A Challenge for Society, Primary Care and the Individual Patient to Curb the Obesity Epidemic and Malnutrition

The paper defined “overweight” adults as those who were age 25 and over with a body mass index (BMI) at or over 25 kg/m², and “obese” adults as those with a BMI at or over 30 kg/m². Although the BMI is an imperfect measure that falls short of capturing variations in body fat distribution across the population, it is a practical first approximation fat accumulation. The shape of major fat deposits in both men and women also contribute to the to how damaging they are to our health and biomarkers of body-wide pathology.

The authors found a steady increase in the proportion of overweight and obese individuals over the past three decades. The rate of obesity in particular rose sharply in adults between 1990 and 2021 and doubled to more than 40 percent.  Equally alarming, among girls and women aged 15 to 24 the rate of obesity nearly tripled to 29 percent.

Beyond the economic implications found by the 2024 Joint Economic Committee Republicans (JEC Republicans) estimated that obesity causes an “average of $5,155 in average excess medical costs per affected person corresponding to $520 billion in total excess healthcare costs in 2023 alone”. Over the next 10 years, obese individuals will result in $8.2 to $9.1 trillion in excess medical expenditures. These costs will result in lost productivity and labor supplies that will translate in lost tax revenues. Obesity increases the likelihood of numerous metabolic symptoms and their associated complications: high blood pressure, Type 2 diabetes, liver disease, kidney disease, heart attack and stroke. Acting via global body inflammation, obesity is correlated with infertility, cancer and increases in anxiety and major depression. High maternal BMI’s often translate to high BMI’s for their children.

Fortunately, we are experiencing an increase in our understanding of the physiology of hunger and its genetic, physiological, and environmental underpinnings. Amongst the environmental contributors are high caloric ultra processed foods, poor access to fresh fruits and vegetables, and increased sedentary activity. Unlike Japan with much lower rates of obesity, we lack walkable, fast and clean reliable public transport and cars are mere extensions of ourselves.

Bariatric Surgery and Glucagon-like peptide 1 (GLP-1 Receptor agonists like Wegovy,  Zepbound, and Mounjaro, whose mechanism of action involves mimicking a natural hormone in the body called GLP-1 will be needed. They stimulate insulin production from the pancreas, reduce liver sugar production, and slow down digestion. These agents are effective obesity treatments to augment lifestyle changes. To have a public health impact, these drugs will have to be affordable, and more research will be needed to determine how to tapper them without a rebound of weight. Moreover, individuals will need to adhere to healthy nutrition habits (e.g. Mediterranean diet) for the health benefits to be manifest.

Society’s Role and Chile’s Example of How to Promote Healthy Nutrition

To impact the diets of individuals will require major structural changes in nutrition that must be coordinated at the federal level to bolster regulatory changes at the local and state levels. These must include subsidies for healthy foods and taxes on sugar-sweetened beverages and cereals. More government regulation of the nutritional content in foods, and marketing of unhealthy foods is clearly needed. In a February 7, 2018, New York Times Article (In Sweeping War on Obesity, Chile Slays Tony the Tiger), Andrew Jacobs cites how in Chile’s “New regulations, which corporate interests delayed for almost a decade, require explicit labeling and limit the marketing of sugary foods to children”.

Another 2024 article (Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population representative studies with 222 million children, adolescents, and adults) in The Lancet concluded that the “combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.”