A new way of thinking about metabolic health

Just a few weeks ago, a GLP-1 medication was released in pill form for the first time. And McKinsey partner Lars Hartenstein says this kind of innovation is just the beginning. GLP-1s, which helped lower blood sugar and reduced appetite, have already proven to be a game changer. "Know that it's, at the moment, on track to be probably the biggest drug class we have ever seen?" But despite the positive effects these drugs have had for many people, when it comes to overall metabolic health, they're not a magic bullet. "It's not that this drug class is going to solve obesity or metabolic health. It is a very important tool, the most important new tool for sure." This is the McKinsey podcast, where we help you make sense out of the world's toughest business challenges. I'm your host for today, Roberta Fassaro, and we're here to talk about a recent McKinsey report titled "A Path Toward a Metabolic Health Revolution." What makes metabolic health and obesity such a pressing global issue today? Lars explains. Right now, approximately a billion of adults are living with obesity globally. And that's a cause of many, many health effects and creates a lot of diseases down the road. And for obesity is a very big focus for everybody who's interested in global health essentially. What has changed is that we have new classes of drugs. For many years, we've really treated obesity as an intractable condition. And now, it is a treatable disease. So now, that changes the conversation because metabolic health is a much bigger notion than just obesity. So overall, I see this as a giant opportunity economically and also for health. And it's really going to disrupt and create many opportunities through many different industries. Which industries do you think will be most affected? If we start with a consumer or an individual, that is maybe very interested in metabolic health. Looking at their glucose levels in a continuous way, so maybe they scan the barcodes. And so forth to get information about the products when they're going to the grocery store. So the food industry is involved as well. As well as the broader wellness industry that needs to do offerings. And then, of course, the more standard medical industries around asthmacuticals and healthcare and med devices and so forth. So the impact is widespread. The report argues that we face this choice between two different paths. Both one being treatment focused versus path two being prevention focused. Can you explain, Lars, the difference between the two paths? So path one is we follow the trail of innovation. There are these new drug classes and they are adding health value and also economic value in the sense that we are able to treat obesity in a different way. The focus, though, of this path, really those that are already living with obesity or perhaps those that are overweight and have significant risks in addition, path two is altogether more ambitious. We call it a big climb towards a metabolic health revolution because it's strenuous. There, the ambition level is that we really deliver metabolic health for all. That means we can't just build only on innovation we have. We need to mobilize across investments and leadership across societies. Some of the different industries are mentions but also governments, education and civil society to change the environment that we live in that allows us to be more metabolically healthy. And in our analysis, we've seen that the health effect of path two can be three to four times larger than if we are just looking at treating obesity. That sounds incredibly transformative, right, but we know that that's not going to just happen automatically out of the blue. In the report, Lars, you talk about five big shifts that are needed to happen to make this path to a reality, the five levers advancing science, improving measurement, using technology for personalization, aligning incentives, driving societal change. Tell us a little bit more about these five shifts. Yeah. So number one, advances in science, we don't have a clear definition of what a metabolic health is from a medical scientific perspective. It's not aligned. So therefore we need to be able to really clearly define what metabolic health means for everybody, not just for a person who is already not doing well, but really define it on a spectrum from being not metabolic the healthy at all to really optimize metabolic health with all the different elements within that that may include blood glucose, blood pressure, blood lipids, organ function of kidney, liver, and so forth. So then the another shift is we need more transparency as individuals. Most people do not know what their metabolic health is. They may know at some point when they're running into trouble, but we don't individually have transparency on our metabolic health. We know little aspects of my cholesterol is high or a little aspect. Yeah. Yeah. And when do we start testing for cholesterol? Maybe it depends on the country environment, maybe at 50, you know, but like it is very useful to talk about the metabolic health of a child, not only whether they're obese or not, but how metabolically healthy are they? Are they already building some insulin resistance early on in their lives? So it's really the notion that applies to everyone also for the so-called healthy individuals, which is a tricky notion, so therefore the second one is transparency and the third one is technology and innovation because how do we bring this to the individuals? We need offerings for the individuals that work for them. We need innovation in the notion how we talk about things also so we can talk about our metabolic health as we talk about how many steps we do in the day. And that requires consumer oriented technology innovation that allows folks to really engage and also identify ways to optimize and improve their metabolic health, be it for physical activity, be it through the way they eat their sleep, which is also affecting your metabolic health or other ways. Fourthly, and that's perhaps the most tricky one. We need to change some things in terms of our economic setup, so there's better incentives to provide choices in life, be it how we move, how we eat, and so forth, that are affordable, available, and attractive, that we also want to have because we are all struggling with facing choices that we find attractive, that are not necessarily good for our health. Everybody has that. The reality, and then the last one is really changing communities and society through education and engagement. A lot of that is already starting to happen. We've talked with economists about the concept of nudging and moving people in the behavioral directions that you want. How do we start to achieve these different states? Who needs to get involved with this? The answer is everybody needs to get involved. It needs to be a societal priority and the private sectors in cross different industries as a role to play, but certainly also government, civil society, and frankly, all of us as individuals. It is a true moonshot, that's cross-sector, cross-society, that is needed if we want to accomplish metabolic health revolution. The case we are making, and our report of the McKinsey Health Institute is to say, it's worth it. Modern investment is huge and therefore it merits the kind of attention that is needed. Can you give us an example of something that's working right now? Maybe unexpected one is government initiative like