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Tag: chronic disease

  • Kennedy, RealFood.gov misrepresents chronic health spending

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    Have you seen the Mike Tyson ad telling people to eat “real food?” The black-and-white spot that debuted during the Super Bowl is the latest promotion for the federal government’s new dietary guidelines. 

    With a quick scroll, football watchers who visited the website in the ad would have encountered the statistic that “90% of U.S. healthcare spending goes to treating chronic disease — much of which is linked to diet and lifestyle.” 

    This statistic also appeared in the dietary guidelines and on the CDC’s website. Health and Human Services Secretary Robert F. Kennedy Jr. said it this way in his Jan. 7 announcement: “The CDC reports that 90% of healthcare spending treats chronic disease.” 

    This number grabbed podcaster Michael Hobbes’ attention. “I couldn’t find anyone fact-checking this number,” Hobbes said on the Jan. 30 episode of “Maintenance Phase,” a podcast that digs into the science behind health and wellness trends.

    No worries — PolitiFact is here to answer the call! 

    The 90% figure has roots in a 2017 report by the Rand Corp., a nonpartisan research organization. But one of the researchers told PolitiFact that the claim, as stated by Kennedy and RealFood.gov, didn’t accurately reflect their findings. 

    The Rand report calculated all health spending on people with chronic illnesses, which includes a majority of Americans. It did not isolate the total spending on treating chronic illness itself.

    Here’s another way to think about it: If someone with asthma broke a leg, got glasses or picked up antibiotics, that all counted as spending on a person with a chronic disease — even if it’s not treating the asthma. 

    The department did not respond to our request for comment. HHS relayed the research more accurately in the dietary guidelines document and CDC website. 

    What the report really said

    A trail of footnotes in the dietary guidelines leads to the 2017 Rand report.

    Rand used data from an annual government-run survey. The Medical Expenditure Panel Survey asks families to report a year’s worth of personal health care use and spending — including doctor’s visits, prescriptions and hospital stays. It also collects data on people’s health conditions, which can be categorized as chronic or not chronic.

    The sample size has varied over the years, ranging from about 18,000 to 37,000 people. Experts said it is among the best data sources on personal health spending. 

    The report defines a chronic condition as a mental or physical health condition lasting over a year that either requires functional restrictions or ongoing medical treatment. Many conditions fall into this category, including hypertension, diabetes, depression, anxiety, osteoarthritis, asthma, heart disease, high cholesterol, and cancer. 

    Using survey data collected in 2014, Rand researchers estimated almost 60% of Americans had at least one chronic condition. 

    Then they looked at people’s health care costs, including payments made by insurers and out-of-pocket costs. 

    According to Rand, spending on the 60% of people with one or more chronic conditions made up 90% of all spending. The 40% with no chronic illnesses made up 10% of the spending. 

    “A person in a year spends or incurs health care costs for multiple related things,” said Christine Buttorff, a Rand health policy researcher and study co-author. “It could be their chronic disease, but it also could be something as simple as an acute illness where they had to go to the doctor or go to the emergency room for something totally unrelated to the chronic disease. So our estimates lump all of that together.” 

    The claim that 90% of U.S. health care spending goes to treating chronic disease is “not an accurate reflection of our report,” Buttorff said. 

    Limited data on chronic illness treatment spending

    Estimating how much Americans spend on treating chronic illness is harder. It typically requires using insurance claims data, which is spread across government databases and private insurers. 

    It can be difficult to link expenses and conditions. If, for example, a person with asthma is hospitalized with pneumonia, is that part of their chronic disease treatment or an acute case? If a person pays to see a psychiatrist but has both anxiety and depression, which diagnosis is that cost linked to? 

    University of Washington researchers have been tackling this question. The university’s Institute for Health Metrics and Evaluation in 2025 analyzed personal health care spending from 2010 to 2019 on 148 health conditions, without distinguishing chronic illnesses from other ailments. 

    In 2019, the top three most expensive conditions were Type 2 diabetes ($143.9 billion), musculoskeletal disorders such as joint pain and osteoporosis ($108.6 billion), and oral disorders such as cavities and orthodontia ($93 billion). 

    “Reality is, we spend a ton of money on things that people don’t associate with chronic diseases,” said Joseph L. Dieleman, a University of Washington health metrics sciences professor and study co-author.

    PolitiFact did not find any studies since 2018 that looked specifically at past chronic disease treatment spending. 

    One recent report tried to model future spending on chronic disease. A 2025 report from GlobalData and the Partnership to Fight Chronic Disease estimated an average of $2.2 trillion annually in medical costs over the next 15 years. 

