A moonshot to halt the obesity and diabetes pandemics

With more than one in 10 people globally projected to suffer from diabetes by 2050, the human and economic costs of this debilitating metabolic disease are due to soar. Nothing less than a "moonshot" is needed for what has become a pandemic of metabolic ill-health. In October, Swiss Re hosts experts at two conferences aimed at finding solutions to the human health challenge of our time. 

As a doctor and chief medical officer at one of the world's largest reinsurers, I've tracked the tidal wave of obesity and diabetes that's been cresting for decades. Still, I admit I was stunned by a recent study suggesting diabetes cases will more than double, hitting 1.3 billion people by 2050.

The dimensions of type 2 diabetes are already almost unfathomable: More than 500 million men, women and children struggle with this life-threatening metabolic illness. In the United States, one of every four dollars spent on health care costs goes to diabetes care, according to the US Centers for Disease Control and Prevention. Globally, the WHO estimates 2 million people in 2019 died due to diabetes and diabetes-related kidney disease. 

In the US and the United Kingdom, obesity and diabetes have been factors in the past decade's alarming plateauing of life expectancy, something Swiss Re documented in our recent report "The future of life expectancy". Metabolic illness is dragging down the hard-won cardiovascular gains made by advanced economies in the late 20th century, including from smoking cessation.  

Interconnected trends of more metabolic disease and slowing or declining long-term mortality improvements are key reasons why we're hosting two important conferences this October.   

"Fixing Metabolic Health" on Oct. 9 and "Food for Thought 2023" on Oct. 10-11, which Swiss Re is sponsoring again with our partner The BMJ, are dedicated to better understanding drivers of obesity, diabetes and related metabolic disorders. These in-person and online events are venues for scientists, clinicians, and policymakers to discuss and debate how to turn the tide – and help people live longer, healthier lives. 

This topic has never been timelier – or more controversial. Consider this: When the World Health Organization in July updated its guidelines for fat and carbohydrate consumption, some of the recommendations immediately prompted criticism including from nutrition experts at Harvard University. If the WHO and Harvard are fighting over what we should be eating, it’s high time we put our heads together to discuss the path forward.

At the root of metabolic ill-health is insulin resistance, when muscle, fat and liver cells don't respond well to insulin that helps them take up glucose from the blood. Excess weight and obesity are key risk factors, with prolonged insulin resistance often resulting in higher-than-normal blood glucose levels, pre-diabetes or diabetes.  

By reversing or improving insulin resistance, we know cardiovascular risk factors can improve. Studies show that programmes targeting "insulin-lowering lifestyles" can help half of type 2 diabetics achieve medication-free remission. Approaches like these, unheard of even a few years ago, are still not taught in medical schools. That should change. 

Of course, finding long-term remedies that succeed with broad populations has been difficult, largely because they're linked to lifestyle factors, including advising people to eat less. Still, hunger is tough to overcome, making alternative eating patterns – those that avoid hunger but improve metabolic health – very important. Some of these programmes have been shown to be sustainable and acceptable, lifting many health measures including simply "feeling better".  

At Swiss Re's "Fixing Metabolic Health" event, experts will help us understand how different interventions are achieving success. We'll also talk about food addiction, and hear from trailblazers now exploring metabolic psychiatry, a new field aiming to treat mental health conditions including bipolar disorder. Our new and growing understanding of brain metabolism is creating insights into why sugar highs lead to sugar lows.

For Swiss Re's third "Food for Thought" event with our BMJ partners (following 2018 and 2020 editions) we've again commissioned expert and scientific papers about issues surrounding the rise of obesity and diabetes. We'll extend the tradition of debate and scientific exchange over mechanisms of hyperinsulinaemia, or overproduction of insulin, and pancreatic beta cell function.  

We'll also examine models of obesity that break from our traditional understanding and have the potential to help us see this disease, and our responses to it, in fresh ways.  This year, we're considering how harnessing the microbiome, the vast collection of microorganisms inhabiting the body, may help our quest to slow or reverse obesity and diabetes trends.  We'll assess the link between COVID-19 and obesity and diabetes. As always, a "Food for Thought 2023" centrepiece will be the panel discussions so key to stimulating rigorous and vigorous debate.

Our food system has failed us. A recent study investigating links between what we eat and non-communicable diseases (NCDs) in the US came to this conclusion: "Processed and ultra-processed foods dramatically increased over the past two centuries, especially sugar, white flour, white rice, vegetable oils, and ready-to-eat meals. These changes paralleled the rising incidence of NCDs".

Obesity and diabetes amount to twin pandemics moving from wealthy countries through the developing world. This heightens our urgency, since we know metabolic ill-health contributes not only to cardiovascular disease, but is linked to cancer, neurodegenerative disorders and mental illness – in fact most if not all NCDs.   

For three years, we've witnessed the destructive power of the COVID-19 pandemic. It was even more tragic for those with metabolic ill health. What the obesity and diabetes pandemics lack in COVID's lightning swiftness, they make up for in brute force, driving up health care costs while driving down quality of life for the afflicted.   

For Life & Health insurers seeking to reduce death claims, tackling non-communicable diseases spreading globally due to metabolic ill-health has become mission critical. Obesity and diabetes are the most pressing health challenges of our time.  

In 2016, the US launched its "moonshot" programme against cancer. Something similar is needed for metabolic disorders. I need only to consider prospects of 1.3 billion people with diabetes by 2050, a figure amounting to more than a tenth of humanity, to see why changing this trajectory is a challenge where we cannot afford to fail. 

A version of this article previously appeared in the Evening Standard.