Chronic disease is, by its very definition, omnipresent. But changes year to year have the potential to make certain conditions into flaming-red targets for researchers and drugmakers. This year was one for obesity, marked by new — and for the first time, highly effective — weight loss drugs that demonstrated other health benefits.
But whether that wave of interest will persist into the new year, or transfer to some other condition — maybe some liver diseases that are troublingly on the rise — is what we’re asking our crystal ball. Here are three predictions for what’s to come in the world of chronic disease in 2024:
The obesity revolution enters a new phase
If 2023 was the year a new generation of obesity drugs entered into the spotlight, next year will be about their performance on that big stage. Can drugmakers bolster evidence of the efficacy and benefit of the GLP-1 based drugs like Wegovy and Zepbound? Will new therapies emerge (companies like Pfizer are already running into barriers developing an oral drug)? Will insurance coverage expand in the wake of positive data, like the SELECT trial results that showed Wegovy mitigated the risk of major heart problems?
Next year could bring results from a SELECT follow-up study, on whether Wegovy can prevent Type 2 diabetes. Burgeoning research on the multifactorial roots of obesity and food craving could also offer a better understanding of how we got here in the first place, and guidance for more targeted therapies.
Above all, as the public shifts attention toward new shiny objects (it’s hard to imagine Ozempic being a reality TV punchline for more than a season), will people continue to seek the drugs out and adhere to them, and will clinicians see them as a reliable medical tool? Their decisions will determine if the market will become as sprawling as some analysts predicted, or if the treatments just become another example of the pharmaceutical boom-and-bust cycle.
Climate effects on chronic diseases
Coming off the hottest year on human record, and with some experts predicting a warm winter and even-hotter 2024, our eyes are on the health implications of climate change.
Heat kills more people each year, an estimated 1,300 Americans, than any other weather-related event. Hot days also take a toll on mental health, and can increase the odds of being injured at work, or having a heart attack or an infection, straining emergency departments. Heat can also set off flare-ups of various chronic health conditions.
Mounting evidence shows how prolonged and extreme heat exposure harms the health of workers — including farmworkers, construction, factory and warehouse workers. And many of the millions of people living with chronic conditions have layers of vulnerability to very hot days, air pollution and environmental toxins. We expect to see more research in the area in 2024, and maybe some innovative steps to protect the public from climate hazards.
As climate shocks and natural disasters like hurricanes and wildfires grow increasingly common, people with chronic diseases are also exposed to lapses in access to care, medication, and the day-to-day tools and services they rely on to manage their conditions.
Liver disease arising in younger people
Liver doctors have been sounding an alarm for several years now: rates of liver disease are rising, especially among women and younger people. After a long crusade against hepatitis-induced liver injury and disease, the field is now facing dual threats of liver disease driven by metabolic disorders and alcohol. Still, transplant is usually the only option for the large population of people in the U.S. with the most common forms of liver disease — a group of over 100 million people, some estimates suggest. And the costs to the healthcare system are similarly huge: it’s estimated about $100 billion in annual medical costs are directly attributable to what was formerly called fatty liver disease.
To strip these conditions of some stigma and make the nomenclature more accurate, national liver groups decided this year to change the names of several liver conditions. What was previously dubbed non-alcoholic fatty liver disease, or NAFLD, is now metabolic dysfunction-associated steatotic liver disease, or MASLD. And non-alcoholic steatohepatitis, or NASH, should be called MASH: metabolic dysfunction-associated steatohepatitis.
There are other signs that the largest internal organ is getting more attention. In 2023, the ADA recommended that all diabetes patients be screened for MASLD. Cases of MASLD in children, especially in Hispanic and Asian kids, are of growing concern among pediatricians. And pharmaceutical interest in MASH is growing. Despite failed trials and the FDA’s rejection this year of a MASH drug from Intercept, there are several therapies in the pipeline (including one by Madrigal that’s expected to go before the FDA in the spring). Researchers are also studying whether GLP-1-related medications might help people with MASH.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.