Global Health & Policy

Hong Kong Unveils First Territory-Wide Weight Management Strategy to Address Rising Obesity Rates

Key Takeaways:

• Hong Kong has launched its first comprehensive three-year Action Plan on Weight Management, introduced on World Obesity Day (4 March) in response to data showing that more than half of the city’s adults are living with overweight or obesity.
  
• The strategy is built around five pillars and 15 specific objectives, including improved health education, strengthened healthcare services, and environmental changes that support healthier lifestyles.
  
• Officials acknowledge that low awareness and misperceptions about body weight remain major barriers, with many individuals who are overweight believing their weight is “just right”.
  
  
  

Hong Kong launches its first comprehensive weight management plan

Hong Kong has introduced its first territory-wide action plan aimed at improving weight management across the population, marking a significant step in the city’s efforts to address rising levels of overweight and obesity.

The initiative was officially launched on World Obesity Day, 4 March, and will run for three years. It follows findings from the Department of Health’s Population Health Survey conducted between 2020 and 2022, which revealed that more than half of Hong Kong’s adult population are living with either overweight or obesity.

Officials have positioned the plan as part of broader international and national efforts to address obesity. The strategy contributes to China’s national Weight Management Year initiative and aligns with the World Health Organization’s global framework aimed at reducing obesity worldwide.

The new plan aims not only to raise awareness of weight management but also to create conditions that make healthier choices easier for people across the territory.

A framework built around five strategic pillars

The action plan is organised around five core pillars, each designed to address different aspects of weight management across society.

These pillars include:

• Strengthening health education and promotion
  
• Creating a supportive social environment
  
• Enhancing health service delivery
  
• Adopting a life-course approach to health promotion
  
• Continuously monitoring population weight trends
  

Together, these pillars translate into 15 concrete objectives that government departments will pursue during the programme’s three-year implementation period.

The timeline of the plan is also structured in stages. 2026 will focus primarily on raising public awareness, helping people better understand healthy weight and lifestyle behaviours. The second year will concentrate on encouraging positive behavioural change, while the final year will emphasise long-term maintenance, with the goal of embedding healthier habits into everyday life.

Public initiatives begin with a city-wide walking challenge

The first public initiative under the strategy will begin on 21 March, when authorities launch a “10,000 Steps a Day” walking challenge.

The programme will be integrated into the eHealth mobile application’s e+Life platform, allowing participants to track their daily activity digitally. The launch will be marked by a ceremony and public carnival at the West Kowloon Cultural District, intended to encourage participation and raise awareness about physical activity.

Alongside this campaign, the action plan outlines several longer-term measures aimed at promoting healthier lifestyles across the city.

These include:

• Installing weight measurement devices in public housing estates and schools
  
• Integrating weight management education into school curricula
  
• Designing pedestrian-friendly urban environments that encourage walking and other forms of physical activity
  

By combining digital tools, education, and environmental changes, officials hope to create a more supportive ecosystem for healthier behaviours.

A life-course approach to health promotion

According to public health officials, the plan adopts a life-course approach, addressing health and weight management from the earliest stages of life through to older adulthood.

Dr Edwin Tsui, controller of the Centre for Health Protection, explained that the strategy is intended to cover the entire lifespan.

He said the plan takes “a systematic approach covering the full lifespan, from prenatal nutrition to maintaining function in old age.”

Tsui also emphasised the role of primary healthcare as a central component of the initiative, noting that healthcare services will act as the gatekeeper of public health within the strategy.

The plan also encourages collaboration between Chinese medicine and Western medicine practitioners, reflecting Hong Kong’s mixed healthcare landscape. At the same time, authorities intend to use the eHealth digital platform to help residents track and manage their personal health information.

Low awareness and misperceptions present major challenges

Despite the ambitious scope of the initiative, health officials acknowledge that significant barriers remain.

One of the most notable challenges is limited awareness about healthy weight and weight management among the public.

Dr Anne Chee, head of the Non-Communicable Disease Branch at the Department of Health, highlighted this issue during a radio programme. She explained that many individuals living with overweight may not recognise it as a health concern.

Among people who are overweight, she said two-thirds believe their weight is “just right” or even “too thin.”

Chee also noted that many individuals have taken no action to manage their weight over the past year, reflecting gaps in public understanding of healthy weight management.

She further emphasised that some people may not know how to calculate their body mass index, pointing to broader deficiencies in knowledge related to weight and health.

Sustaining behaviour change may prove difficult

Experts outside government have also raised concerns about the challenge of maintaining behavioural change over time.

Sports scientist Professor Lobo Louie from the Education University of Hong Kong warned that while awareness campaigns can be effective, they do not always translate into lasting lifestyle changes.

Louie pointed to the gap between initial engagement and long-term commitment, noting that maintaining motivation may prove difficult for many individuals.

This highlights a broader challenge faced by public health initiatives worldwide – transforming awareness into sustained behaviour change.

Cross-government collaboration to support healthier lifestyles

The action plan is designed as a cross-government initiative, bringing together multiple public agencies.

Departments involved include those responsible for:

• Health
  
• Education
  
• Leisure and cultural services
  
• Urban planning
  

A cross-departmental working group established in October is coordinating these efforts. The group aims to strengthen collaboration not only within government but also with businesses, academic institutions, and community organisations.

Officials hope that this multi-sector approach will create broader societal support for healthier lifestyles.

A voluntary strategy with long-term ambitions

For the moment, the programme relies largely on voluntary participation and public education, rather than regulatory measures.

Whether these measures will be sufficient to reverse current trends remains uncertain. Officials recognise that individual willpower or clinical care alone cannot solve the obesity challenge.

Instead, they emphasise that the wider social and physical environment must also support healthier choices, making it easier for people to adopt and maintain healthy behaviours.Further information about the strategy and related initiatives is available on the Department of Health’s Change4Health website.

CCH insight:

We wish the authorities and people of Hong Kong the best of luck with this programme, but evidence from other countries suggest it is highly unlikely to make a significant reduction in the prevalence of obesity. We know that obesity results from genetic and biological factors driving overeating, made possible by an environment which encourages over-consumption of food. The programme is not attempting to change the population’s biology (by increasing access to anti-obesity medications, for example), nor to restrict the availability of obesogenic foods, so it is unlikely to lead to the kind of changes in behaviour it is aiming for.

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Economic Survey Urges Tougher Action on Ultra-Processed Foods as Obesity and Heart Disease Risks Rise in India

Key Takeaways: 

• India’s Economic Survey links rising consumption of ultra-processed foods with increasing risks of obesity, heart disease, diabetes and mental health conditions.
  
• The survey recommends stronger policy measures, including higher taxes, stricter labelling and limits on advertising, particularly to protect children and young people.
  
• Rapid growth in ultra-processed food sales has coincided with a marked rise in overweight and obesity rates across adults and children in India.
  
  
  

Growing concern over ultra-processed food consumption

India’s latest Economic Survey has flagged the rapid growth in the consumption of ultra-processed foods and its implications for public health, recommending that the government consider increasing taxes on products that exceed defined nutritional thresholds, alongside a broader package of regulatory measures.

Tabled in Parliament, the survey draws attention to mounting evidence linking ultra-processed foods with poorer diet quality and higher risks of obesity, diabetes, heart disease and mental health conditions.

“There is a growing body of evidence on the impact of UPFs on human health, indicating that there should be no delay in implementing public health policies while further research continues to unfold,” the survey said.

What are ultra-processed foods?

Ultra-processed foods are industrially manufactured products that undergo multiple stages of processing and typically contain additives not commonly used in home cooking. These include preservatives, flavour enhancers, emulsifiers, colours and sweeteners.

They are generally high in fat, sugar and salt, while being low in fibre and essential nutrients. Common examples include packaged snacks, instant noodles, sugary drinks, reconstituted meat products and ready-to-eat meals.

