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, even I was stunned by a recent study suggesting diabetes cases will more than double, hitting 1.3 billion people, by 2050.
Currently, more than 500 million men, women and children struggle with this life-threatening metabolic illness. In the UK, diabetes consumes more than 10% of the NHS budget, or some £14 billion annually.
In the US, the problem is more dire: one of every four dollars in US healthcare costs is spent on caring for people with diabetes, according to the US Centers for Disease Control and Prevention.
In these countries especially, obesity and diabetes have also contributed to a plateauing of life expectancy over the last decade, dragging down the hard-won gains made by advanced economies in the late 20th century.
As such, the problem of metabolic ill health has never been timelier. How to fix it is a question that affects our whole society – and which all major sources of public and private finance, from the government to the city, should be keenly set on answering.
Where to look for a solution
At the root of metabolic ill-health is insulin resistance, when muscle, fat and liver cells don’t respond well to the insulin that helps them take up glucose from the blood.
By reversing or improving insulin resistance, we know cardiovascular risk factors can improve. For example, 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.
Finding long-term remedies that succeed with broad populations has been difficult, largely because they’re linked to lifestyle factors (including advising people to simply eat less) and also focused on fat rather than refined carbohydrate reduction. This clearly hasn’t worked.
Our food system has also failed us. A recent study linked the exponential growth of ultra-processed foods over the last 200 years to the rising incidence of non-communicable diseases (NCDs).
While addressing these known shortcomings, we should also examine models of obesity that break from our traditional understanding and have the potential to help us see metabolic disease – and our responses to it – in fresh ways. Metabolic psychiatry, a new field aiming to treat mental health conditions including bipolar disorder, is just one area of progress we are watching with interest.
How to mobilise capital
For the past three years, we’ve witnessed the destructive power of the COVID-19 pandemic, a health crisis of epic proportions that demanded nothing less than a global response. It’s through a similar lens that we must view obesity and diabetes – diseases that amount to twin pandemics. What they may 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 those afflicted.
My industry has a big stake in succeeding here: for Life & Health insurers, tackling noncommunicable diseases due to metabolic ill-health is mission critical as we seek to better manage claims and help people live longer, healthier lives. But this challenge applies to every corner of society.
In 2016, the US launched its “Moonshot” programme to mobilise efforts – and both private and public finance – in the fight against cancer. Now, something similar is needed for metabolic disorders – on both sides of the Atlantic.
We are pleased to see that the US National Institutes of Health has provided $3.5million for clinical trials of a new approach to type-2 diabetes that focuses on reducing blood glucose elevations after eating and drinking.
Actual interventional trials such as these are what’s needed internationally if we are to change the trajectory of metabolic diseases, and without a pharma income stream, public and private financing will be essential to fund them. With the human and economic stakes so high, this is a challenge we cannot afford to fail.
John Schoonbee is Swiss Re Global Chief Medical Officer
