Our global metabolic health crisis demands a new approach

With cardiovascular gains slowing and obesity and diabetes on the rise, life expectancy improvements have plateaued in some nations. To change this trajectory, Swiss Re's Julien Descombes writes, we need to re-visit science-based nutrition guidance as well as consider new approaches focused on tackling insulin resistance, the body's inability to take up blood sugar that is driving what has become an epidemic of metabolic ill health.

Food takes an amazing journey through our bodies. What we ingest as protein, fat and carbohydrates is transformed into energy that allows us to think, move and grow as chemical reactions set off a cascade of complex cellular functions. In recent decades, however, something has gone awry, as more people suffer from chronic conditions linked strongly to the food they're eating.

On World Diabetes Day this 14 November, it's worth noting 1.3 billion people, or twice current levels, by 2050 may develop type 2 diabetes. At Swiss Re, we see efforts to tackle metabolic ill health, a set of disorders that include the body's inability to take up blood glucose, as both central to our business and a matter of urgent importance to society.

We've watched with concern as diseases driven by nutrition and lifestyle factors have played a role in a plateauing of life expectancy for the general population since around 2010 in the United Kingdom, Canada and United States. Cardiovascular health gains slowed while obesity and diabetes rates have soared, as Swiss Re Institute (SRI) documented in its recent publication "The Future of Life Expectancy."

Data shows metabolic ill health is contributing to higher rates of numerous other non-communicable diseases like cancer, too. In short, people are losing years and quality of their lives, while healthcare costs climb. This must change.

Swiss Re's Life & Health Reinsurance business, where I lead our global teams of actuaries and underwriters, sits at the heart of discussions about improving metabolic health. We have the world's largest L&H reinsurance mortality balance sheet, so increasing life spans benefit the contracts we write.

We are optimistic that overall mortality improvements, which often come in waves, will continue. As middle classes grow, this also underpins our ambition to expand our life insurance business. Our interests are clearly aligned with those of policyholders: When people live longer, healthier lives, we all reap the rewards.

Tragically, however, more than 4 million people may die annually from type 2 diabetes. This isn't merely a problem of advanced economies, either. Premature African deaths from diabetes exceed global averages, as per the World Health Organisation (WHO). It should be a concern for every country, advantaged or not – and there are lessons to be learnt. 

The need to address poor metabolic health is a driving force behind Swiss Re's push to advance a science-based understanding of this epidemic. We just completed our latest "Food for Thought" conference with the medical journal BMJ, and our "Fixing Metabolic Health" symposium. Experts who joined us in Switzerland highlighted how insulin resistance, caused by excessive intake of sugar and refined carbohydrates, is the root cause of metabolic ill health. The complexity of fixing this problem is exacerbated by food addiction, the ubiquity of ultra-processed foods and genetic predisposition.

But complexity should not be a barrier to finding solutions.

My colleague, Swiss Re Chief Medical Officer Dr. John Schoonbee, has suggested a "moonshot"-style programme against diabetes and obesity, along the lines of the US initiative to boost cancer research and prevention.

We already have models for how to accomplish this in the successful campaigns that urged people to quit smoking starting in the 1960s, leading to profound reductions in cardiovascular disease and cancer. These efforts resulted in the largest mortality improvement gains based on individuals changing their behaviors and lifestyles.

As we aim now to create a similar narrative for metabolic health, we must first get the science of nutrition right. This starts with acknowledging that existing nutritional guidelines have not succeeded in curbing the rising obesity and type 2 diabetes rates.

Consequently, governments and societies should prioritise high-quality research – like Swiss Re is pursuing with our commitment to the Food for Thought series -- to underpin new, science-based guidance on appropriate food choices. These approaches must be driven by the latest, most-impactful research, not outdated information without strong empirical foundations.

As medical treatments continue to develop, prevention must take equal precedence. Moreover, as the population of insulin-resistant people rises globally, experts who set nutritional guidance should consider the needs of people living with metabolic dysfunction alongside those of healthy individuals.

With the prevalence of good metabolic health "alarmingly low" in places like the US, as some scientists have concluded, we need nutritional guidance that focuses on needs of the metabolically impaired. This will help equip them and their physicians with the resources they require to get well.

None of this will be easy. After all, food is deeply personal. Nearly everywhere, what people put on their plates often defines who they are. Historical nutritional patterns have become etched in our consciousness as they've been handed down over generations and become embedded in our culture, institutions and economy.

Still, policymakers should stay nimble as they consider fresh approaches that are emerging with the potential to expand our prevention-and-treatment arsenal for metabolic illnesses.

For instance, doctors in the UK, US and elsewhere are deploying promising new methods including low-carbohydrate, higher-fat diets to empower patients to prevent ill health, reduce their reliance on medications and improve their mental well-being. We should regard these endeavors with open mind and, crucially, the investment needed to understand the mechanisms underlying their successful nutritional interventions.

Put plainly, new nutritional approaches to prevent and treat diseases like type 2 diabetes are needed, because the status quo has so far failed to change our metabolic health trajectory.