Rising obesity across adults and children

The survey highlights concerning trends in overweight and obesity across India’s population. According to the National Family Health Survey 2019–21, 24 percent of women and 23 percent of men are living with overweight or obesity. Among women aged 15–49 years, 6.4 percent are living with obesity, compared with 4 percent of men.

Excess weight among children under five has also increased, rising from 2.1 percent in 2015–16 to 3.4 percent in 2019–21.

Looking ahead, the survey warns that the scale of the problem is likely to grow substantially. It cites estimates that more than 33 million children in India were living with obesity in 2020, with this figure projected to rise to 83 million by 2035.

A rapidly expanding market

India has emerged as one of the fastest-growing markets for ultra-processed foods. The survey notes that sales increased by more than 150 percent between 2009 and 2023, while retail sales rose from around $0.9 billion in 2006 to nearly $38 billion in 2019, representing a forty-fold increase.

“It is during the same period that obesity nearly doubled in both men and women,” the survey said.

Health and economic costs

Drawing on evidence from the Lancet Series on Ultra-Processed Foods and Human Health, the survey reports that high intake of ultra-processed foods is associated with obesity, heart disease, diabetes, respiratory conditions and mental health disorders.

Beyond health impacts, it notes substantial economic consequences, including higher healthcare spending, productivity losses and long-term fiscal pressures on the health system.

Marketing practices under scrutiny

The survey raises concerns about marketing strategies that encourage overconsumption of ultra-processed foods. These include the use of celebrity endorsements and messaging that presents such products as healthy options.

It highlights evidence showing that children and adolescents exposed to this advertising report greater desire and intention to consume ultra-processed foods.

“Policies have so far focused on advocacy to reduce consumption of foods high in added fats, sugar, and sodium, many of which are UPFs. However, improving diets cannot depend solely on consumer behaviour change; it will require coordinated policies across food systems that regulate UPF production, promote healthier and more sustainable diets and marketing,” the survey said.

Existing policies and regulatory gaps

The Economic Survey refers to the National Multi-sectoral Action Plan for non-communicable diseases, which set a target to halt the rise in obesity by 2025. Proposed measures include front-of-pack labelling and restrictions on advertising foods high in fat, sugar and salt.

It also cites the 2024 dietary guidelines issued by the Indian Council of Medical Research-National Institute of Nutrition, which explicitly warn against the consumption of ultra-processed foods.

However, the survey points to gaps in enforcement. While current advertising rules prohibit misleading claims, they do not define such claims using nutrient-based criteria, allowing companies to continue making broad or vague health and energy claims.

“This regulatory ambiguity highlights a critical policy gap that needs reform,” it said.

Proposed measures, including advertising restrictions

Building on recommendations made in last year’s Economic Survey, the latest report outlines a more detailed set of policy options. These include exploring a time-based ban on advertising ultra-processed foods from 6am to 11pm across all media platforms, including digital channels, and restricting sponsorship of school and college events by manufacturers.

On food labelling, the survey refers to a multi-sector statement endorsed by 29 organisations that supports warning labels rather than rating systems such as health stars. “Studies have shown that warning labels are the most effective option for discouraging UPF consumption,” it said.

The survey also suggests a nutrient-based tax approach, including applying the highest GST slab and an additional surcharge on ultra-processed foods that exceed thresholds for sugar, salt or fat. It proposes that revenues from such taxes be earmarked for public health programmes.

Call for a multi-pronged response

In conclusion, the Economic Survey reiterates that “a multi-pronged approach is necessary” to address the growing burden of diet-related disease. It calls on the Food Safety and Standards Authority of India to clearly define ultra-processed foods, set enforceable standards, strengthen labelling requirements and increase public awareness, particularly among young people.

Taken together, the recommendations reflect a shift towards more assertive regulation of ultra-processed foods as part of India’s wider strategy to curb obesity and reduce the long-term burden of non-communicable diseases.

CCH insights:

India has undergone a typical ‘nutrition transition’ over the past 20 years. Rapid economic growth and development, accompanied by globalisation of food manufacturing and mass access to online advertising, have lead to the adoption of many aspects of the western diet and the associated non-communicable diseases. We applaud the government’s plans to introduce a multi-sectoral action plan to reduce UPF consumption, but we know from other countries that these tend to have limited effects, and UPFs are just one part of a very complex puzzle of rising obesity rates.

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Heart Disease Now Affects Nearly Half of US Adults, as Obesity and Diabetes Continue to Rise

Key Takeaways: 

• Nearly half of adults in the United States are now living with cardiovascular disease, with prevalence projected to rise further as obesity, diabetes, and hypertension increase.
  
• New data highlight worsening cardiometabolic risk factors, including declining blood pressure and glycaemic control, alongside rising concerns around sleep health, physical inactivity, and nicotine exposure.
  
• The report underscores the urgent need for prevention-focused, equitable approaches to cardiovascular, kidney, and metabolic health across the life course.
  
  
  

A comprehensive annual snapshot of cardiovascular health

The 2026 Heart Disease and Stroke Statistics Report from the American Heart Association, published in the journal Circulation, provides an updated and wide-ranging overview of heart disease, stroke, and cardiovascular risk factors. Updated annually, the report integrates the most recent data, adds new thematic chapters, and removes outdated material to reflect the evolving cardiovascular health landscape.

The latest edition draws on a year-long collaborative effort involving volunteers, scientists, clinicians, government representatives, and AHA staff. It includes an expanded chapter on nicotine and tobacco use and exposure, alongside a new chapter focused on cardiovascular, kidney, and metabolic (CKM) syndrome. Together, these additions reflect growing recognition of the interconnected nature of cardiometabolic risk factors and their cumulative impact on population health.

Cardiovascular health trajectories and nicotine exposure

According to the report, several major cardiometabolic conditions are projected to rise substantially by 2050 among adults in the United States. Hypertension prevalence is expected to reach 61 percent, diabetes 26.8 percent, and obesity 60.6 percent. In contrast, hypercholesterolaemia is the only major risk factor projected to decline, falling from 45 percent to 24 percent.

Most core health behaviours are projected to worsen over time. An important exception is sleep, where inadequate sleep duration is expected to increase. Evidence from a 2010 to 2022 meta-analysis showed that people with ideal cardiovascular health experienced a 74 percent lower risk of cardiovascular disease events compared with those with poor cardiovascular health.

Nicotine exposure remains a major concern. People who smoke have a mortality risk three times higher than those who have never smoked. While smoking prevalence among adults in the United States has declined, the use of e-cigarettes has increased sharply. National Health Interview Survey data from 2017 to 2023 indicate that e-cigarette use has quadrupled over this period.

Physical activity and sleep health

Levels of physical activity remain suboptimal across age groups and regions. Only one in five children and adolescents aged 6 to 17 years achieved at least 60 minutes of daily physical activity. Globally, around one-third of adults across 163 countries did not meet recommended activity levels.

Sleep health has emerged as a significant cardiovascular risk factor. Data from the National Health and Nutrition Examination Survey covering 2017 to 2020 showed that 30 percent of adults experienced at least one hour of sleep debt, defined as the difference between sleep duration on workdays and free days. Observational analyses linked poor sleep with higher odds of type 2 diabetes, hypercholesterolaemia, and hypertension.

Obesity, lipids, blood pressure, and diabetes

Obesity prevalence continues to rise among both children and adults in the United States. Estimates from the Global Burden of Diseases, Injuries, and Risk Factors study indicated that in 2021 more than 15 million children aged 5 to 14 years, 21 million young people aged 15 to 24 years, and 172 million adults aged 25 years or older were living with overweight or obesity.

While the prevalence of high total cholesterol has decreased, low-density lipoprotein cholesterol remains a major driver of cardiovascular mortality. Global data from 2021 attributed a cardiovascular disease mortality rate of 43.7 per 100,000 people to elevated low-density lipoprotein cholesterol.

