A new way of thinking about metabolic health

On this episode of The McKinsey Podcast, Lars Hartenstein, partner at the McKinsey Health Institute, and Roberta Fusaro, an editorial director at McKinsey, discuss the findings from McKinsey’s recent research on obesity and metabolic health—specifically, the potential interventions for sparking a metabolic health revolution, the economic impact of improving outcomes, and the technologies that are emerging as the connective tissue between prevention and treatment.

The McKinsey Podcast is cohosted by Lucia Rahilly and Roberta Fusaro.

The following transcript has been edited for clarity and length.

Changing the conversation

Roberta Fusaro: What makes metabolic health and obesity such a pressing global issue today?

Lars Hartenstein: Right now, approximately a billion adults are living with obesity globally, and that’s because of many health effects that create a lot of diseases down the road. Therefore, obesity is a big focus for everybody who’s interested in global health. What has changed is we have new classes of drugs. For many years, we’ve treated obesity as an intractable condition. And now, it is a treatable disease. This changes the conversation and enables us to broaden it, because metabolic health is a much bigger notion than just obesity. Overall, I see this as a giant economic and health opportunity. It’s going to disrupt and create opportunities across different industries.

Roberta Fusaro: Which industries will be affected?

Lars Hartenstein: We can start with an individual consumer who is maybe very interested in metabolic health. They’re tracking their glucose levels continuously, so they could scan barcodes and so forth to get information about products at the grocery store.

The food industry is involved, as well as the broader wellness industry, to help folks along their journey toward metabolic health. And then there are the standard medical industries around pharmaceuticals, healthcare, and medtech devices.

Prevention and treatment

Roberta Fusaro: So, the impact is widespread. The report argues that we face a choice between two different paths: path one being treatment focused versus path two being prevention focused. Can you explain the difference between the two paths?

Lars Hartenstein: On path one, we follow the trail of innovation. There are these new drug classes, and they are adding health value and economic value in the sense that they enable us to treat obesity in a different way.

The focus of this path is for those who are already living with obesity or those who are overweight and face significant risks.

 Path two is altogether more ambitious. This is a big climb toward the metabolic health revolution. The ambition level is to deliver metabolic health for all. That means we can’t only build on the innovation we have. We need to mobilize investments and leadership across societies, different industries, government, education, and civil societies to change the environment we live in to allow us to be more metabolically healthy.

In our analysis, on path two, we’ve seen health benefits can be three to four times larger than if we were just looking at treating obesity.

Five ways to transformation

Roberta Fusaro: That sounds incredibly transformative. But we know that’s not going to happen automatically out of the blue. In the report, you talk about five big shifts that are needed to make path two a reality. The five levers: advancing science, improving transparency, using technology for personalization, aligning economic incentives, and driving societal change. Tell us a little bit more about these five shifts.

Lars Hartenstein: So—number one, advances in science. We don’t have a clear definition of what metabolic health is from a medical, scientific perspective. There’s no alignment. Therefore, we need to be able to clearly define what metabolic health means for everybody, not just for a person who is already not doing well. We need to define it on a spectrum from being metabolically unhealthy to optimal metabolic health, with all the different elements within that. These may include blood glucose, blood pressure, blood lipids, organ function of the kidneys, liver, and so forth.

Another shift we need is more transparency as individuals. Most people do not know how their metabolic health is. They may learn at some point when they’re running into trouble, but we don’t individually have transparency about our metabolic health. We know little aspects about our cholesterol, but when do we start testing for it? It depends on the country and environment; maybe at the age of 50. But it is also useful to talk about the metabolic health of a child, not only whether they’re obese or not, but how metabolically healthy they are. Are they already building insulin resistance early on in their life?

So, transparency is a notion that applies to everyone, also to so-called healthy individuals, which can be tricky.

The third one is technology and innovation because how do we bring this to individuals? We need offerings that work for them. We need to change how we talk about our metabolic health. This requires consumer-oriented technology innovation that allows people to engage and identify ways to optimize and improve their metabolic health, be it through physical activity, the way they eat, or sleep, and other ways.

Fourth, and perhaps the trickiest one: We need to change some things in terms of our economic setup so that there are better incentives for making better choices in life, be it how we move or how we eat. They can be made affordable, available, and attractive. We’re all struggling with many attractive choices that are not necessarily good for our health. Everybody is facing this; it’s a reality.

And then the last shift is to change communities and societies through education and engagement. A lot of this is already starting to happen.

Roberta Fusaro: How do we start to achieve all these states? Who needs to get involved?

Lars Hartenstein: The answer is everybody needs to get involved. It needs to be a societal priority and private sectors across different industries have a role to play, but certainly also government and civil society. And frankly, all of us as individuals.

It is a true moonshot that is cross-sector, cross-society, and it is needed if we want to accomplish a metabolic health revolution. The case we are making in our report at the McKinsey Health Institute is to say it’s worth it. The return on investment is huge. And therefore, it merits attention.

Roberta Fusaro: All the shifts seem intertwined; can you give us an example of something that’s working right now?

