→ Many people stop taking them, and weight, and so presumably risk, return.
Are we fixing the causes of disease?
→ No, we are badly managing the consequences of the same environments that created it.
Medication can reduce risk.
It cannot replace nutrition, movement, education, or healthy food systems.
Obesity, longevity, and what “health” really means
A new JAMA (2026) analysis estimates that 42.5% of U.S. adults were living with obesity (BMI>30) in 2022, up from ~19% in 1990, with prevalence projected to reach ~47% by 2035. That’s more than 126 million people. BTW, 2 in 3 (~75%) are overweight (BMI>25).
At first glance, this looks like a straightforward story of declining health. But the longer view matters.
In the 1980s and early 1990s, obesity rates were far lower — yet the population was not necessarily healthier. Coronary heart disease and stroke mortality were substantially higher, smoking was common, and effective prevention and treatment were limited. Many people simply died earlier.
Over the past four decades:
- Cardiovascular mortality has fallen due to better treatment and pharmacological/procedural prevention
- Life expectancy increased (yet life expectancy at birth is 75.8 years for U.S. men and 81.1 for U.S. women (2023) versus 81.4 for Italian men and 85.5 for Italian women)
- People now live longer with a multitude of chronic metabolic disease, rather than dying early from acute events.
So today’s obesity epidemic reflects not just behaviour, but systems:
- Low health literacy
- Food environments dominated by ultra-processed products
- Corporate incentives misaligned with public health
- A healthcare system built to treat disease more than prevent it.
New therapies, including GLP-1 medications, can reduce weight and lower cardiovascular risk, a major advance. But they also raise a critical question:
Are we fixing the causes of disease, or managing the consequences of the same environments that created it?
Medication can reduce risk.
It cannot replace nutrition, movement, education, or healthy food systems.
In a $27 trillion economy, the goal should not be to normalise lifelong pharmacologic rescue. It should be to create conditions where fewer people need it in the first place.
Obesity is not a moral failure.
It is a signal of how we design our markets, policies, and priorities.