Hypertension prevalence remained broadly stable between 2013 and 2023. However, blood pressure control worsened, declining from 54.1 percent in 2013 to 2014 to 48.3 percent in 2017 to 2020. Some improvement was observed among non-Hispanic Black adults between 2017 to 2020 and 2021 to 2023.

Diabetes prevalence also remains high. Between 2021 and 2023, an estimated 29.5 million adults had diagnosed diabetes, 96 million had prediabetes, and 9.6 million were living with undiagnosed diabetes. Among people with diagnosed diabetes, glycated haemoglobin levels increased significantly from 2017 to 2020 and again from 2021 to 2023, while overall glycaemic control rates declined.

Kidney disease, CKM syndrome, and pregnancy outcomes

The burden of kidney disease has risen markedly over the past two decades. The prevalence of end-stage kidney disease nearly doubled between 2002 and 2019, before stabilising in subsequent years. Across 114 cohort studies, both albuminuria and reduced kidney function were consistently associated with increased risk of kidney failure and mortality.

Data from NHANES between 2011 and 2020 suggest that approximately 90 percent of adults in the United States were in stage 1 or higher of CKM syndrome. People from underrepresented ethnic and racial groups experienced a disproportionately higher burden of advanced CKM stages. More advanced stages were strongly associated with increased cardiovascular disease mortality.

The report also highlights links between cardiometabolic health and pregnancy outcomes. In Japan, pregnant individuals with higher healthy lifestyle scores before pregnancy had around a one-third lower risk of adverse pregnancy outcomes compared with those with the lowest scores. Although maternal mortality rates declined across all ethnic and racial groups between 2021 and 2022, persistent disparities remain.

Cardiovascular disease, stroke, dementia, and congenital conditions

Overall cardiovascular disease prevalence reached nearly 49 percent among adults aged 20 years or older, based on NHANES data from 2021 to 2023. Prevalence increased with age in both women and men. At the population level, stronger adherence to healthy dietary patterns was associated with lower cardiovascular disease risk.

Stroke incidence declined between 1993 and 2015 among both Black and White adults, although rates remained consistently higher in Black populations. Dementia prevalence among older adults decreased between 2011 and 2021, though findings varied depending on study design and population. Evidence from selected intervention studies suggested that high-intensity training may help slow cognitive decline.

Congenital cardiovascular defects were estimated to affect around 1 in 80 babies in high-income regions of North America. Globally, survival into adulthood among people born with congenital heart disease improved substantially between 1990 and 2019. Population-based analyses linked limited prenatal care, neighbourhood deprivation, and air pollution to increased risk of heart defects, poorer outcomes, and delayed diagnosis.

Heart rhythm disorders, cardiac arrest, and heart failure

Heart rhythm disorders and heart failure continue to contribute significantly to cardiovascular morbidity. Atrial fibrillation affected an estimated 10.55 million adults in the United States, representing 4.48 percent of the adult population.

Patterns of cardiac arrest have also shifted. Opioid-related out-of-hospital cardiac arrests accounted for less than 1 percent of cases in 2000 but rose to between 7 percent and 14 percent by 2023. Coronary heart disease prevalence was estimated at 5.2 percent among adults aged 20 years or older between 2021 and 2023. Over the same period, heart failure prevalence increased from 6.7 million people in 2017 to 2020 to 7.7 million in 2021 to 2023.

A growing burden with global implications

Taken together, the 2026 Heart Disease and Stroke Statistics Report paints a picture of a growing cardiovascular disease burden affecting around half of the adult population. Despite major advances in diagnostics, prevention strategies, and treatment options, ageing populations, widening health inequalities, and rising cardiometabolic risk factors continue to place increasing pressure on healthcare systems.

The report emphasises the need for coordinated, prevention-led approaches that prioritise early intervention and equitable access to care. Without sustained action across policy, healthcare, and community settings, current trends are likely to continue, with profound long-term health and economic consequences.

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Italy Officially Recognises Obesity as a Chronic Disease under New Law

Key Takeaways:

• Italy becomes the first country to officially recognise obesity as a chronic, progressive, and relapsing disease under national law.
  
• The new legislation ensures access to prevention, early diagnosis, and treatment through the National Health Service, supported by dedicated funding and professional training.
  
• The law marks a cultural and clinical milestone, combating stigma and embedding obesity care into multidisciplinary health and social policies.
  
  
  

A landmark in public health policy

Italy has taken a historic step forward in the recognition and treatment of obesity. Following final approval in the Senate, a new law formally recognises obesity as a chronic, progressive, and relapsing disease, fully incorporated within the National Health Service (Servizio Sanitario Nazionale, SSN). This recognition places obesity among the conditions requiring prevention, early diagnosis, and integrated care, marking a fundamental shift in how the nation addresses one of its most pervasive health challenges.

Until now, obesity—despite its well-documented health, social, and economic burden—was often perceived as an “individual problem” tied to lifestyle choices and personal responsibility. This new law redefines that narrative. It positions obesity as a medical condition requiring structured clinical and social support, thereby recognising the biological, psychological, and environmental factors that contribute to it.

Leadership and legislative consensus

The legislation was spearheaded by Hon. Roberto Pella, President of the Interparliamentary Group on Obesity, Diabetes and Non-Communicable Diseases (NCDs), who has long advocated for stronger prevention policies, enhanced patient rights, and healthier urban environments.

The final version of the bill approved by the Senate mirrors that previously passed by the Chamber of Deputies, reflecting broad cross-party agreement on the urgent need to address obesity as a national health priority.

Key provisions of the law

The new law introduces a comprehensive framework of measures that address obesity through prevention, treatment, research, and social inclusion.

• Access to Essential Levels of Care (LEA): People living with obesity will now have guaranteed access to diagnostic and therapeutic services under the National Health Service, ensuring equitable treatment and continuity of care.
  
• National Programme for Prevention and Care: Dedicated funding will progressively increase from €700,000 in 2025, to €800,000 in 2026, and €1.2 million annually from 2027 onwards. These resources will support prevention campaigns, public awareness efforts, anti-stigma initiatives, and projects promoting social inclusion.
  
• Health Promotion: The law prioritises preventive health measures, including nutrition education in schools, support for breastfeeding, and programmes encouraging regular physical activity across all age groups.
  
• Social Inclusion: New provisions promote the full participation of people living with obesity in society—whether in the workplace, education, or recreation—by addressing structural barriers and discrimination.
  
• Training for Health Professionals: From 2025, €400,000 annually will be invested in training doctors, paediatricians, psychologists, and other healthcare professionals to improve clinical understanding of obesity and strengthen multidisciplinary care.
  
• National Observatory for the Study of Obesity (OSO): A new Observatory will be established within the Ministry of Health to oversee the implementation of the law. It will monitor outcomes, coordinate research, and present an annual report to Parliament, ensuring transparency and accountability.
  
• Awareness Campaigns: A permanent fund of €100,000 per year will support public initiatives promoting balanced nutrition and physical activity. Schools, pharmacies, physicians, and local authorities will play key roles in these campaigns.
  
  
  

Cultural and clinical significance

The adoption of this law represents a dual victory—both cultural and medical. Culturally, it challenges the long-standing stereotypes and stigma that have surrounded obesity, reframing it as a health condition rather than a personal failing. It acknowledges the dignity and rights of people living with obesity and underscores the need for inclusion and respect in both healthcare and everyday life.

Clinically, the law ensures equal access to prevention and treatment and formally integrates obesity into structured healthcare pathways. This institutional recognition paves the way for better coordination between medical professionals, community services, and social care systems.

A multidisciplinary and cross-sectoral approach

The reform promotes a multidisciplinary model of care, encompassing prevention, education, inclusion, and research. It also aligns obesity management with broader public health objectives, connecting healthcare policy with urban planning, education, and sport.

