What is causing the recently noted mild decline in national obesity rates?

Recently published data suggested that, for the first time in many years, national obesity rates have mildly declined in 2023 after plateauing in 2022 (1) (the figure below stems from a recent report by the National Center for Health Statistics). 

The most notable decrease was in the South, which – interestingly – also had the highest observed per capita GLP-1 receptor agonist (GLP-1RA) dispensing rate. The paper reporting this decline, however, also noted that dispensing does not necessarily mean uptake. The South, indeed, also experienced disproportionately high COVID-19 mortality among individuals with obesity.

A recent Commentary in Medscape Diabetes & Endocrinology, argued that the increasingly popular GLP-1RAs do not explain this observed drop in obesity and that other factors must have played a role (2).

For us somewhat far-fetched, however, appears the argument in the paper that excessive mortality of obese patients during the COVID pandemic may have affected obesity rates. Moreover, more severe COVID cases among obese patients, according to this author, may have led to significant weight loss. He unquestionably was, however, correct that first and second generation GLP-1Ras were FDA-approved only after the national obesity rate had already plateaued. 

The author of the article correct in acknowledging that with increasing utilization of especially second-generation medications like tirzepatide (in the U.S. sold as Munjaro) the national obesity crisis must be expected to improve further, as a just recently published study demonstrated a whopping 25.3% weight loss in obese patients at 88 weeks of treatment with these drugs. And it, of course, is not only about weight loss as an end goal; weight loss also improves fertility and, ultimately, general health and life expectancy.

References

1.      Rader et al., JAMA Health Forum 2024; 5(12):e243685

2.      Freedhoff Y. Medscape  Diabetes and Endocrinology. January 17, 2025. https://www.medscape.com/viewarticle/obesity-medications-dont-explain-decrease-obesity-rates-2025a10000in