Predictions: what will obesity medicine look like in 2028?

I was fascinated by a recent article published in Obesity Pillars, asking members of the American Obesity Medical Association (OMA) leadership what they think obesity medicine will look like 5 years from now.

While many of the topics that these US obesity medicine leaders brought up were similar, including:

access and coverage of obesity medications
use of BMI to make a diagnosis or assessment of obesity
how much primary care doctors will be prescribing weight management medication
use of bariatric surgery as a treatment option

– what they actually predicted will happen was often completely different. There were even different opinions on what the prevalence of obesity in USA will be in 5 years, with predictions ranging from an increase to over 75%, to a decrease of overweight and obesity to 35%.

Naturally, after seeing these wide discrepancies in the American opinion, I asked this question to obesity medicine physicians across Canada: What will obesity medicine in Canada look like 5 years from now? (2028)

Here are some of the answers I received!

General:

All provinces and territories will recognize obesity as a chronic disease. (currently only seven do)
Legislation will protect people with obesity from discrimination in education, work, and healthcare.
We will have genetic risk scores that predict the risk of developing obesity.
Obesity medicine will be mostly in the hands of family doctors, pharmacists and online healthcare services.
Obesity medicine will be in the hands of multidisciplinary specialty clinics, including cardiologists, kidney doctors (nephrologists), and liver doctors (hepatologists).
We will move away from body mass index (BMI), with more focus on waist circumference and ethnic-specific weight criteria for diagnosis and management.
We will move away from BMI, and focus more on improvement in health as a reason for treatment.
There will be more public-driven campaigns to get provincial goverments to pay for obesity medications.
All health care providers will recognize obesity as a chronic disease (and not a lifestyle ‘choice’).
The focus of treatment will shift towards treating obesity earlier, based on better predictive models of those at risk.
With more effective obesity medications being available, there will be more focus on prevention of obesity-related health conditions.

On the prevalence of obesity:

The prevalence of obesity will begin to decrease.
The prevalence of adult obesity will increase to 40%.
Pediatric obesity prevalence will continue to increase.

On education:

Medical schools and residency programs will increasingly incorporate some degree of obesity education (currently there is very little).
Obesity will become core curriculum in every medical school.

On treatments:

Psychological interventions will be covered (paid for by insurance/government) for weight management.
A greater number of obesity medication choices will be available.
Obesity medications will for the most part be injectable treatments, given monthly or every 6 months.
There will be improved insurance coverage for obesity medications.
There will not be improved insurance coverage for obesity medications (neither public nor private), due to cost and weight stigma.
Older generations of obesity medications will be generic and avialable at lower cost, which will also improve accessibility.
There will be more experience and data using obesity medications in combination.
Newer obesity medications will probably surpass bariatric surgery in terms of efficacy.
The demand for bariatric surgery will increase, as obesity is increasingly accepted as a medical condition needing treatment.
The demand for bariatric surgery will decrease, resulting in shorter waiting lists, because more effective medications will be available.
There will be more bariatric surgery centers.

I’ll go on record here with my predictions as well! (which I generated before asking my colleagues)

Obesity prevalence will continue to increase in Canada.
Although there will be continued progress, we will still have a long way to go in conquering weight bias and discrimination. (Canada and globally)
With emerging data showing the benefit of obesity medication to improve obesity-related health issues, medication will become increasingly utilized as an important Pillar of treatment of obesity.
About 60% of private insurance plans will cover weight management medication (currently about a third of plans cover).
Public insurance will not yet cover obesity medication (but we will be close, maybe by 2030, when they may begin to cover obesity medication for people with specific health conditions associated with elevated weight, for improvement/risk reduction in that health condition, eg cardiovascular disease).
The number of bariatric surgeries in Canada per year will stay about the same as currently (due to lack of additional funding), but waiting lists for surgery will decrease (due to more effective obesity medications, and a little better access to these medications).

Stay tuned for 2028…. I’ll round back to this blog in 5 years and see how our predictions turned out! (and you know I will! :D)

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