By mandating ongoing monitoring through the National Observatory and annual parliamentary reporting, the law ensures a strong framework for governance and sustained progress.

Towards broader change

As Hon. Roberto Pella’s leadership demonstrates, this legislation is not merely a symbolic step—it establishes a concrete foundation for long-term change. The next phase will involve implementing its provisions effectively, strengthening local prevention programmes, supporting patient associations, and fostering partnerships between healthcare providers, schools, and community organisations.

Obesity is not only a disease but also a reflection of how societies live, eat, and structure their environments. Italy’s new law acknowledges this complexity. It is a decisive move toward compassion, inclusion, and evidence-based care, ensuring that people living with obesity receive the attention, respect, and medical support they deserve.

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WHO expands essential medicines list to include GLP-1 agonists and Cystic Fibrosis therapies

Key Takeaways:

• The World Health Organization (WHO) has added GLP-1 receptor agonists, rapid-acting insulin analogues, and innovative cancer therapies to its 2025 Essential Medicines Lists (EMLs), signalling their importance in global diabetes and oncology care.
• Advocates welcomed the inclusion of GLP-1 agonists and insulin analogues but warned that current prices remain prohibitive, particularly in low-resource settings, where these medicines are often unavailable.
• The updated lists also include new treatments for cystic fibrosis and haemophilia, and vaccines for malaria and mpox, while controversy surrounds the continued exclusion of risdiplam, a therapy for spinal muscular atrophy.
  

WHO expands access through 2025 Essential Medicines Lists

The World Health Organization (WHO) has published its 2025 Essential Medicines Lists (EMLs), marking a significant step in the recognition of medicines that address pressing global health needs. Among the 20 new medicines recommended this year are GLP-1 receptor agonists – such as semaglutide, the active ingredient in Ozempic and Wegovy – which are increasingly used in the management of type 2 diabetes worldwide.

The updated lists also incorporate immune checkpoint inhibitors, including pembrolizumab and two therapeutic alternatives, reflecting advances in cancer treatment. WHO emphasised that the inclusion of these therapies highlights the importance of both non-communicable and infectious disease management at a global scale.

Diabetes treatments strengthened with insulin and GLP-1 agonists

For the first time, rapid-acting insulin analogues have been included on the EML, complementing long-acting synthetic insulin formulations that were added in 2021. This provides a complete package of insulin options recommended by WHO.

“These are complementary; there [are] those conditions where it’s more appropriate to use long-acting but also we need [to] have conditions where we need short acting,” explained Deus Mubangizi of WHO at a press briefing.

GLP-1 receptor agonists were recommended not primarily for weight management but for their proven role in lowering blood glucose in adults with type 2 diabetes mellitus who also have established cardiovascular disease, chronic kidney disease, or obesity (body mass index ≥ 30 kg/m²).

The medications mimic the natural GLP-1 hormone to regulate blood sugar. They stimulate pancreatic insulin release, reduce hepatic glucose production, slow digestion, and act on the brain to suppress appetite. In addition to glycaemic control, they offer cardiovascular and renal benefits.

Cancer therapies chosen based on long-term evidence

WHO also endorsed pembrolizumab and comparable therapies for metastatic cervical, colorectal, and lung cancers. These medicines have been shown to prolong survival by four to six months.

“The expert committee had a preference for those results in which we had long-term follow up data and we are sure about the effect on overall survival and quality of life,” explained Lorenzo Moja of WHO. He noted that trials for some newer breast cancer drugs remain ongoing, with evidence not yet mature enough to warrant inclusion.

Essential Medicines List for children expanded

The separate Essential Medicines List for children (EMLc) also grew, with 15 new additions. These include therapies for cystic fibrosis and haemophilia, as well as vaccines recently approved for malaria and mpox.

WHO simultaneously announced the end of its declaration of mpox as a Public Health Emergency of International Concern (PHEIC), stating that case numbers in Africa – the region most affected – had stabilised.

The 2025 EML now covers 563 medicines on the adult list and 361 treatments on the children’s list. Both lists are updated every two years and guide over 150 countries, insurers, and healthcare providers in the procurement and provision of essential therapies.

Access advocates highlight affordability concerns

The inclusion of new insulins and GLP-1 agonists was welcomed by Médecins Sans Frontières (MSF). Elizabeth Jarman, representing MSF’s ACCESS initiative, called the decision a “critical milestone” but warned that affordability remains a major barrier.

“In our experience of providing diabetes care in low-resource settings and humanitarian emergencies, rapid-acting insulins and GLP-1s are unaffordable and often unavailable,” said Jarman. “Current prices are unacceptably high, with rapid-acting insulin analogues priced as much as 75 times and GLP-1 agonists 400 times higher than what they can be profitably produced for, according to a recent MSF study.

“We call on countries to take urgent steps to update their national EMLs, begin procurement planning, and – alongside the WHO – demand pharmaceutical corporations make these key diabetes treatments available in-country by immediately registering them and – critically – making them affordable.”

Exclusion of risdiplam sparks criticism

Not all decisions were met with approval. Knowledge Ecology International (KEI) criticised the EML committee for again rejecting risdiplam, a therapy for spinal muscular atrophy (SMA).

“The second rejection of risdiplam is appalling,” said Jamie Love, director of KEI. “This is exactly the type of drug for a rare disease the EML should embrace. It works and it’s easy and cheap to make and distribute generic versions. The consequences of no access are terrible for many children.”

The committee’s rejection was reportedly due to a lack of peer-reviewed data from ongoing trials in pre-symptomatic infants. However, a study published in August in the New England Journal of Medicine demonstrated high rates of developmental milestones – such as sitting and walking – in treated infants compared with untreated counterparts.

Breakthrough for Cystic Fibrosis patients

For people with cystic fibrosis (CF), the inclusion of ivacaftor and its therapeutic alternatives represents a major advance. The combination therapy elexacaftor/tezacaftor/ivacaftor (ETI), marketed as Trikafta or Kaftrio, was added to both adult and paediatric lists.

“This decision is a turning point,” stated the patient advocacy group Right to Breathe. “For the first time, a medicine specifically aimed at treating CF has been included on the EML and the world’s leading health authority has recognised that Trikafta is not a luxury drug, but an essential medicine – and that every child and adult living with CF should have the right to access it.”

The group added: “This is a powerful statement from the WHO: not only is Trikafta recognised as essential, but its inclusion is about breaking down barriers to access and ensuring patients everywhere – not just in the richest countries – can benefit from its lifesaving impact.”

Balancing innovation, cost, and health system strengthening

David Reddy, Director-General of the International Federation of Pharmaceutical Manufacturers and Associations, said that the inclusion of multiple advanced therapies “highlights how scientific advances are transforming how we prevent, treat and cure disease, and reinforces the importance of ensuring patients everywhere can benefit from them.”

However, WHO’s expert group has sometimes withheld recommendations for expensive new treatments due to affordability concerns. Reddy emphasised that solutions such as “tiered pricing, voluntary licensing and value-based healthcare models” can improve access.

He also underlined the importance of robust healthcare systems: “Healthcare systems need to be strengthened with the right infrastructure, diagnostics and trained professionals in place, alongside effective regulatory pathways and sustainable procurement, to help ensure these innovations can achieve greatest impact for patients.”

CCH Insight:

The inclusion of GLP-1RAs in the Essential Medicines List (EML) signals global recognition of these medications as critical therapies for serious chronic conditions, in stark contrast to the ongoing trend that positions them as optional add-ons or a quick-fixes for cosmetic weight loss.

Hopefully this will increase prescribing of GLP-1 medicines, at least for type 2 diabetes. Although the cost of these drugs continues to be a barrier for many less well-off people, patents start to end from next year – the patent for liraglutide ends in Europe in 2026, as does the patent for semaglutide (Ozempic/Wegovy) in Canada and India. So cheaper generic versions should start to become available soon, improving access to these very important medications.