    Given that current health care spending is over $5.3 trillion annually, that rate of spending would put chronic disease spending around 42% annually. 

    Rising chronic illness burden is not all related to diet and lifestyle

    U.S. chronic illness rates are rising.

    In 2010, about 50% of Americans had at least one chronic condition. The number has climbed closer to 75% in recent years, boosted in part by better diagnostics and longer lifespans. 

    “Chronic conditions linked to lifestyle choices such as physical inactivity or diet are a huge issue in the U.S., even if their use of this statistic isn’t quite right,” Buttorff said. 

    Several of the most common chronic conditions — hypertension, Type 2 diabetes, heart disease, and high cholesterol — have been linked to diet and lifestyle related risk factors. 

    Others can’t always be linked to lifestyle, including mental health conditions, asthma, Type 1 diabetes, cancer, rheumatoid arthritis, Alzheimer’s disease, and dementia.

    Our ruling

    Kennedy and his department said that 90% of health care spending is for treating chronic disease.

    The statistic is based on all health spending on people with chronic diseases, not spending on treatment itself. 

    A majority of Americans have chronic illnesses, so it’s likely the real number is high. We were unable to find a reliable report that isolated chronic illness spending in the past few years, but a predictive report estimated it could be around 2.2 trillion annually, which would be less than half of current health spending. HHS did not provide evidence to support the claim about treatment spending. 

    We rate this statement False. 

    Staff Researcher Caryn Baird contributed to this report

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  • America May Be Missing Out on a Better COVID Treatment

    America May Be Missing Out on a Better COVID Treatment

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    Japan is home to an untold number of conveniences and delights that American consumers regularly go without: Faster public transit! Better sunscreen! Lychee KitKats! But as we head into sick season, one Japanese invention would be especially welcome on the U.S. market: an antiviral pill that appears to shorten COVID symptoms, might protect against chronic disease, and doesn’t taste like soapy grapefruit.

    Ensitrelvir, a drug made by the Osaka-based pharmaceutical company Shionogi, was conditionally approved in Japan last November. Like Paxlovid, ensitrelvir works by blocking an enzyme that the SARS-CoV-2 virus uses to clone itself inside the human body. But for the millions of Americans who will likely get COVID in the coming months, the new drug is almost certain to be out of reach. In 2021, Pfizer waited just five weeks for Paxlovid to receive its emergency use authorization. But ensitrelvir is still sitting in the approval pipeline, stuck in another round of clinical trials that may run well into 2024.

    Existing data (not all of which have been peer-reviewed) show that people with COVID who promptly take ensitrelvir, marketed as Xocova in Japan, test negative about 36 hours faster than people who take a placebo. Fever, congestion, sore throat, cough, and fatigue disappear about a day earlier too. Even smell and taste loss appear to resolve more quickly. The company also has some tentative evidence suggesting that the drug can help protect patients from developing long COVID.

    These findings were not enough for the FDA, but they are extremely encouraging, says Michael Lin, a bioengineering professor at Stanford University who works on drugs for treating coronavirus infections. Xocova “looked as good or a little bit better than Paxlovid,” he says. For instance, Pfizer’s clinical trials failed to show that Paxlovid clears symptoms any faster than a placebo in people who aren’t at high risk of developing severe COVID. Shionogi’s did just that.

    Reshma Ramachandran, a family physician at Yale, told me that if the early Xocova results hold up in additional trials, she’d be inclined to prescribe it to her vaccinated patients in place of Paxlovid, simply because the evidence supporting its use is more direct. She said she’d be especially keen to give Xocova if the long-COVID finding can be reproduced.

    Read: Rebound COVID is just the start of Paxlovid’s mysteries

    No lab or pharmaceutical company has yet published a study that pits Xocova against Paxlovid head-to-head in treating COVID, so it’s impossible to say with certainty which one is better. You can’t draw conclusions just by comparing Pfizer’s clinical-trial results with Shionogi’s: Their drugs were tested in different populations with different levels of immunity at different points in the pandemic when different variants were circulating. Shionogi also required clinical-trial participants to start taking Xocova within three days of feeling sick, whereas patients in the Paxlovid trials began their treatment up to five days after symptoms started. Daniel Griffin, an infectious-disease specialist at Columbia University, told me that timing is everything when it comes to antivirals: In general, the sooner a patient starts taking a drug, the better it works.

