The Macroeconomic impact of defining obesity as illness

The Obesity Revolution

New weight loss drugs are changing the narrative on obesity, with a push from pharma

  • Elaine Chen
  • Matthew Herper

By Elaine Chen and Matthew Herper, Stat News, March 5, 2023

A two-part message is permeating the halls of medicine and the fabric of society, sliding into medical school lectures, pediatricians’ offices, happy hours and social feeds: Obesity is a chronic biological disease — and it’s treatable with a new class of medications.

The condition has long been framed as a result of poor lifestyle decisions and a failure of willpower — eating too much and exercising too little. But a new generation of highly effective obesity medications, and the overt and subtle messaging from the pharmaceutical companies making them, are starting to change the narrative…

The new obesity drugs are in a class called incretin mimetics or GLP-1 based drugs, which emulate the effects of a hormone called glucagon-like peptide 1 that can help people feel full. They can lead to a startling amount of weight loss, up to a fifth of body mass, but have to be taken regularly by injection to avoid regaining pounds. They could reach staggering numbers of people: the worldwide obesity rate has surged to 13%, nearly tripling since 1975. In the U.S., 42% of adults and 20% of children are estimated to have obesity… [end quote]

Notice the change in phrasing from the old “people are obese” to “people have obesity,” reframing obesity as a disease. If obesity is a disease, drugs to treat it should be covered by insurance, similar to drugs to treat diabetes. And, in fact, some GLP-1 based drugs are already FDA-approved to treat diabetes.

Wegovy is sold by Novo Nordisk. Pfizer, which is developing an oral (instead of injected) GLP-1 drug, estimates a market of $100 billion annually within a decade. This is truly Macroeconomic impact since it would affect a huge swath of the population and burden everyone who either pays for the drugs out of pocket or the insurance that funds the purchases.

It’s ironical that the problem of obesity could be solved simply by eating the way our great-grandparents did in the days before processed and fast food. In the words of the food writer, Michael Pollan, “Eat food. [Whole, not processed, food.] Not too much. Mostly plants.”

But the medical profession has given up on getting the population to avoid cheap, convenient, ultrapalatable, highly addictive processed foods. Instead, they said, “If you can’t beat 'em, join 'em” and redefined obesity as an illness for which people are not personally responsible but can be treated medically.

As investors, we can ride this train. At the same time that we cook our healthful, whole foods meals.



Just as you can’t choose your family, doctors can’t choose the population they’re presented with.


And that is indeed the case!

My doctor says his diet book is the key: Chapter 1: Eat less. Chapter 2: Move more.

I use a free app called MyNetDiary. Makes it easy to stay within my daily calorie target… and that target can be modified to account for daily exercise. Stuff like “I can’t, it’s my metabolism” is just fooling oneself, if that. When I pay attention, I continue to move toward my target weight. When I slack off, it will start to creep up.


My only struggle is evening snacks. I need to take care to choose low calorie ones if I can’t otherwise resist.

He is no fool who gives what he cannot keep to gain what he cannot lose.

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Try clementines. They take a while to eat, are intensely flavored and high in Vitamin C.

Wendy (sugar addict – needs alternatives)

@DrBob2 yes, I understand that. But how does it help the obese if the doctor avoids teaching them the truth and instead gives them a free pass to continue their unhealthy lifestyles by calling obesity a “disease” without even a hint of education?


I’m not sure the “without even a hint of education” came from. The two approaches are not mutually exclusive. Perhaps some parallels to a health care provider who sees a drug user at a clinic. He may tell him about the down side of his habit, etc. and at the same time supply him with clean needles.



Good suggestion! 35-45 calories each, depending on ?

I also snack on carrots. They take a while to eat. Plenty of fiber. Mild sweetness. Very low calories.

But… if I don’t watch it, I’m grabbing stuff we shouldn’t have in the house… because of a scarcity of willpower: peanut butter, cheese, cashews, raisins (raisins fine in oatmeal).

Not hard at all to lose 1-2 pounds per week depending on discipline with eating and exercise. I bobbled the ball in mid-February (birthday!) and am slowly getting back at it because I also slightly injured myself by running a bit. I felt like my 4 miles a day could be helped with some running and…no. I’m better off just walking at 70. I hurt myself too often with running and the benefit isn’t worthwhile. If I want to push things, I can just walk faster. These days, doing a mile in 15:30 is my comfortable limit, 16:30 if I want to loaf. Used to be able to do miles in the low 14s when I walked the Flying Pig Half Marathon in Cincinnati a decade or so ago.

He is no fool who gives what he cannot keep to gain what he cannot lose.

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One of the things that the overweight complain about when visiting their doctors for symptoms that may well be unrelated to their bodyfat is that, all too frequently, they’re harangued about their weight and symptoms are ignored. Oftentimes delaying a diagnosis that is unrelated to their weight. I guess those of us who don’t, and never have had weight management issues are likely to make the assumption that the overweight are just like “us” and just need a heads-up on what we’re doing wrong in order to fix it. That doesn’t seem to be the case.