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Make obesity prevention and management central to public health, experts urge

Obesity must be recognised and treated as a chronic, progressive condition that affects people of all ages and genders, and must be integrated throughout primary, secondary, and tertiary care systems. This was the collective message from experts representing Ireland, Portugal, Slovenia, and Spain who gathered in Dublin in January 2025 for the WHO Demonstration Platform on Obesity Management. These countries, working alongside WHO/Europe’s Special Initiative on Noncommunicable Diseases (NCDs) and Innovation (SNI) and the WHO European Centre for Primary Health Care, issued a clear call: health systems must elevate obesity prevention and management to a central role in the broader effort to achieve universal health coverage and reduce the burden of NCDs.

A Complex, Chronic Disease with Widespread Consequences

Obesity is a multifaceted and chronic condition that is strongly linked to over 250 other diseases, including cardiovascular disease, type 2 diabetes, and several cancers. In the WHO European Region, an estimated 1 in 4 children and 60% of adults live with overweight or obesity. This growing prevalence poses a significant threat to achieving Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from NCDs, and has far-reaching implications for other development goals related to education, economic growth, and inequality.

With the global burden of NCDs continuing to escalate, experts are calling for immediate action to implement proven strategies. This demand aligns with the SNI’s Race to the Finish initiative to meet NCD targets by 2030 and gains urgency as the world prepares for the Fourth High-Level Meeting of the United Nations General Assembly on the Prevention and Control of NCDs in 2025 – a key opportunity to reinforce obesity as a public health priority.

Momentum for Scaled-Up Action

The 75th World Health Assembly marked a pivotal moment when countries endorsed the WHO Acceleration Plan to Stop Obesity. Building on this, in 2023 the WHO launched its Health Service Delivery Framework for the Prevention and Management of Obesity – a comprehensive, integrated model designed to guide nations in providing consistent, accessible obesity care across all levels of health systems.

The recent demonstration platform in Ireland showcased a national model of care that integrates practical, scalable solutions within existing health infrastructure. By coordinating multidisciplinary teams, increasing staffing, and optimising treatment protocols, Ireland’s experience demonstrates that high-quality obesity care can be delivered system-wide – provided there is political will, good governance, and collaboration across sectors.

Equally, the platform underscored the high societal cost of untreated obesity and the critical need to tackle the broader environment that contributes to weight gain – often referred to as the obesogenic environment. This includes the widespread availability of unhealthy foods, sedentary lifestyles, and pervasive marketing of unhealthy products.

Urgent Actions to Support People Living with Obesity

The WHO and its partners are urging countries to act decisively on a series of priority interventions:

1. Strengthen Multidisciplinary Care Pathways

Obesity care must be embedded across the entire health system, starting with primary care. Countries are encouraged to establish and expand multidisciplinary teams – comprising physicians, dietitians, nurses, psychologists, and physiotherapists – that offer comprehensive, evidence-based care for people living with obesity. These teams must be integrated into referral networks that ensure continuity of care from early prevention through to specialist services.

Portugal offers a recent example of such progress: in 2023, the country introduced a legal framework to implement an Integrated Care Model for the Prevention and Treatment of Obesity, aligned with WHO’s service delivery framework. This legislation aims to ensure consistent, equitable care throughout the national health service.

2. Address Commercial Determinants and Conflicts of Interest

Governments must enact robust policies to reshape food environments in ways that prioritise public health. This includes:

• Regulating digital and traditional marketing of unhealthy food and beverages, especially to children;
• Introducing clear, front-of-pack nutrition labelling;
• Mandating reformulation of processed foods to reduce sugar, salt, and unhealthy fats;
• Using taxation and subsidies to discourage unhealthy options and incentivise healthier ones.

Given the increased screen time among children and adolescents, special attention is needed to tackle commercial determinants in digital environments. Nutritional education programmes must be aligned with advertising regulations to ensure coherence between health messages at school and broader media. Portugal’s restrictions on food marketing to children provide a model of how cross-sectoral alignment can reinforce health promotion efforts.

3. Expand Early Intervention and Life-Course Prevention

Prevention efforts must begin early and continue throughout the life course, with a strong emphasis on high-risk populations. Interventions include:

• Promoting healthy eating and physical activity in schools and childcare settings, such as the EU’s school fruit scheme and Slovenia’s Slofit programme;
• Supporting families with tailored lifestyle advice;
• Ensuring that community-based programmes offer culturally appropriate support for nutrition and physical activity;
• Integrating routine screening, psychological support, and counselling into primary care.

By acting early, countries can prevent the development of obesity and avoid severe health complications later in life.

4. Build Health Workforce Capacity and Tackle Stigma

To provide respectful, effective obesity care, health professionals must be trained to address the condition without bias or stigma. This includes education on sarcopenic obesity – the co-occurrence of low muscle mass with excess fat – and training in clinical nutrition, sleep, movement, and psychological support.

Since 2022, Ireland has delivered obesity education to more than 3,000 medical and physiotherapy students, helping to embed non-stigmatising, evidence-based care into clinical practice. This model should be replicated globally.

At the same time, public health campaigns are needed to challenge stigmatising narratives and raise awareness of obesity as a chronic condition that requires medical and social support. Transitioning from a weight-centric to a body composition-based approach may further reduce stigma. Creating safe, inclusive environments for individuals living with obesity will improve their willingness to seek care and ultimately lead to better health outcomes.

Global Leadership Required – The Time to Act Is Now

Governments, health authorities, and policy-makers must now act on this evidence and make obesity a cornerstone of public health strategy. Real change demands multi-sectoral coordination, as seen in Spain’s national obesity prevention plan, which involves ministries beyond health.

The human and economic costs of inaction are simply too high. By scaling up coordinated responses across the health system, societies can prevent unnecessary suffering, improve population well-being, and take meaningful steps toward achieving the SDGs.

As the UN High-Level Meeting on NCDs approaches, the world is watching. There is a clear mandate: to elevate obesity on the global agenda and implement decisive, system-wide actions. The time for commitment and leadership is now.

“Obesity is a progressive, chronic and complex disease affecting all ages and genders.”

“Health systems worldwide need to prioritise obesity prevention and management as a core component of universal health coverage and NCD control.”

“The demonstration platform for obesity in Ireland highlighted the importance of a continued focus on driving significant changes to the obesogenic environment.”

“Shifting the focus from ‘obesity’ to ‘excess body fat’ through body composition measurements can help combat stigmatization.”

CCH Insight:

CCH supports this call for resources and actions to tackle obesity, particularly with regard to building health workforce capacity. Currently there is inadequate training for healthcare professionals in obesity care, so the first step must be to expand the provision of obesity care training for existing practitioners, and revise healthcare curricula to ensure the future workforce is capable of meeting this call to action. 

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Obesity rates among children and adolescents set to soar by 2050

A staggering rise in childhood and adolescent obesity is anticipated over the next 25 years, with one in six young people worldwide predicted to be living with obesity by 2050. A newly published study warns that without immediate intervention, this escalating public health crisis could place immense strain on healthcare systems and economies across the globe.

The research, conducted by the Murdoch Children’s Research Institute (MCRI) and published in The Lancet, estimates that by 2050, 385 million children and adolescents will be categorised as overweight, while a further 360 million will have obesity. This projection encompasses 356 million children aged 5–14 years and 390 million individuals aged 15–24 years, highlighting the pervasiveness of the issue across developmental stages.

The Alarming Acceleration of Obesity Rates

Between 1990 and 2021, the global obesity rate among young people aged 5–24 years more than tripled, increasing by a shocking 244% to reach 174 million. The researchers argue that such a dramatic rise demonstrates the failure of current interventions to curb the trend, leaving an entire generation vulnerable to long-term health complications. By 2021, an estimated 493 million children and adolescents worldwide were classified as overweight or obese, underscoring the magnitude of the crisis.

