adults who are overweight develop metabolic dysfunction or 'metabolic syndrome,' which then further perpetuates weight gain and exacerbates the situation.
It has become clear in recent years that many people struggling with obesity require medical intervention – not just lifestyle intervention – and that prescriptions can substantially improve weight loss. The explosion in use of GLP-1 agonists, such as Wegovy and Zepbound, over the last two years has underscored the need for medical intervention in obese and overweight patients.
Currently, about 6 percent of the U.S. population, or 15 million people, are on GLP-1 weight loss treatments, and the numbers are only expected to increase. However, while most patients lose 10 percent to 25 percent of their body weight while on a GLP-1, they do not maintain GLP-1 treatment in the long-term, with approximately 80 percent of patients discontinuing treatment within 1 year.
Gastrointestinal side effects, injectable administration, and high cost have prevented long-term use of GLP-1's for weight maintenance. And unfortunately, most patients gain back all the weight after stopping the medication.
Healthcare professionals and the pharmaceutical industry now recognize that obesity — like most other medical conditions — requires an 'arsenal' of treatments, rather than a one-size-fits-all approach. Post-GLP-1 weight maintenance is now widely recognized as an emerging unmet need. And patients who are not candidates for or cannot tolerate GLP-1s require alternatives.
Diet and lifestyle modifications are important alongside prescription medications in fighting obesity. If we are going to be successful in overcoming this major health crisis, we need to ensure that both the pharmaceutical industry and groups like MAHA work hand in hand. Both treatment and prevention are critical in order to regain control of our nation's health.
Dr. Shoshana Shendelman, Ph.D. is a scientist and entrepreneur who has founded numerous biotech companies. She is a pioneer in the development of drugs and therapeutics for rare and underserved diseases. Currently she is Vice Chair of the Advisory Board of Columbia University Medical Center and Columbia University Vagelos College of Physicians and Surgeons.
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Opinion - Beyond MAHA: Defeating obesity requires a new strategy
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