Lars Hartenstein: An unexpected one is a government initiative in Singapore to materially increase the physical activity of its population. For ten years now, Singapore has been successfully doing a step challenge, with incredibly high numbers of participants, to increase the activity of an increasingly sedentary population. That contributes to metabolic health and is a very interesting example.

Another simple example is Yuka, an app that scans product barcodes in grocery stores. You can see exactly how healthy the food you’re about to buy is. It influences what you buy at the point of purchase.

Another unique example is of a reinsurance company, Swiss Re. The company publishes and pursues thought leadership on metabolic health and insulin resistance. You wouldn’t necessarily expect this, but they have identified that ill metabolic health is a major potential risk to their portfolio. They are thinking about what, as a reinsurer of other companies like life insurance companies, they can do about this risk. That’s a different kind of stakeholder stepping up and doing something in the field of metabolic health.

What’s also interesting is the notion of food as medicine. This is happening in the United States, where in some situations food is being prescribed to people instead of, or in addition to, drugs. That sets new types of incentives between those who are selling the food and the insurance companies. That’s a very encouraging example.

Roberta Fusaro: Lars, thinking about those five shifts, do they all need to happen at once?

Lars Hartenstein: I think all five are needed. But we can’t run before we can walk. It’s not like you’ll pull a switch. It’s more like a long journey. That’s how to think about these shifts. There are things to start with, and then things to follow through. All of them are needed, but it will take time and that’s OK.

Since you liked Yuka, I wanted to emphasize something from a consumer perspective, which is about this continuous biofeedback. There’s emerging evidence that if you know how well your body is functioning on a particular thing, that has implications, at least for a number of people, for how they continue glucose monitoring. Measuring how much glucose you have in your blood is originally something for diabetic patients, or at least for those who already have metabolic health conditions. But it’s increasingly also used by “healthy individuals,” as a consumer value proposition, to monitor how they’re doing, and to learn about individual metabolism. This can change behavior.

What we know about GLP-1 medications

Roberta Fusaro: One of the shifts that’s making headlines is the surge of GLP-1 medications. These medications are being called a breakthrough. Can we talk a little bit about what that means, and what’s the promise?

Lars Hartenstein: These medications are transformative. There are still a lot of things we don’t know about them, but we know they are transformative because they enable their users to lose more than 10 percent of their body weight; and even 20 percent for some.

Given how important too much weight is as a risk factor for so many diseases, that’s tremendous news. GLP-1 has enabled us to shift away from unproductive conversations about everybody being responsible for their weight. We blame those who are overweight. But now we have tools that enable changes in a different way. We now recognize obesity as a condition or disease. This enables us to discuss what experts have known for a long time. What are the real causes of obesity, and what can we do about it? These drugs help open up this conversation about metabolic health.

Having said that, there are a lot of things we don’t know about this drug class yet. We know that, at the moment, GLP-1 is on track to be probably the biggest drug class we have ever seen.

Of course, predictions vary. We don’t fully know its long-term effectiveness. We don’t know its long-term safety profile in healthy individuals. The drugs have been used for many years in diabetic patients, but not in healthy individuals.

So, we don’t know what major problems to watch out for. There are some, but for now we haven’t picked up big concerns that would change the picture I’ve just characterized. On the upside, these drugs may give you a sense of your own satiety and slow food processing via the brain. This may also have positive implications for other things. They’re also studied in relation to alcohol consumption, so we may still learn a lot of things about this drug class. Definitely a thing to watch for.

Getting educated about metabolic health

Roberta Fusaro: But GLP-1 is just one piece of a larger puzzle. You’d also mentioned the importance of transparency in tracking. I’m thinking about policy, education, and community engagement; that last shift you talked about earlier. What role do they play in making prevention the easier default path out of the two we’ve outlined in the report?

Lars Hartenstein: Let me give you a simple example. I remember exactly one class from my school days when we were educated about our metabolic health in a meaningful, practical way. I still remember our biology teacher gave us a list of foods and asked us to underline healthy and unhealthy foods with different colors. That was the only class, so I think there is tremendous opportunity to do more and embed metabolic health in education. That of course includes the type of meals that are provided in schools.

Employers also have a big role to play because many people eat a meal a day at their office. How much you move about is very much influenced by your employer and your working conditions in the office. Employers have a chance to improve or influence working conditions; therefore, every company provides an ecosystem that can be more or less conducive to metabolic health across industries.

Roberta Fusaro: It’s all those little things that people aren’t thinking about. If you could speak directly to business leaders and individuals, what’s the one action you’d urge them to take, starting tomorrow?

Lars Hartenstein: I think two angles. For individuals, there’s an obligation to get more educated. It’s good to understand metabolic health and what drives it and then make choices. That’s an important thing for individuals—to try to understand more about how your body functions, to get more educated and try and distinguish fads from actual information.

For leaders of organizations, there’s so much opportunity. I’d say don’t be afraid to be the first because there’s momentum being driven by enormous investments flowing into the metabolic health space. It’s worthwhile to take some calculated risks and think about your industry and what this means for you. Spot the opportunities and try to seize them because the underlying trends are very strong.