Dr Jessica Kerr, a researcher at MCRI, emphasised the urgency of immediate action, stating that failing to implement effective five-year intervention strategies could lead to dire consequences for future generations.

“Children and adolescents remain a vulnerable population within the obesity epidemic. Prevention is key as obesity rarely resolves after adolescence.

This giant burden will not only cost the health system and the economy billions, but complications associated with a high Body Mass Index (BMI), including diabetes, cancer, heart problems, breathing issues, fertility problems and mental health challenges, will negatively impact our children and adolescents now and into the future, even holding the potential to impact our grandchildren’s risk of obesity and quality of life for decades to come.

Despite these findings indicating monumental societal failures and a lack of coordinated global action across the entire developmental window to reduce obesity, our results provide optimism that this trajectory can be avoided if action comes before 2030.”

Global Trends and High-Risk Regions

The study, released in conjunction with World Obesity Day, utilised data from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study, led by the Institute for Health Metrics and Evaluation. The analysis included forecasts for 204 countries and territories, identifying key regions where obesity prevalence is expected to be particularly severe.

The United Arab Emirates, Cook Islands, Nauru, and Tonga are projected to have the highest obesity prevalence by 2050, while China, Egypt, India, and the United States are expected to have the largest absolute numbers of children and adolescents with obesity.

Australia has been identified as one of the countries experiencing the fastest transitions to obesity among young people. The study highlights a concerning trend in which Australian girls are already more likely to have obesity than be overweight. By 2050, it is projected that 2.2 million Australians aged 5–24 years will have obesity, with an additional 1.6 million classified as overweight.

Globally, the research indicates a shift where boys aged 5–14 years will be more likely to have obesity than be overweight by mid-century, demonstrating an accelerating trend in early childhood.

Urgent Policy Action Required to Prevent a Public Health Emergency

Dr Kerr warned that without significant policy reforms, regions such as North Africa, the Middle East, Latin America, and the Caribbean could experience the most rapid increases in obesity rates due to their high population growth and limited healthcare resources.

“Without urgent policy reform, the transition to obesity will be particularly rapid in North Africa, the Middle East, Latin America and in the Caribbean, where the rise is concurrent with high population numbers and limited resources.

Many regions have historically had to focus on preventing undernutrition and stunting in children. To prevent a public health emergency from this newer threat, an immediate imperative should be creating national surveillance surveys of obesity in children and adolescents in every country.”

The study identifies adolescent girls aged 15–24 years as a particularly vulnerable group, given their entry into reproductive years and the potential for intergenerational transmission of obesity-related health risks.

“Adolescent girls who have obesity are a main focus if we are to avoid intergenerational transmission of obesity, chronic conditions and the dire financial and societal costs across future generations.

With this age group increasingly being out of school and cared for by adult services, we need to focus interventions at the community and commercial level.”

The Role of Governments and Environmental Interventions

Professor Susan Sawyer, also of MCRI, emphasised the need for governments to adopt comprehensive strategies that address obesity drivers beyond individual behaviours, encompassing food environments, physical activity, urban planning, and public health policies.

“While people and families can work to balance their physical activity, diet and sleep, everything in our environments works to counteract these efforts.

Given this huge global shift in children’s and adolescents’ weight, we can no longer keep blaming people for their choices. We require governments to step up by addressing regulatory interventions including taxing sugar-sweetened beverages, banning junk food advertising aimed at children and young people and funding healthy meals in primary and secondary schools. We also need to consider the benefits of wider policies such as overhauling urban planning to encourage active lifestyles.”

The Path Forward

This research presents a stark warning about the future of global childhood and adolescent obesity rates but also provides a glimmer of hope that targeted, immediate action could alter the projected trajectory. The findings reinforce the need for urgent, evidence-based interventions at both national and global levels, with a focus on preventing obesity from early childhood through adolescence. By enacting systemic changes, policymakers and public health experts have the opportunity to mitigate the long-term health and economic burdens of obesity, ultimately improving the lives of millions of young people worldwide.

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Obesity is pushing healthcare costs to new heights

Adults living with obesity face significantly higher healthcare expenses than those without the condition, according to a study conducted by the Health Action Council (HAC) and UnitedHealthcare. The research, which analysed data from members across the United States, found that healthcare costs for individuals with obesity are, on average, 2.3 times higher than for those without obesity.

Obesity rates have surged over the past few decades, highlighting an escalating public health crisis with far-reaching economic consequences.

Understanding Obesity and Its Health Impacts

Obesity is clinically defined as having a body mass index (BMI) of 30 or higher. It is a chronic condition linked to over 250 health complications, including serious conditions such as type 2 diabetes, cardiovascular disease, kidney disease, and certain types of cancer. Beyond its physical health implications, obesity is also closely associated with mental health conditions, including anxiety and depression, which can further contribute to rising medical expenses.

Given the increasing prevalence of obesity, researchers emphasise the necessity of understanding its economic burden. This knowledge is critical for policymakers, employers, and healthcare providers as they navigate the challenges associated with rising healthcare costs.

A Growing Epidemic: Trends in Obesity Rates

The percentage of U.S. adults living with obesity has more than doubled over the past three decades, rising from approximately 20% in 1990 to around 40% in 2021, according to the study. This increase signifies a dramatic shift in the nation’s health landscape. In addition, three out of four adults in the U.S. are now classified as either overweight or living with obesity, compared to just 50% in 1990.

The study also highlighted the regional variations in obesity rates. In 23 states, more than 35% of the population is classified as having obesity.

Younger adults are experiencing some of the most significant increases in obesity prevalence. Between 2010 and 2020, obesity rates among individuals aged 20 to 59 rose by seven percentage points, reflecting a concerning trend that could have lasting implications for healthcare systems and workforce productivity in the coming decades.

The Financial Burden of Obesity

The economic consequences of obesity extend far beyond the direct costs of medical treatment. The condition significantly contributes to the overall strain on healthcare systems, increasing both individual and employer-sponsored insurance costs.

A 2024 report estimated that obesity-related healthcare costs could reach an astonishing $9.1 trillion over the next decade. Individuals living with obesity, on average, incur an additional $662 in healthcare expenses per year.

According to HAC data, approximately 26% of its 224,000 members are living with obesity, yet this group accounts for nearly half (46%) of total healthcare spending. The disparity in healthcare costs is striking, with monthly expenses for individuals with obesity averaging $973 per person, compared to $421 for those without obesity.

The financial implications of obesity are also evident in workplace settings. The study found that if just 10% of HAC members avoided obesity, the organisation could save up to $30 million annually. On a corporate level, a 25% reduction in obesity among a company’s workforce of 5,000 employees could generate annual savings of up to $8.6 million.

Increased Risk of Chronic Conditions

One of the primary drivers of higher medical costs among individuals with obesity is the increased risk of developing chronic diseases.

Among HAC members living with obesity, 61% have metabolic conditions such as diabetes, high cholesterol, and hypertension. The study revealed that adults in their 40s with obesity experience hypertension at three times the rate of their peers without obesity. Similarly, adults in their 50s with obesity are 2.5 times more likely to be diagnosed with diabetes.

In addition to metabolic disorders, obesity is strongly linked to musculoskeletal conditions, autoimmune diseases, and certain cancers. Individuals with obesity are 80% more likely to experience back pain and arthritis. Moreover, conditions such as lupus and rheumatoid arthritis occur at more than twice the rate in individuals with obesity. Certain cancers, including breast and colon cancer, are twice as prevalent in this population.

Future Projections and Employer Considerations

Looking ahead, researchers predict that by 2030, nearly half (49%) of U.S. adults will be living with obesity. If this trajectory continues, employer-sponsored health plans could face an additional $500 million in costs per year.

The financial impact of obesity is particularly evident among younger generations. Millennials and Gen Z adults with obesity are experiencing chronic diseases such as diabetes and hypertension at rates comparable to older adults. Additionally, the study found that obesity doubles the prevalence of anxiety and depression among Gen Z, leading to increased healthcare expenses and decreased workplace productivity.

