Look at almost any photograph of an American crowd taken 60 years ago. It can be a baseball game, a high school graduation, a beach, an airport terminal, a factory floor, or simply people walking down a city street. Something is immediately noticeable to modern eyes, although almost nobody in the photograph would have considered it remarkable: most people are relatively thin.
They did not have continuous glucose monitors, smartphone applications that counted calories and macronutrients, wearable devices reminding them to stand, boutique fitness studios, bariatric surgery centers, or medications capable of producing 15 or 20 percent reductions in body weight. They were not necessarily more virtuous than we are, and they certainly did not possess superior genes. They lived in a different metabolic environment.
The data backs up what we see in those old photos. In the early 1960s, about 13 percent of American adults were obese. By August 2023, that number had jumped to 40.3 percent, with another 31.7 percent considered overweight and nearly one in ten classified as severely obese.[1] This trend isn’t just in the United States. A huge study of over 220 million people from 200 countries found a dramatic global rise in obesity between 1990 and 2022.[2] Our genes haven’t changed much in that time. Something else has.
We’re now at a turning point in medicine. Faced with one of the biggest and fastest changes in human health, we’re treating the results as a condition that needs lifelong medication. The newest drugs are very effective, and that’s important to recognize. Semaglutide and tirzepatide have led to weight loss that older nonsurgical treatments rarely matched.[3,4] Semaglutide has also reduced the risk of major heart problems in people with overweight or obesity and heart disease who didn’t have diabetes.[5] Tirzepatide has greatly improved sleep apnea in people with obesity.[6] These results are significant, and these drugs are much more than cosmetic weight-loss aids.
That’s why we need to look closely at what’s happening now. The problem isn’t that these drugs don’t work; they clearly do. The real concern is that they might work so well that we stop asking why so many people need them in the first place. We could be seeing a major medical breakthrough, but at the same time, we might be accepting that the effects of an unhealthy environment should just be managed with medication. The real question isn’t whether these “GLP-1” drugs are effective. It’s whether their success is making us stop looking for the root causes of the obesity epidemic.