    A Pfizer spokesperson told me that the efficacy and adverse-event rates of Paxlovid and Xocova cannot directly be compared, and emphasized Paxlovid’s power to stave off hospitalization and death. (Xocova’s clinical trials were not able to provide meaningful data on those outcomes, which are now much rarer than they were in 2021.) “Since the beginning of the pandemic, we’ve known it will take multiple treatment options and preventative measures for the world to overcome the challenges of COVID-19,” he said in an email.

    Even if Xocova turns out to be no more effective than Paxlovid, it still has several practical advantages. For one thing, it is literally easier to swallow. Paxlovid must be taken twice a day for five days, and each time you have to gulp down three pills: two containing nirmatrelvir (which actively combats the virus), plus one containing ritonavir (which slows the metabolism of nirmatrelvir, keeping it in your system longer). Xocova is taken just once a day for five days, and after the first three-pill dose, it’s one pill at a time. Paxlovid can also cause dysgeusia, a.k.a. Paxlovid mouth—a sour, metallic, taste that may last for hours after swallowing. Xocova seems to taste just fine.

    Read: Paxlovid mouth is real—and gross

    Experts hope that Xocova will be more widely accessible than Paxlovid, too. Pfizer announced last week that the price of Paxlovid will soon rise from $529 to $1,390 when the drug enters the commercial market. Shionogi hasn’t decided on Xocova’s price in the U.S. market, but there’s reason to think it will be cheaper. In Japan, the only market where both drugs are currently available, a course of Xocova costs 51,851 yen (about $346), and Paxlovid is nearly double the price, at 99,027 yen (about $661). And whereas Japanese health authorities—like those in the U.S.—have recommended Paxlovid for use by patients at high risk of severe COVID, Xocova has been shown to benefit people with infections regardless of their risk status. Finally, whereas Paxlovid’s reach is limited by its many harmful interactions with other drugs, Xocova might pose fewer problems because it doesn’t contain ritonavir, Lin told me. The newer drug’s interaction profile is still being ironed out, but a company spokesperson pointed me to a running list from the University of Liverpool. (According to that source, you should avoid taking Paxlovid and Adderall at the same time—but going on Xocova is fine.)

    Xocova may also sidestep one of patients’ most commonly voiced concerns about Paxlovid: that it will make their COVID go away and then return. One recent observational study of COVID patients found that symptoms rebounded among 19 percent of Paxlovid takers, versus 7 percent of nontakers. By contrast, Shionogi has reported that symptom rebound was vanishingly rare in its clinical trials of Xocova.

    Read: Inside the mind of an anti-Paxxer

    Neither Shionogi nor the FDA would give me an estimate of Xocova’s approval timeline in the U.S., but earlier this year, the company’s CEO estimated that it might get the nod in late 2024. This past spring, the FDA gave the drug “fast track” status, which means Xocova will be eligible for an expedited review process once the company submits its application. (The FDA declined to comment on Xocova’s prospects for approval, citing federal disclosure laws.) Until then, it’s running more clinical trials in the U.S. and abroad. One of them, conducted in partnership with the National Institutes of Health, will evaluate the drug’s performance in hospitalized patients. Another will evaluate its efficacy against long COVID, among other things.

    To some experts, Xocova’s track is not nearly fast enough. David Boulware, an infectious-disease specialist at the University of Minnesota, told me that the FDA appears to be “slow walking” the approval process. Lin, too, would like to see more action. But it’s not clear how, exactly, that would happen. “I think the FDA is doing all that they can,” Ramachandran said; an emergency use authorization for Xocova isn’t a realistic option, given that the COVID public-health emergency has expired. Plus, Griffin said, caution is prudent when dealing with new drugs. “We want to make sure it’s safe. We want to make sure it’s effective,” he told me. “We also don’t want to fall into the trap we fell in with molnupiravir,” an earlier antiviral that looked promising at first, but ultimately offered disappointing benefits to COVID patients (though a surprising utility for cats).

    If the FDA were to approve Xocova tomorrow, demand for Paxlovid likely wouldn’t disappear, experts told me. Lin said the two drugs might compete for users, like Motrin and Aleve. People who are in danger of being hospitalized or dying from COVID could still opt for Paxlovid. “But there’s a much larger group of people who just feel crummy, and they just want to feel better,” Griffin told me. For them, Xocova could make more sense. They just won’t have a choice until the FDA approves it.

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    Rachel Gutman-Wei

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  • Americans Eat Obscene Amounts of Protein. Is It Enough?

    Americans Eat Obscene Amounts of Protein. Is It Enough?