How many folk reading this thread who’re overweight or have been until recently can honestly say that they haven’t made excuses for their fatness or looked for reasons why the Cals In vs. Cals Out doesn’t apply to them…or, for that matter, “recced” posts that’ve attempted to refute the notion.

Education only works when folk are at a point to be receptive and that oftentimes doesn’t happen even when actual disease (as most folk would describe it) presents itself in the form of diabetes…and worse.

It’s a bit of a head scratcher, for sure … but folk tend not to want “help” when they think the problem is not one of their own making (and this isn’t just confined to weight management)


I have been on this bitter fence for decades. I hear ya.

But had a sudden older wave of maturity this afternoon. I will note when I think of food between meals that often it kind of disgusts me. That battle underneath it is a good dose of disgust. It is a mellow sort of feeling. Just enough is enough. Not every moment is actually lets eat when thoughts of food come up. Surprise! I will probably run with it for the rest of my life.


XMFRob, you might already be doing this, but if not, walk hills. The steeper the better, burn some major calories. If you’re walking a near 4mph ( that’s a good pace ), you are fit enough to walk uphill, a lot of benefits to be gained.

Burn enough calories, and can within reason eat anything you darn well want, lol.

Thanks, UpNorth… already doing that. They’ve gotten a lot easier to scale as I’ve put on the miles and worn out shoes. :slight_smile:

He is no fool who gives what he cannot keep to gain what he cannot lose.

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Some of the problem could be, maybe most of it. But obesity in adults is highly correlated to childhood trauma.

Drugs aren’t going to fix the underlying problem. But instructions to eat less won’t either.


I wonder if it is more related to “treating” childhood trauma with food, usually high calorie, sugar laden foods? Starting the the candy and/or lollipop after your vaccination shots at age 2, 6, 9, 12, etc. Or offering a candy to your kid that fell and skinned their knee. Or the obligatory ice cream after tonsil removal (usually an unnecessary procedure to begin with). Etc, as applicable to worse forms of trauma.

It appears to be more related to serious trauma, like child sexual or physical abuse. Eating feels good, so the child takes refuge in food, which carries onto adulthood.

And the frequency of childhood traumas is highly correlated with lower socioeconomic status. So maybe it is less about the trauma and more about the money? This is my way of saying that studies like this have to be taken with a huge grain of salt, particularly when they assume a causal relationship. No doubt that traumas have all kinds of negative impacts and could certainly contribute to obesity. But I would bet dollars to donuts…I mean carrots… that the impact is minor.

The generation who spent their childhood in the Great Depression didn’t have an adult obesity problem. Neither did those who were children during WWI or WWII or the polio epidemic. I mean seriously, does anyone really believe that if one eliminated childhood trauma the obesity epidemic in a world full of Big Macs and Coca Cola would disappear?

It is almost a cliche that as societies grow in wealth, its people become fatter. After WWII, global living standards have increased significantly and so has the global rate of obesity. Automation means less physical labor, jobs are more sedentary. Increased wealth means people can more often buy what tastes good rather than simply what they can afford. And when all this happens people gain weight.

This may not be politically correct. It is not woke. But I think it is true. For the great majority of people, obesity is a choice not a disease. It is a life style not a traumatic injury.


That was never asserted.

What is being asserted? Is the suggestion that childhood trauma contributes significantly to the obesity epidemic? Is there an implication that the sharp rise in obesity in the Boomer generation is due their being more frequently traumatized?

I think neither is likely to be true. This is just another attempt like “obesity is a disease” to remove personal accountability from the equation. It is the victimization of America, done because you shouldn’t blame the victim.

Bah! We Americans eat too much and don’t move around enough. That is really all there is to the obesity problem.

Americans today have more food choices available to them than any society or generation in history. If people make the wrong choices, whose fault is that?

Here is my very simple strategy for beating obesity that is relevant to a board about money. The average American household spends about $20 per day on food. Cut that in half for the work week. Folks with a weight problem should set a hard $50 limit for food for the five day work week. Can’t afford to go out to eat or buy the $6 latte. Can’t afford too many breakfast bars and chips for snacks. Even fast foods will deplete that budget pretty fast. Folks will have to make stews and soups that are mostly vegetable and bring leftovers for lunch. Splurge on the weekends, eat whatever and how much you want. But discipline during the work week.

In six months weight will be lost and money will be saved.


Those with inadequate access to food likely to suffer from obesity -- ScienceDaily.

40 to 50 percent in USA are obese and it all happened in last 40 years. Is anyone claiming such widespread increased childhood trauma?


It’s not JUST that. We eat too much of the wrong things. The obesity started to rapidly increase right when fats were vilified and sugar elevated to a primary source of nutrition. So I suspect that that has something to do with it, though I have no specific evidence that it is so.