Following the White House’s recent announcement of price reductions and expanded coverage for GLP-1 medications like Wegovy and Zepbound, many patients searching for obesity treatments are about to gain access to highly effective options.
The implications for U.S. public health are vast.
As a population health researcher examining the widening of the U.S. mortality gap compared to other high-income countries, my work has shown that rising obesity has reduced the annual rate of improvement in U.S. death rates by just over half a percentage point per year. I have also found that differences in life expectancy between the U.S. and other high-income countries would be more than 40% smaller for women and 60% smaller for men if differences in obesity were eliminated.
A well-planned public health agenda that incorporates GLP-1 drugs has the potential to reduce obesity rates, increase life expectancy, and narrow the mortality gap between the U.S. and other high-income countries.
However, increased use of GLP-1 drugs must not curb public health advocacy efforts to advance obesity prevention policies.
A serious concern with prioritizing a downstream solution like GLP-1 drugs to a complex, upstream, and structural condition like obesity is that doing so could divert resources and attention away from addressing its upstream drivers. High obesity rates are associated with low wages and income inequality, racism and residential segregation, and food insecurity and the food environment.
Each of these upstream factors has a multitude of health impacts. Although GLP-1 drugs can help with some of them, others, such as chronic stress and its multisystem health consequences, are still going to accumulate. Policymakers must not throw up their hands now that we have GLP-1 drugs and stop investing in research, policy, and programs to address these social determinants of health.
One of the main reasons why 40 out of 100 adults in the U.S. have a BMI equal to or above 30 (the World Health Organization cut-off for obesity) is under-regulation of the food industry. More than half of U.S. diets come from ultra-processed foods, a notable difference from other high-income countries with lower obesity rates. While the food industry reports $2.6 trillion in sales annually, chronic disease attributable to obesity costs the health care system more than $480 billion in direct spending.
Even with improved access to GLP-1 drugs, preventive actions targeting the social, policy, and structural determinants of obesity will continue to be important, such as nutrition policy and food industry regulation. This includes policies and programs to address food insecurity, access to healthy foods, nutrition labeling, sugar-sweetened beverages and candies, and ultra-processed foods. In recent decades, implementing such policies has proven to be politically challenging due to food industry lobbying. While health secretary Robert F. Kennedy Jr. says that improving U.S. nutrition is a priority, it remains unclear to what extent he and the Trump administration are prepared to take on the power of “Big Food” as part of their Make Our Children Healthy Again strategy.
Recently, researchers have emphasized specific policy proposals for reducing the health effects of ultra-processed foods. For example, one proposed regulation for food products is to impose limits on industrial trans fats, partially hydrogenated oils, sodium, and artificial dyes. Due to the large public health and financial costs associated with ultra-processed foods, transnational manufacturers of ultra-processed foods and the supermarket and fast food corporations that sell them should face increased taxation and greater tax enforcement. In contrast, smaller food producers and retailers should receive tax incentives to encourage more local and minimally processed food.
A related policy proposal would involve limiting the percentage of supermarket revenue that can come from ultra-processed foods. Corporations that produce ultra-processed foods also source many ingredients from low- and middle-income countries where these companies have large extractive social and environmental impacts. Supply chain laws to limit those impacts could provide the U.S. and other countries with greater regulatory power over “Big Food” and a mechanism to limit the supply of ultra-processed foods.
For health policymakers, childhood obesity prevention, in particular, is a major concern. Nutrition in early life, such as the amount of sugar consumed, can affect lifetime risk for chronic disease. Youth have less autonomy over their dietary choices than adults. Because of this, health policymakers have a responsibility to ensure young people are not subjected to food industry marketing, food environments, and nutrition policies (or a lack of policies) that we know cause obesity. Expanding funding for school meals and SNAP benefits, while improving their nutritional quality, and regulating the nutritional content and marketing claims for infant formula, are some related policy priorities.
Public health stakeholders must also keep working to reduce weight discrimination, which may increase as a result of discourse and policies related to GLP-1 drugs. High BMI is associated with increased mortality risk, and the evidence for this is particularly strong at the population level after accounting for end-of-life, illness-related, and smoking-related weight loss that may otherwise bias studies. In addition to the many pathophysiological mechanisms linking excess weight to mortality, one important pathway by which obesity increases risk for mortality is through weight discrimination in society and especially in health care settings. Public health officials must work to balance accurate communications about the health risks of obesity and new treatments that can improve health and extend life with investments in evidence-based interventions to reduce weight discrimination. If weight discrimination is left off the agenda, it could worsen, further harming people in larger bodies who choose not to take GLP-1 drugs or don’t have access to them.
According to recent data, U.S. obesity rates declined from 2023 to 2025 for the first time in decades. While this trend may partially reflect the disproportionate death toll of Covid-19 among people living with obesity, a more optimistic possibility is that it shows population-level weight loss from the uptake of GLP-1 drugs. There is perhaps no more serious recent example, however, of the public health importance of obesity prevention than the Covid-19 pandemic. Research from its first year showed that as many as 78% of patients hospitalized and 73% of patients who died from Covid-19 had a BMI in the overweight or obesity range. In this way, excess weight became a key mechanism by which socioeconomic and other disparities in COVID-19 mortality in the U.S. took place.
Ultimately, public health efforts to address the social, policy, and structural drivers of obesity are necessary actions to confront stagnating life expectancy trends that have gripped the U.S. since 2010. Coupled with novel GLP-1 drugs, investments in obesity prevention have the potential to reduce chronic disease and extend life in the U.S. in a way that has proven elusive until this moment.
Andrew C. Stokes, Ph.D., is an associate professor of global health and sociology at Boston University.
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