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    For years, the American approach to protein has been a never-ending quest for more. On average, each person in the United States puts away roughly 300 pounds of meat a year; we are responsible for more than a third of the multibillion-dollar protein-supplement market. Our recommended dietary allowance, or RDA, for protein is 0.8 grams per kilogram of body weight per day—a quota that a 160-pound person could meet with a couple of eggs in the morning and an eight-ounce steak at night. American adults consistently eat well above that amount, with men close to doubling it—and recent polls show that millions of us want to increase our intake.

    The American appetite for protein is, simply put, huge. And still, Jose Antonio thinks we’re getting nowhere near enough.

    The RDA of 0.8 grams per kilogram is “nothing, literally nothing,” Antonio, a health-and-human-performance researcher at Nova Southeastern University, in Florida, told me. “Most of my friends get that at breakfast.” In an ideal world, Antonio said, totally sedentary adults should consume at least twice that; people who seriously exercise should start with a minimum of 2.2 grams per kilogram, and ramp their levels up from there. (Antonio is also a co-founder of the International Society of Sports Nutrition, which has received sponsorships from companies that sell protein supplements.)

    In Antonio’s pro-protein world, people would be fitter, more energetic, and suffer less chronic disease; they’d build muscle more efficiently, and recover faster from workouts. There is no definitive cap, in his view, on how much protein people should strive for. The limit, he said, is “How much can a human consume in a single day?”

    Among nutritionists, Antonio’s viewpoint is pretty fringe. There is, other experts told me, such a thing as too much protein—or at least a point of rapidly diminishing returns. But researchers don’t agree on how much protein is necessary, or how much is excessive; they’ve reached no consensus on the extent of its benefits, or whether eating extra servings can send our health into decline. Which leaves Americans with no protein ceiling—and plenty of room for our protein hunger to grow, and grow, and grow.

    Read: You’re probably drinking enough water

    Not having enough protein is clearly very bad. Protein is essential to the architecture of our cells; we rely on it for immunity and hormone synthesis, and cobble it together to build muscles, skin, and bone. Among the three macronutrients—the other two being carbohydrates and fat—protein is the only one that “we need to get every day,” Joanne Slavin, a nutrition researcher at the University of Minnesota, told me. Nearly half of the 20 amino-acid building blocks that make up protein can’t be produced in-house. Go without them for too long, and the body will start to break its own tissues down to scavenge the molecules it needs.

    That state of deficiency is exactly what the protein RDA was designed to avoid. Researchers decided the threshold decades ago, based on their best estimations of the amount of protein people needed to balance out their loss of nitrogen—a substance that’s in amino acids but that the body can’t itself make. The average person in the study, they found, needed 0.66 grams of protein per kilogram of body weight to avoid going into the red. So they set the guidelines at 0.8, a level that would keep the overwhelming majority of the population out of the deficiency zone. That number has stuck in the many years since, and Slavin, who has sat on the Dietary Guidelines Advisory Committee, sees no reason for it to change. People who are expending extra energy on growth, or whose muscles are taxed by exercise or aging, might need more. But for the typical American adult, Slavin said, “I think 0.8 is the right number.”

    Others vehemently disagree. The current standard is “not enough to support everyday living,” Abbie Smith-Ryan, a sports-nutrition expert at the University of North Carolina at Chapel Hill, told me. Adults, she and others told me, should be getting more like 1.2 or 1.6 grams per kilogram at baseline. Their beef with the RDA is twofold. For one, the original nitrogen analyses oversimplified how the body metabolizes and retains protein, Stuart Phillips, a protein researcher at McMaster University, in Canada, told me. And second, even if the 0.8 number does meet our barest needs, “there’s a much more optimal amount we should be consuming” that would further improve our health, Katie Hirsch, an exercise physiologist at the University of South Carolina, told me. (I reached out to the USDA, which helps develop the U.S.’s official Dietary Guidelines, about whether the RDA needed to change; a spokesperson referred me to the National Academy of Sciences, which said that the RDA was last reviewed in 2002, and was expected to be reviewed again soon.)

    If Hirsch and others are right, even people who are slightly exceeding the government guideline might not be maximizing their resilience against infections, cardiovascular disease, metabolic issues, muscle loss, and more. People who are working out and still eating the measly 0.8 grams per kilogram per day, Antonio told me, are also starving themselves of the chance to build lean muscle—and of performance gains.

    But the “more” mentality has a limit. Experts just can’t agree on what it is. It does depend on who’s asking, and their goals. For most people, the benefits “diminish greatly” past 1.6 grams per kilogram, Phillips told me. Smith-Ryan said that levels around 2.2 were valid for athletes trying to lose weight. Antonio is more liberal still. Intakes of 3.3 or so are fair game for body builders or elite cyclists, he told me. In one of his studies, he had athletes pack in 4.4 grams of protein per kilogram of body weight for weeks—a daily diet that, for a 160-pound person, would require three-plus pounds of steak, 16 cups of tofu, or 89 egg whites.

