William Vest III used to be pretty active. “Running, basketball, weightlifting, martial arts, the lot,” he said. Then came a bike accident in 2013 that left the writer needing knee surgery.

Unable to exercise, the weight piled on and he developed type 2 diabetes. When a decade later his doctor told him he might benefit from Ozempic, Vest thought to himself: “I never imagined needing something like this.”

Today, at 52 years old, he is 20lb lighter and his glucose level has gone from a dangerously high 12.3 per cent to about 7.7. “There have definitely been costs,” he says of the side-effects, such as nausea, “but it is worth it.”

Vest is one of thousands of residents of Bowling Green, Kentucky — about 4 per cent of its 75,000 population — on prescribed weight-loss medication, a rate so high the city has been dubbed the “Ozempic capital” of the United States.

America has long had the highest obesity rate in the industrialised world:

But the country’s embrace of GLP-1 drugs such as Ozempic, Wegovy and Mounjaro has helped to lead to the most dramatic national weight loss in modern history:

Last year the country’s self-reported obesity rates dropped for a third consecutive time, according to a recent Gallup study — falling from 40 per cent in 2022 to 37 per cent last year. The findings prompted the question: has America finally turned the tide on the obesity crisis?

GLP-1 drugs, which act on the body’s hormones to suppress hunger and slow digestion, offer an answer to Americans’ long struggle with obesity and the diseases related to it, such as cancer, heart failure and diabetes.

For Vest and his wife Samantha, a 37-year-old social worker, Ozempic has completely changed their dietary habits. Whereas in the past, Vest would look forward to his weekends off work so he could cook a big breakfast of bacon, eggs, biscuits and gravy, now he can no longer stomach it.

“Many times I skip breakfast or just have a few raisins or maybe an apple,” Vest said. For lunch, he eats only a salad or a small bowl of soup, “nothing greasy and nothing heavy”, and he’s stopped snacking altogether.

Samantha and William Vest

RAY DI PIETRO FOR THE TIMES

Crystal Rattliff, 26, another resident of Bowling Green, has struggled with her weight since she was a child. “I lost 10, 20, 30lb here and there, but it was never sustainable without the weight-loss medication,” she said. After she began daily injections of the drug in late 2023, she lost 25lb in the first few months and a further 80lb over the course of the year.

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Neither Rattliff nor the Vests were surprised that their hometown had earned the title of Ozempic Town USA. “It’s the South so we like our gravy, butter and fried food, but Bowling Green is also very vain,” said Vest. “It’s not a wealthy area, but everything here is image-driven. The restaurants are all high-priced, trendy places, not mom-and-pop shops.”

Over the past year several medical diagnostic laboratories and pharmacies have opened up on the town’s main street to service the growing demand for GLP-1 drugs.

Rattliff said it felt like everyone she knew was taking Ozempic or a cheaper, off-brand version, including “my mom, my aunt, my sister-in-law and my doctor”.

“Then there’s co-workers”, added Rattliff, a registered nurse. “The environment has changed. When I first started, people had more scepticism and concern. Now everybody is, ‘Oh, you’re on that, I’d like to try that too.’”

Crystal Rattliff was never able to keep weight off until she started GLP-1 medication

RAY DI PIETRO FOR THE TIMES

About 45 million Americans — 13 per cent of the population — have tried a type of GLP-1, and that number is rising as more people have access, according to the Gallup National Health and Well-Being Index. The biggest reduction in obesity, the survey found, was among people aged 40 to 64, which is also the group most likely to take injections for weight loss.

Obesity has climbed steadily in the US over the past few decades, with smaller decreases in 2007–08 and 2011–12 both being followed by a rise. This time, however, the rate has decreased three years running, which is unprecedented in the nearly two decades Gallup has been conducting its poll. Some speculate this is due to people losing weight they put on during the Covid pandemic but it also coincides with the mass adoption of GLP-1 drugs.

If access to these treatments continues to increase, experts say the current decline will become a lasting trend rather than just another blip. The biggest barrier to that goal, for most people, is money. Injections typically cost patients about $500 a month, putting the treatments out of reach for many.

But Bowling Green, a working-class town with one of the highest obesity rates in the country, has several large employers, including General Motors, which offer insurance plans that cover shots. Vest pays $35 a month for four and the rest is covered by his insurance. Rattliff pays about $150.

At present, 13 states fully cover the treatment under Medicaid and the Trump administration wants to expand coverage. In January the first oral weight-loss pills approved by the Food and Drugs Administration hit the market, expanding the treatment to help millions more people.

Some health experts caution that weight-loss drugs are not a silver bullet that will alone end the problem. Doctors stress that body mass index (BMI) is just one measure of overall health, and encourage people to combine exercise with a healthier diet. There are still questions about how long people should stay on GLP-1 drugs and what happens once they come off them.

“Although medication can help some individuals lose weight, obesity is not a simple disease of inactivity or overeating,” said Dr Fatima Cody Stanford, an obesity expert at Harvard Medical School. “A myriad factors including genetics, mental health, socioeconomic status and environmental influences contribute to the development and progression of this disease.”

Bowling Green has seen clinics springing up offering weight-loss medications

RAY DI PIETRO FOR THE TIMES

RAY DI PIETRO FOR THE TIMES

While rates of smoking have declined dramatically thanks to health warnings, tax incentives and bans in public spaces, weight gain has proved harder to combat than almost any other public health issue.

Robert F Kennedy Jr, the Trump administration’s health secretary, has described an “obesity epidemic” and made the disease a key focus of his Make America Healthy Again campaign. At a Senate committee before his confirmation in January, Kennedy said that when his uncle, John F Kennedy, was president in 1961-63, only “3 per cent of Americans were obese. Today, 74 per cent of Americans are either obese or overweight. No other country has anything like this. In Japan, the obesity rate is still 3 per cent. Epidemics are not caused by genes.”

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“Something is poisoning the American people,” he added, arguing that the fault lay in high-sugar, carbohydrate-heavy diets.

This month the US health and agriculture departments published a new food pyramid that put red meat and “real foods”, such as cheese and dairy, along with vegetables and fruits at the top, while relegating breads and cereals to the very bottom. The department also recommends that children do not start consuming any added sugars until they are ten (previous guidelines set the age at two).

If Americans manage to change their dietary habits, the dividends could be enormous. A 2022 Lancet medical study found that obesity-related conditions contributed to more than 1,300 deaths per day in the US — or nearly 500,000 a year — costing the country more than $1.4 trillion each year.

Rattliff said that being on Ozempic had helped her make healthier food decisions, which is not unusual. Weight-loss drugs have been found to alter food preferences, making those who take them feel fuller for longer and less tempted by highly processed food.

“I eat less but also eat higher-quality foods, and don’t really eat a whole lot of junk food now,” she said. “That’s one of the things that have helped with sustained weight loss.”

She believes that Bowling Green could offer a model for the country.

“We’ll eventually get to the point where they won’t have to do as many hip replacements and knee replacements; fewer heart attacks, less diabetes,” she said. “I think within 10 to 20 years we’ll look back and this will be the No 1 improvement in public health.”