Is obesity as a threat to public health a thing of the past?

One billion people in the world are overweight. In Sweden it is 51 %, with more than a quarter of them suffering from obesity, defined by a BMI over 30. The group with the fastest-growing number of overweight individuals in Sweden is "young adults" (Folkhälsomyndigheten). Being overweight or obese are risk factors for cardiovascular diseases, arthritis, type 2 diabetes, and certain forms of cancer, known as "non-communicable diseases," which account for the majority of global deaths (WHO). Various surgical, medical, and preventive interventions have been implemented globally, regionally, and locally. WHO recommends increased physical activity, reduced consumption of fat, salt, and sugar, and increased intake of fruits, vegetables, legumes, and nuts. However, despite these interventions, BMI is still increasing at the population level worldwide.

Five years ago, the European Medicines Agency (EMA) approved the Danish pharmaceutical giant Novo Nordisk's new GLP-1 analog, Ozempic (semaglutide), for the treatment of type 2 diabetes. Last year, Wegovy, a higher-concentration version of the drug for the indication of obesity, was approved (expected approval in Sweden in 2024). Semaglutide, injected once a week, binds and activates the GLP-1 receptor, increasing insulin production and reducing blood glucose levels. The result is reduced appetite, hunger, and slower digestion, leading to weight loss. Several similar drugs from other manufacturers are awaiting approval.

Does this mean that one of the major threats to public health has been resolved?

Well, it remains to be seen. The medications work, patients lose weight, and the treatment protects against the development of cardiovascular diseases (Novo Nordisk). However, there are troublesome side effects, and the drug's effects disappear when treatment is stopped. The question of who should pay for treatment also arises. There is enormous interest and demand for these drugs, with one billion posts on TikTok related to Ozempic, resulting in most pharmacy shelves in Sweden being empty. Patients with type 2 diabetes must switch to other, less effective treatments. An article from The New York Times in late August highlights the inequality in drug prescription. Despite being one of the wealthiest areas in New York, with the healthiest residents and the highest life expectancy in the entire metropolitan region, the Upper East Side has the highest prescription rate for Ozempic. This rate is slightly higher compared to socioeconomically disadvantaged areas in the city, which have a significantly higher prevalence of obesity and type 2 diabetes (NY Times).

Novo Nordisk has now taken the top spot as Europe's most valuable company, pushing the French company LVMH with its portfolio of luxury brands down from the throne. Is this, in fact, two sides of the same coin, representing humanity's desire to be rich, thin, and beautiful, or does it reflect our belief in medical and technological innovation and our will to survive?

Further reading at ri.se: Social outcome contracts, Drug development, Transitioning to healthy and sustainable food consumption