    Read: The Jordan Peterson all-meat diet

    That is … a lot of protein. And most of the other experts I spoke with said that they didn’t see the point, especially for Americans, who already eat more protein than people in most other countries. “There’s very little evidence that more is better,” Marion Nestle, a nutrition researcher at New York University, told me.

    The worry isn’t necessarily that tons of protein would cause acute bodily harm, at least not to people who are otherwise in good health. Over the years, researchers have raised concerns that too much protein could damage the kidneys or liver, leach calcium from the bones, or even trigger cancer or early death—but the evidence on all fronts is, at best, mixed. In Antonio’s high-protein studies with athletes, he told me, their organs have remained in tip-top shape. The known drawbacks are more annoying than dangerous: High-protein diets can raise the risk of bloating, gas, and dehydration; burning through tons of protein can also make people feel very, very hot. Roughly a quarter of the participants in Antonio’s ultra-high-protein study dropped out: Many of them felt too full, he told me, and no longer enjoyed food. One volunteer was so plagued by night sweats by the close of the trial, he said, that she could no longer fall asleep.

    Whether many years of an ultrahigh-protein lifestyle could be harmful is less clear. Native communities in the Arctic have healthfully subsisted on such diets for generations, but they’ve had a long time to adapt; those in Western society might not fare the same.

    Over the years, it’s gotten easy to interpret protein’s apparent lack of immediate downsides as permission to reach for more. But for now, many experts would rather err on the side of moderation. “Would I feed that much to one of my relatives? I would not,” Susan Roberts, a nutrition researcher at Tufts University, told me. Even if protein itself turns out not to be hard on the body, the foods it comes in still might be, including processed meats or sugary “high-protein” powders, shakes, cookies, chips, and bars. People pounding protein also risk squeezing other nutrients out of their diet, Roberts told me—whole grains, nuts, fruits, and vegetables, all of them packed with fiber, a vital ingredient that nutritionists actually do agree we lack.

    Read: Selling the fantasy of high-protein everything

    Plus, Slavin argued, there’s a point at which excess protein becomes a straight-up waste. When people eat more than about 20 to 40 grams of protein in a single sitting, their protein-processing machinery can get overwhelmed; the body eliminates the nitrogen as waste, then treats the rest as it would a carbohydrate or fat. “You can get fat on proteins just like you can get fat on carbohydrates,” Slavin told me. Which makes overdoing protein, in her eyes, “expensive and stupid.”

    The excess can have consequences beyond what our own bodies endure. Meat production drives greenhouse-gas emissions and uses up massive tracts of land. And Maya Almaraz, a food-systems researcher at Princeton, has found that the majority of the nitrogen pollution in wastewater is a by-product of our diets. The more protein we eat, the more we might be feeding toxic algal blooms.

    There’s no denying that protein deficiency is a problem in many parts of the world, even within the United States. Protein sources are expensive, putting them out of reach of poor communities. Meanwhile, many of the people who worry most about getting enough of it—the wealthy, the ultra-athletic, the educated—are among those who need to supplement the least. Experts, for now, may not agree on how much protein is too much for individuals. But if appetite is all we have to curb our intake, going all in on protein might create problems bigger than anything we’ve had to stomach so far.

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    Katherine J. Wu

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  • Ozempic in Teens Is a Confusing Mess

    Ozempic in Teens Is a Confusing Mess

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    Somehow, America’s desire for Ozempic is only growing. The drug’s active ingredient, semaglutide, is sold as an obesity medication under the brand name Wegovy—and it has become so popular that its manufacturer, Novo Nordisk, recently limited shipments to the U.S. and paused advertising to prevent shortages. Its promise has enticed would-be patients and set off a pharmaceutical arms race to create more potent drugs.

    Part of the interest stems from Ozempic’s potential in teens: In December, the FDA approved Wegovy as a treatment for teenagers with obesity, which affects 22 percent of 12-to-19-year-olds in the United States. The drug’s ability to spur weight loss in adolescents has been described as “mind-blowing.” In January, in its new childhood-obesity-treatment guidelines, the American Academy of Pediatrics (AAP) recommended that doctors consider adding weight-loss drugs such as semaglutide as a treatment for some patients.