and Singapore to materially increase the physical activity of the population. So for 10 years now, Singapore has been doing a very successfully a step challenge with incredibly high numbers of participants to fundamentally increase the activity of an increasingly sedentary population that contributes to metabolic health. Very interesting example. Let me give you a very different example. Yuka is an app that you can scan barcodes in the grocery store. So you see in the grocery store exactly how healthy the food is that you're about to buy. At the point of purchase and influences, you can have support in terms of what you want to purchase. Another one very differently that is coming from a life of a re-insurance company like Swiss Re. Swiss Re is publishing and doing thought leadership on metabolic health and insulin resistance. You wouldn't necessarily expect that, but they have identified that say ill metabolic health is a major potential risk in their portfolio and they are thinking what as a re-insurance company like life insurance companies, they can do about that. So I think that's a very encouraged, a different stakeholder stepping up and doing something in the field of metabolic health. What's also interesting is the notion of food as medicine, particularly also United States happening that in particular situations food is almost prescribed if you want particular types of food so people are better in instead or in addition to drugs. That sets new types of incentives between those that are selling the food and the insurance companies that's a very encouraging example. Lars, thinking about those five shifts, do they all need to happen together? I think all of the five are needed for sure, but we can't run before we can walk. All of them are needed, but it will take time. That's okay. I wanted to come back since we liked Yuka, I wanted to emphasize something from the consumer perspective which is really this continuous biofeedback. There's emerging evidence more and more that if you know how well your body is functioning on a particular thing that has implications, at least for a number of people, continuous glucose monitoring. So measuring all the time, how much glucose you have in your blood is originally something for diabetic patients or at least for someone who already have metabolic health conditions. But it's exceedingly used also in quotation marks, healthy individuals to inform as a consumer value proposition to monitor how they're doing and frankly speaking, learn about the individual metabolism and that can change behavior. So I wanted to make a shift, Lars, because one of the shifts that's already making headlines is the surge of GLP1 medications. These are medications that are being called a breakthrough. Can we talk a little bit about what that means? So these medications are transformative in this space, there are things we don't know, but for all we know, they are transformative because they enable many of those that take it to lose more than 10% of their body weight. And for some, in the region of 20%, given how important too much weight is as a risk factor for so many diseases, that's tremendous use, news, and it has enabled us to shift away from this conversation that is not very productive, that everybody's responsible for their weight. You blame those that have too much and so forth because now we have tools that are enabling changes in a very different way and it opens up the conversation and we recognize it more as a condition or disease. And it enables us to then discuss really more what experts know for a long time, what are the real drivers of it and what do we do about it that really helps to open up this conversation that then allows us now to talk about metabolic health. Having said that, there are a lot of things we don't know about this drug class yet. We know that it's at the moment on track to be probably the biggest drug class we have ever seen, of course, predictions vary, but extremely large. We don't know fully the long-term effectiveness. We don't know the long-term safety profile and healthy individuals. The drugs have been used for many years in diabetic patients, but not in healthy individuals. So we don't know that yet. We don't know of major problems to watch or so, there are some, but for now we haven't picked up big things that would change the picture after it's characterized. On the upside also, these drugs that may give you a sense of, if you want satiety, slows the food processing, also have work via the brain, may be have also positive implications for other things, starting to alcohol and so forth. So we may still learn a lot of things about this drug class. So definitely a thing to watch. It's just one piece of a larger puzzle, right? I'm thinking about things like policy, education, community engagement, maybe that last shift that you had talked about earlier. What role do they play in making prevention the easier default path out of the two that we've outlined in the report? We give you a simple example. When I remember my school days, I remember exactly one class where we were educated about, let's say, our metabolic health in a meaningful, practical way. I still remember that our biology teacher gave us a list of foods he asked us to underline the healthy and the unhealthy food in different colors or something like that. That's the only one. I think there is tremendous opportunity to do more and to embed this already in education. It includes, of course, also the type of meals that are provided in schools for sure. And the employers, of course, have a big role to play because many, many people eat a meal a day at the employer. How much you're moving about, very much influenced by your employer and you're working conditions and the employer has a chance to improve or influence working conditions. So therefore, every company, it's an ecosystem that can be more or less conducive to metabolic health. That's really across industries. If you could speak directly to business leaders and individuals, what's the one action you'd urge them to take starting tomorrow? So I think two angles. For individuals, I think there's an obligation to get more educated. I think it's good to understand metabolic health and what drives it and then make choices, right? That's an important thing for individuals. Just to try to understand more, what's actually happening, how your body is functioning, not in the biological way, but just to get more educated and try and also distinguish the fats from actual information. And then for leaders of organizations, there's so much opportunity and such a dynamic here. I'd say don't be afraid to be the first, because there is a momentum driven by the norm with investment that's flowing into space. It's worthwhile to take some calculated risks and think about your industry, what does this mean for you and where some things where there may be an opportunity and try to seize it. Because the underlying trends are very strong. Lars, thanks so much for taking time to record with us today and thanks for the information. Thank you very much. That was fun. Thanks so much for listening to the McKinsey podcast. I'm Lucia Riley and I'm Roberta Fisaro. Find us on McKinsey.com. We'll have a transcript of this episode up shortly. And download the McKinsey Insights app where you can find this podcast in other helpful content updated daily. If you enjoyed the show, we'd love for you to leave a rating and a review. We'll see you in two weeks. [BLANK_AUDIO]