Strategies to Reduce Obesity and Lower Healthcare Costs

Addressing obesity can result in substantial healthcare savings. Employers and healthcare providers can implement proactive strategies to mitigate the impact of obesity, including:

• Wellness Programmes: Providing access to nutrition education, fitness programmes, and mental health resources can support individuals in managing their weight and overall health.
• Access to Medications and Treatments: Expanding access to new weight-loss medications and lifestyle interventions can help prevent long-term health complications associated with obesity.
• Early Screening and Intervention: Encouraging routine health screenings for obesity and related conditions can lead to earlier diagnoses and reduce the long-term financial burden of treating advanced chronic diseases.

Conclusion

The rising prevalence of obesity presents significant challenges, not only in terms of public health but also in the financial strain it places on individuals, healthcare providers, employers, and policymakers. As obesity rates continue to climb, taking proactive measures to address its underlying causes and associated healthcare costs is essential. By investing in prevention, treatment, and workplace wellness initiatives, it is possible to curb the growing economic toll of obesity and improve health outcomes for millions of individuals.

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Significant increase in severe obesity among U.S. adults over the past decade

The prevalence of severe obesity among adults in the United States has risen steadily over the past decade, according to a research letter published online on 13 February in the Journal of the American Medical Association.

Samuel D. Emmerich, D.V.M., from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues conducted an analysis using data from 41,449 participants in the National Health and Nutrition Examination Survey (NHANES). The study spanned multiple survey cycles, from 2013–2014 to the most recent period of August 2021–August 2023, to assess trends in obesity prevalence across different age groups and demographics in the United States.

Key Findings from the Study

Childhood and Adolescent Obesity Trends

The researchers found that among children younger than 24 months, the prevalence of high weight-for-length remained stable at 8.1% throughout the study period. However, the overall rate of obesity among children and adolescents showed a gradual increase, rising by an average of 0.44 percentage points annually, reaching a prevalence of 21.1% by the most recent survey period.

Obesity Prevalence in Adults

Among adults, general obesity rates remained largely unchanged across different sex and age groups, with one notable exception. Adults aged 40 to 59 years saw an increase in obesity prevalence, which reached 40.3% in this age group.

Severe Obesity on the Rise

A particularly concerning trend highlighted in the study is the increase in severe obesity among adults. Over the ten-year period, the prevalence of severe obesity increased by an average of 0.23 percentage points per year, reaching 9.4% by the most recent data collection period. Women and individuals aged 40 to 59 years were disproportionately affected by this increase.

Additionally, the study reported that, between August 2021 and August 2023, the prevalence of high waist circumference among adults was 57.6%, highlighting a growing concern regarding central adiposity, which is strongly linked to cardiometabolic risk factors.

Authors’ Conclusions

The authors summarised their findings by stating, “From 2013 to 2014 to August 2021 to August 2023, there were small increases in the percentage of children and adolescents with obesity, as well as in adults with severe obesity (but not obesity).”

These findings underscore the continued rise in severe obesity among adults, particularly in middle-aged populations and women, reinforcing the need for sustained public health interventions and policies aimed at addressing obesity-related health risks across different age groups.

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Life expectancy progress stalls across Europe: Obesity, poor diet, and inactivity identified as key factors

The steady rise in life expectancy across Europe has stagnated since 2011, according to a new study from the University of East Anglia (UEA) and its research partners. The findings, published today in The Lancet Public Health, identify obesity, poor diet, and physical inactivity as major contributing factors, alongside the impact of the COVID-19 pandemic.

A Dramatic Shift in Life Expectancy Trends

Historically, advances in public health and medicine have led to consistent increases in life expectancy across Europe. However, the latest analysis suggests that this upward trend has significantly slowed, with some countries experiencing more pronounced declines than others. Of all the nations studied, England showed the most substantial stagnation in life expectancy improvements.

This shift signals a concerning reality: rather than anticipating longer lifespans than previous generations, many individuals may face the prospect of shorter lives. The study underscores the importance of prioritising healthy lifestyles from an early age, with researchers calling on governments to implement bold public health initiatives to reverse this trend.

Understanding the Underlying Causes

Professor Nick Steel, lead researcher from UEA’s Norwich Medical School, explained the significance of the findings:

“Advances in public health and medicine in the 20th century meant that life expectancy in Europe improved year after year. But this is no longer the case.”

“From 1990 to 2011, reductions in deaths from cardiovascular diseases and cancers continued to lead to substantial improvements in life expectancy. However, from 2011 onwards, these improvements slowed considerably, with significant variations between countries.”

The study identifies cardiovascular disease as the primary driver behind the slowdown in life expectancy improvements between 2011 and 2019. The COVID-19 pandemic further exacerbated the issue, causing an overall decline in life expectancy between 2019 and 2021.

One of the most alarming trends highlighted in the study is the increasing prevalence of major health risks, such as obesity, high blood pressure, and high cholesterol. Professor Steel noted:

“After 2011, major risks such as obesity, high blood pressure, and high cholesterol either increased or stopped improving in almost all countries.”

“Better cholesterol and blood pressure treatments have not been enough to offset the harms from obesity and poor diets.”

A Comprehensive Analysis of European Health Data

The study is based on data from the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Disease 2021—the most extensive research initiative quantifying health loss across time and locations. This research draws on contributions from nearly 12,000 experts across more than 160 countries and territories.

Researchers compared changes in life expectancy, causes of death, and population exposure to risk factors across Europe during three key periods: 1990–2011, 2011–2019, and 2019–2021. The study included data from a broad range of European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, England, Northern Ireland, Scotland, and Wales.

Have We Reached a Biological Limit to Longevity?

Despite the worrying decline in life expectancy progress, researchers argue that humans have not yet reached a biological ceiling for longevity. Professor Steel elaborated:

“Life expectancy for older people in many countries is still improving, showing that we have not yet reached a natural longevity ceiling.”

“Life expectancy mainly reflects mortality at younger ages, where we have ample opportunity to reduce harmful risks and prevent early deaths.”

“Comparing countries, national policies that improved population health were linked to better resilience to future shocks.”

The study highlights examples of nations that have maintained better life expectancy outcomes. Norway, Iceland, Sweden, Denmark, and Belgium showed more resilience after 2011, benefiting from policies that reduced the impact of major risks for heart disease. In contrast, England and the other UK nations performed the worst after 2011 and during the COVID-19 pandemic, experiencing some of the highest rates of heart disease and cancer linked to poor diet.

“This suggests that stronger government policies are needed to reduce major health risks, including obesity, poor diet, and low physical activity—to improve population health over the long term,” Steel concluded.

Implications for Public Health Policy

Professor John Newton, from the European Centre for Environment and Human Health at the University of Exeter, echoed these concerns while also pointing to potential solutions:

“These results are a cause for concern, especially here in the UK, but also provide some hope. We should be concerned because many European countries, including the UK, are showing such poor progress. However, we should be hopeful because addressing the underlying causes of major illnesses appears to be effective—if only improvements in key risk factors can be sustained.”

Sarah Price, National Director of Public Health at NHS England, reinforced the importance of prevention:

“This important study reinforces that prevention is the cornerstone of a healthier society, and is exactly why it will be such a key part of the 10-Year Health Plan, which we are working on with the government.”

“The slowdown in life expectancy improvements, particularly due to cardiovascular disease and cancer, highlights the urgent need for stronger action on the root causes—poor diet, physical inactivity, and obesity.”

“The NHS is playing its part and has already helped hundreds of thousands of people to lose weight through our 12-week digital Weight Management Programme. Additionally, more than a million people a year receive a blood pressure check in NHS pharmacies, which is crucial for identifying cardiovascular issues and significantly improving overall health.”