    But although many doctors and obesity experts have embraced semaglutide as a treatment for adults, some are concerned that taking it at such a young age—and at such a precarious stage of life—could pose serious risks, especially because the long-term physical and mental-health effects of the medication are still unknown. Others, however, believe that not using this medication in adolescents is riskier, because obesity makes teens vulnerable to serious health conditions and premature death. In part because of the apprehension among doctors, prescriptions for semaglutide in teens are not taking off like they are for adults. At this point, whether these drugs will ever catch on as a treatment for teens remains deeply uncertain.

    Semaglutide isn’t just effective for teens; it may be even more effective than it is in adults. In a large Novo Nordisk–funded study published in The New England Journal of Medicine, “the degree of weight reduction in adolescents was better than what was observed in the adult trials,” Aaron S. Kelly, a co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School, told me. In another Novo Nordisk–funded study published last week, a team led by Kelly showed that the drug, combined with counseling and exercise, nearly halved the number of teens with obesity after they received 68 weeks of treatment. Both for adolescents and adults, the weekly injection doesn’t “magically melt away body fat,” Kelly said; instead, it works by triggering a sense of fullness and quieting hunger pangs.

    Teenagers’ experience with obesity is different—in some ways more intense—than that of older people. Puberty is a time of lots of growth and development, so the body fights off attempts at weight loss “with every mechanism that it has,” Tamara Hannon, a pediatric endocrinologist at the Indiana University School of Medicine, told me. Teenagers may also have less control than adults over what they eat or how much activity they get, because these are largely circumscribed by their family and school, as well as by social pressure to conform to how their peers eat. “Making good choices means doing something different than the majority of the other kids,” Hannon said. “At every corner, there’s something that is in direct opposition to losing weight.”

    Because obesity is a chronic disease, developing it early can be devastating. In many cases, it can result in illnesses such as type 2 diabetes and fatty liver at a young age. Children with obesity are five times more likely than their peers to have it in adulthood; as teens with obesity become adults with obesity, they can “develop very, very aggressive disease,” Fatima Stanford, an obesity-medicine physician at Massachusetts General Hospital and Harvard Medical School, told me. Weight-loss drugs give doctors the ability to intervene before the effects of obesity snowball, she said, which is why AAP’s new childhood-obesity guidelines advocate for using them as part of early, aggressive treatment—along with many hours of in-person health and lifestyle therapy. Used early enough, semaglutide or other medications could possibly reroute the trajectory of a teenager’s entire life.

    But semaglutide could also possibly throw a teen’s trajectory off course. Because treatment is considered a lifelong endeavor—stopping usually leads to rapid weight regain—adolescents who start the medication will be taking it for many decades. “We have no way of knowing whether these drugs, used so early in life for so long, could have unanticipated adverse effects,” David Ludwig, an endocrinologist at Boston Children’s Hospital, told me. Although adults face many of the same unknowns, the risks for teens could be more severe, because their body and brain are in constant flux. Of particular concern are the drug’s potential impacts on physiological changes specific to adolescence. “We need to keep an eye on pubertal development and menstrual history for girls,” Hannon said. In addition, the drugs can lead to unsavory side effects such as gastrointestinal issues and may have other impacts, including significant muscle loss and rewiring of the brain’s reward circuitry. Scientists are just beginning to understand these effects; at this point, only two major studies have been conducted on semaglutide in teens, and neither has involved a long follow-up period.

    The repercussions of semaglutide treatment on mental health, an important aspect of obesity care, are even less understood. Teens are “more likely than an adult to have intermittent access to medication,” Kathleen Miller, an adolescent-medicine specialist at Children’s Minnesota hospital, told me—and skipping several doses in a row could pose physical and well as psychological risks. Another concern is that the overall effect of taking semaglutide—a decreased appetite, which leads to eating less—is essentially the same as that of dieting. When teens go on very restrictive diets, whether or not they involve weight-loss medications, “we know that may be harmful to their mental health and promote disordered eating,” Hannon said. Because their brain is so plastic during puberty, “there’s a risk of ingraining those patterns in adolescence,” Miller said.

    With so many unknowns, would teens with obesity be better off avoiding semaglutide? At least for now, many pediatricians are reluctant to prescribe it. “The idea of using anti-obesity pharmacotherapy was challenging even in adults a couple of years ago,” says Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association; acceptance of its role in pediatric care is even further behind. But denying teens the drug, she told me, is the biggest risk: Teens develop an unhealthy mentality about their body when they don’t get help losing weight. Explaining to a teen that obesity is not their fault, and correcting the underlying biological issue with medication or other treatment, helps them to develop “a better body image about themselves,” she said.

