Nearly 70% of U.S. adults could now be classified as obese

A redefinition of obesity that adds waist and other anthropometric measures to BMI, applied to >300,000 participants in the NIH All of Us cohort and published in JAMA Network Open, raises the measured U.S. prevalence to 68.6% from 42.9% (the entire increase driven by 'anthropometric‑only' cases), with nearly 80% of adults over 70 meeting the new criteria and higher rates of diabetes, cardiovascular disease and mortality observed in the newly classified group. The change materially expands the addressable population for obesity therapeutics and waist‑reduction interventions and could increase demand and utilization in pharmaceuticals, devices and related healthcare services, meriting attention from investors in obesity drug developers, device makers and payors.

Analysis

Market structure: Raising the U.S. obesity pool from ~42.9% to 68.6% (a ~60% relative jump in classified prevalence) re-rates addressable populations for GLP‑1/anti‑obesity drugs, body‑composition diagnostics, DEXA/waist‑measurement devices, and chronic‑care management. Winners: branded obesity drug makers (highest pricing power short‑term), diagnostics (Quest DGX, LabCorp LH) and device vendors (Hologic HOLX/analogues). Losers: payers (UNH, CI) and elective/consumer health segments if higher prevalence raises long‑term claims and cost pressure.

Risk assessment: Tail risks include rapid payer reimbursement restrictions or CMS national coverage decisions within 3–12 months capping uptake or price (high impact, medium probability), GLP‑1 safety signals (low probability, high impact), and manufacturing bottlenecks for injectables (near‑term supply risk). Hidden dependencies: clinician adoption of anthropometric screening, EMR coding changes and guideline timelines; catalysts are CMS/Medicare guidance, major insurer formulary decisions, and further professional society endorsements over 3–9 months.

Trade implications: Direct plays — establish 1–3% long positions in LLY and NVO (or biotech exposure to obesity drugs) with 6–18 month horizons; 1% long positions in diagnostics (DGX) and device names (HOLX) to capture increased testing. Pair trade — long LLY (1–2%) / short UNH (0.5–1%) to express revenue upside vs payer margin compression. Options — buy 6–12 month calls on LLY/NVO (25–40% of equity-sized exposure) and 3–9 month put spreads on UNH sized to 0.5–1% portfolio risk.

Contrarian angles: Consensus underestimates payer pushback — not all newly labeled patients will be covered; assume only 20–50% of newly classified become pharmacologically treated over 2–5 years. Diagnostic/device names may be underpriced relative to durable testing demand. Historical parallel: expanded diabetes screening increased diagnosis but reimbursement lagged—trade with phased entries and hedge regulatory catalysts to avoid being early on headline risk.

Key Decisions for Investors

• Establish a 1.5% portfolio long in Eli Lilly (LLY) and/or Novo Nordisk (NVO) split equally, targeting 6–18 month horizon; scale in on any >5% pullback, take profits at +40–80% or after positive CMS/insurer coverage decisions within 3–12 months.
• Initiate a 1% long position in diagnostics (Quest Diagnostics DGX or LabCorp LH) and a 0.5–1% long in device exposure (Hologic HOLX), expecting 10–30% revenue tailwind over 12–36 months as anthropometric screening rises; add on durable contract wins or guideline adoptions.
• Open a pair trade: long LLY (1%) vs short UnitedHealth Group (UNH) (0.5%) to express favorable drug revenue vs payer margin risk; hedge with a 3–9 month horizon and stop‑loss at 15% adverse move on either leg.
• Purchase 6–12 month LLY/NVO call options sized at 25–40% of the equity position to lever upside; buy 3–9 month UNH/CI put spreads (defined risk) sized to 0.5–1% portfolio risk to protect vs reimbursement shocks.
• Monitor CMS national coverage decision, major insurer formulary announcements, and any GLP‑1 safety bulletins over the next 90–270 days; if CMS signals broad coverage, increase long exposures by +50%, if payers tighten, reduce pharma exposure by 30% and increase diagnostic/device exposure.