    None of the experts I spoke with flat-out said that semaglutide should never be used in adolescent treatment. Even those who were wary of the drug acknowledged that it might be medically appropriate in teens who really struggle with their weight and have little success losing it through any other means. That argument may only strengthen as more convenient drugs—or those with fewer side effects—are approved for teen use. This week, both Novo Nordisk and Pfizer announced that pill versions of these medications were successful in early trials.

    Even without all of the answers on how this drug might affect teens in the long term, Fitch predicted that “the uptake of semaglutide and other anti-obesity medications in pediatric clinical care will be slow and gradual.” Eventually, they may come to be seen as just one of several weight-loss tools to help set up kids for healthier lives. Treating adolescent obesity shouldn’t be an “either-or” choice, Ludwig said: “It’s everything-and.” He has proposed that combining semaglutide with a low-carbohydrate diet, for example, could have synergistic effects on adolescent weight loss.

    For the foreseeable future, semaglutide isn’t poised to take off for teens in the way that it has for adults. In spite of all the hype surrounding Ozempic, experts and their patients are left with a difficult choice based on different assessments of risk: what might happen if teens are treated with drugs, and what might happen if they’re not. Either way, teenagers have the most to benefit—and the most to lose.

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    Yasmin Tayag

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  • The COVID Emergency Is Ending. Is Vaccine Outreach Over Too?

    The COVID Emergency Is Ending. Is Vaccine Outreach Over Too?

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    Stephen B. Thomas, the director of the Center for Health Equity at the University of Maryland, considers himself an eternal optimist. When he reflects on the devastating pandemic that has been raging for the past three years, he chooses to focus less on what the world has lost and more on what it has gained: potent antiviral drugs, powerful vaccines, and, most important, unprecedented collaborations among clinicians, academics, and community leaders that helped get those lifesaving resources to many of the people who needed them most. But when Thomas, whose efforts during the pandemic helped transform more than 1,000 Black barbershops and salons into COVID-vaccine clinics, looks ahead to the next few months, he worries that momentum will start to fizzle out—or, even worse, that it will go into reverse.

    This week, the Biden administration announced that it would allow the public-health-emergency declaration over COVID-19 to expire in May—a transition that’s expected to put shots, treatments, tests, and other types of care more out of reach of millions of Americans, especially those who are uninsured. The move has been a long time coming, but for community leaders such as Thomas, whose vaccine-outreach project, Shots at the Shop, has depended on emergency funds and White House support, the transition could mean the imperilment of a local infrastructure that he and his colleagues have been building for years. It shouldn’t have been inevitable, he told me, that community vaccination efforts would end up on the chopping block. “A silver lining of the pandemic was the realization that hyperlocal strategies work,” he said. “Now we’re seeing the erosion of that.”

    I called Thomas this week to discuss how the emergency declaration allowed his team to mobilize resources for outreach efforts—and what may happen in the coming months as the nation attempts to pivot back to normalcy.

    Our conversation has been edited for clarity and length.

    Katherine J. Wu: Tell me about the genesis of Shots at the Shop.

    Stephen B. Thomas: We started our work with barbershops and beauty salons in 2014. It’s called HAIR: Health Advocates In-Reach and Research. Our focus was on colorectal-cancer screening. We brought medical professionals—gastroenterologists and others—into the shop, recognizing that Black people in particular were dying from colon cancer at rates that were just unacceptable but were potentially preventable with early diagnosis and appropriate screening.

    Now, if I can talk to you about colonoscopy, I could probably talk to you about anything. In 2019, we held a national health conference for barbers and stylists. They all came from around the country to talk about different areas of health and chronic disease: prostate cancer, breast cancer, others. We brought them all together to talk about how we can address health disparities and get more agency and visibility to this new frontline workforce.

    When the pandemic hit, all the plans that came out of the national conference were on hold. But we continued our efforts in the barbershops. We started a Zoom town hall. And we started seeing misinformation and disinformation about the pandemic being disseminated in our shops, and there were no countermeasures.

    We got picked up on the national media, and then we got the endorsement of the White House. And that’s when we launched Shots at the Shop. We had 1,000 shops signed up in I’d say less than 90 days.

    Wu: Why do you think Shots at the Shop was so successful? What was the network doing differently from other vaccine-outreach efforts that spoke directly to Black and brown communities?

    Thomas: If you came to any of our clinics, it didn’t feel like you were coming into a clinic or a hospital. It felt like you were coming to a family reunion. We had a DJ spinning music. We had catered food. We had a festive environment. Some people showed up hesitant, and some of them left hesitant but fascinated. We didn’t have to change their worldview. But we treated them with dignity and respect. We weren’t telling them they’re stupid and don’t understand science.

    And the model worked. It worked so well that even the health professionals were extremely pleased, because now all they had to do was show up with the vaccine, and the arms were ready for needles.

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    The barbers and stylists saw themselves as doing health-related things anyway. They had always seen themselves as doing more than just cutting hair. No self-respecting Black barber is going to say, “We’ll get you in and out in 10 minutes.” It doesn’t matter how much hair you have: You’re gonna be in there for half a day.

    Wu: How big of a difference do you think your network’s outreach efforts made in narrowing the racial gaps in COVID vaccination?

    Thomas: Attribution is always difficult, and success has many mothers. So I will say this to you: I have no doubt that we made a huge difference. With a disease like COVID, you can’t afford to have any pocket unprotected, and we were vaccinating people who would otherwise have never been vaccinated. We were dealing with people at the “hell no” wall.

    We were also vaccinating people who were homeless. They were treated with dignity and respect. At some of our shops, we did a coat drive and a shoe drive. And we had dentists providing us with oral-health supplies: toothbrush, floss, paste, and other things. It made a huge difference. When you meet people where they are, you’ve got to meet all their needs.

    Wu: How big of a difference did the emergency declaration, and the freeing-up of resources, tools, and funds, make for your team’s outreach efforts?

    Thomas: Even with all the work I’ve been doing in the barber shop since 2014, the pandemic got us our first grant from the state. Money flowed. We had resources to go beyond the typical mechanisms. I was able to secure thousands of KN95 masks and distribute them to shops. Same thing with rapid tests. We even sent them Corsi-Rosenthal boxes, a DIY filtration system to clean up indoor air.

    Without the emergency declaration, we would still be in the desert screaming for help. The emergency declaration made it possible to get resources through nontraditional channels, and we were doing things that the other systems—the hospital system, the local health department—couldn’t do. We extended their reach to populations that have historically been underserved and distrustful.

    Wu: The public-health-emergency declaration hasn’t yet expired. What signs of trouble are you seeing right now?

    Thomas: The bridge between the barbershops and the clinical side has been shut down in almost all places, including here in Maryland. I go to the shop and they say to me, “Dr. T, when are we going to have the boosters here?” Then I call my clinical partners, who deliver the shots. Some won’t even answer my phone calls. And when they do, they say, “Oh, we don’t do pop-ups anymore. We don’t do community-outreach clinics anymore, because the grant money’s gone. The staff we hired during the pandemic, they use the pandemic funding—they’re gone.” But people are here; they want the booster. And my clinical partners say, “Send them down to a pharmacy.” Nobody wants to go to a pharmacy.

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    You can’t see me, so you can’t see the smoke still coming out of my ears. But it hurts. We got them to trust. If you abandon the community now, it will simply reinforce the idea that they don’t matter.

    Wu: What is the response to this from the communities you’re talking to?

    Thomas: It’s “I told you so, they didn’t care about us. I told you, they would leave us with all these other underlying conditions.” You know, it shouldn’t take a pandemic to build trust. But if we lose it now, it will be very, very difficult to build back.

    We built a bridge. It worked. Why would you dismantle it? Because that’s exactly what’s happening right now. The very infrastructure we created to close the racial gaps in vaccine acceptance is being dismantled. It’s totally unacceptable.

    Wu: The emergency declaration was always going to end at some point. Did it have to play out like this?

    Thomas: I don’t think so. If you talk to the hospital administrators, they’ll tell you the emergency declaration and the money allowed them to add outreach. And when the money went away, they went back to business as usual. Even though the outreach proved you could actually do a better job. And the misinformation and the disinformation campaign hasn’t stopped. Why would you go back to what doesn’t work?

    Wu: What is your team planning for the short and long term, with limited resources?

    Thomas: As long as Shots at the Shop can connect clinical partners to access vaccines, we will definitely keep that going.

    Nobody wants to go back to normal. So many of our barbers and stylists feel like they’re on their own. I’m doing my best to supply them with KN95 masks and rapid tests. We have kept the conversation going on our every-other-week Zoom town hall. We just launched a podcast. We put out some of our stories in the form of a graphic novel, The Barbershop Storybook. And we’re trying to launch a national association for barbers and stylists, called Barbers and Stylists United for Health.

    The pandemic resulted in a mobilization of innovation, a recognition of the intelligence at the community level, the recognition that you need to culturally tailor your strategy. We need to keep those relationships intact. Because this is not the last time we’re going to see a pandemic even in our lifetime. I’m doing my best to knock on doors to continue to put our proposals out there. Hopefully, people will realize that reaching Black and Hispanic communities is worth sustaining.

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    Katherine J. Wu

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