“However, more action is needed across society because we cannot treat our way out of the obesity crisis—we need to stem it at the source.”

Future Directions for Public Health and Policy

The research, led by UEA in collaboration with the Global Burden of Disease Project at the Institute for Health Metrics and Evaluation (University of Washington), the University of Exeter, and the UK Department of Health and Social Care, presents a crucial opportunity for policymakers. The findings call for targeted interventions to address obesity, dietary health, and physical activity, with an emphasis on preventive measures rather than reactive treatments.

The study was funded in part by the Gates Foundation, and while the findings and conclusions represent those of the authors, they do not necessarily reflect the official positions or policies of the UK Department of Health and Social Care or the Gates Foundation.

The full study, “Changing Life Expectancy in European Countries 1990–2021: A Sub-Analysis of Causes and Risk Factors from the Global Burden of Disease Study 2021,” is now available in The Lancet Public Health.

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Global commission proposes comprehensive framework for obesity diagnosis and treatment

A newly published report by a global Commission, featured in The Lancet Diabetes & Endocrinology and endorsed by 75 medical organisations worldwide, calls for a transformative approach to diagnosing and managing obesity. The report challenges the long-standing reliance on body mass index (BMI) as a sole diagnostic tool, deeming it insufficient on its own.

The Commission comprised 56 leading experts, including Professor Louise Baur, a Professor of Child and Adolescent Health at the University of Sydney and former President of the World Obesity Federation. The multidisciplinary team also featured medical specialists from the United States, United Kingdom, India, and Brazil, as well as individuals living with obesity. Together, they have developed a framework to improve care by addressing the complexity of obesity as a chronic condition.

Rethinking Obesity Diagnosis

The report advocates for a shift in diagnostic criteria, urging healthcare professionals to measure excess body fat alongside BMI and evaluate clinical signs and symptoms of ill health, such as breathlessness or joint stiffness. This broader perspective aims to provide tailored, evidence-based care for each individual.

Two new diagnostic categories have been introduced:

1. Clinical Obesity: A chronic disease characterised by organ dysfunction due to excess body fat.
2. Pre-clinical Obesity: A condition where individuals have high levels of body fat without current illness but are at elevated risk of future health complications.

Professor Baur emphasised the need for this shift, stating, “Over a billion people across the world live with obesity, which increases the risk of developing serious conditions such as type 2 diabetes and certain types of cancers. But despite this, people are often diagnosed as having obesity using a single, catch-all measure that is not tailored to the individual. Taking a more nuanced approach will allow people to receive care that is proportionate to their needs.”

Limitations of BMI as a Standalone Measure

BMI has been a standard tool for assessing obesity by calculating weight relative to height. However, the Commission highlights its significant limitations. BMI does not directly measure body fat or account for its distribution, which is critical in assessing health risks. For instance:

• Some individuals with lower BMI may store dangerous levels of fat around vital organs like the liver or heart, increasing their risk of cardiovascular disease.
• BMI was initially designed for populations of European descent and does not adequately account for the diverse risk factors across different ethnic groups.

These shortcomings underline the need for more precise and inclusive diagnostic methods.

Proposed Diagnostic Alternatives

The Commission recommends replacing BMI as a standalone measure with more comprehensive assessments, including:

• Combination of Metrics: BMI supplemented by measurements like waist circumference, waist-to-hip ratio, or waist-to-height ratio.
• Direct Measurement of Body Fat: Techniques such as bone densitometry scans (DEXA) to provide more accurate data.
• Pragmatic Assumptions: In individuals with very high BMI, excess fat may be assumed without further measurements.

Defining Clinical and Pre-clinical Obesity

To enhance the precision of obesity diagnosis, the Commission outlines distinct definitions for two new categories:

Clinical Obesity

This is a chronic disease where excess fat impairs organ function or limits daily activities, such as bathing or dressing. The report identifies 18 diagnostic criteria for adults and 13 for children and adolescents, including:

• Breathlessness caused by lung dysfunction.
• Heart failure due to obesity.
• Joint pain and stiffness, particularly in the knees or hips, caused by excess body weight.
• Altered bone and joint structures in children, restricting movement.
• Signs of dysfunction in various organs, such as the kidneys, lymph system, and metabolic organs.

Pre-clinical Obesity

This category includes individuals with high body fat levels but no current signs of illness. While their organ function remains normal, they are at increased risk of developing chronic conditions, such as cardiovascular disease. Early intervention for this group focuses on risk reduction to prevent the progression to clinical obesity.

Professor Baur hopes these definitions will improve communication between healthcare professionals and patients, “We hope that these new definitions will make it easier for clinicians and patients alike to have discussions about their health, and to get the care that they need without stigma or judgement.”

Personalised Care and Resource Allocation

Commission Chair Professor Francesco Rubino, from King’s College London, explained the significance of the new framework, “Our reframing acknowledges the nuanced reality of obesity and allows for personalised care. This includes timely access to evidence-based treatments for individuals with clinical obesity, as appropriate for people suffering from a chronic disease, as well as risk-reduction management strategies for those with pre-clinical obesity, who have an increased health risk, but no ongoing illness. This will facilitate a rational allocation of healthcare resources and a fair and medically meaningful prioritisation of available treatment options.”

Conclusion

By recognising the limitations of BMI and adopting a more comprehensive diagnostic framework, the Commission aims to provide more equitable, evidence-based care for individuals living with or at risk of obesity. This nuanced approach ensures that treatments and interventions are better aligned with each person’s unique health profile, paving the way for improved outcomes and reduced stigma in obesity care.

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A growing concern: Nearly three-quarters of U.S. adults live with overweight or obesity

Nearly three-quarters of adults in the United States now live with overweight or obesity, according to a major study published in The Lancet. This alarming trend underscores the growing burden of weight-related conditions, including Type 2 diabetes, high blood pressure, heart disease, and reduced life expectancy. The findings also highlight the economic strain on the nation’s healthcare system, with obesity-related costs projected to reach up to $9.1 trillion over the next decade.

The study traces a striking rise in obesity rates nationwide since 1990, when just over half of adults were classified as having overweight or obesity. Researchers found that these conditions are affecting individuals at increasingly younger ages, with more than one in three children now living with overweight or obesity. Without effective intervention, the number of people affected is projected to rise to nearly 260 million by 2050.

“This is an epidemic,” said Dr. Marie Ng, an affiliate associate professor at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine and co-author of the study. The paper’s authors called for sweeping reforms, arguing that current policies have failed to adequately address the crisis. “It’s going to require a lot more attention and a lot more investment than we are currently giving the problem,” said Dr. Sarah Armstrong, professor of paediatrics and population health sciences at Duke University, who was not involved in the research.

The study used body mass index (BMI) to define overweight as a BMI of 25 or higher and obesity as a BMI of 30 or higher. While acknowledging the limitations of BMI as a measure—such as its inability to capture variations in body composition—it remains a practical tool for analysing body fat trends at the population level. The data reveal that rates of obesity have doubled among adults since 1990, affecting over 40% of adults by 2021. Among young women aged 15 to 24, the prevalence nearly tripled during the same period, reaching 29%.

Children and adolescents are particularly vulnerable to the long-term effects of obesity. Almost half of all teens and young adults aged 15 to 24 now live with overweight or obesity, compared with 29% in 1990. Experts are especially concerned about the rise in obesity among children, who are more likely to develop chronic conditions such as high blood pressure, high cholesterol, and Type 2 diabetes. “We’re seeing these conditions emerge more commonly while children are still children,” said Dr. Armstrong. Additionally, obesity during childhood is strongly linked to persistent obesity and chronic health problems in adulthood.

The study highlights the multifaceted drivers of obesity, including the widespread availability of ultra-processed foods, barriers to accessing fresh produce, and sedentary lifestyles. Social determinants of health—such as food insecurity, transportation challenges, and income inequality—further exacerbate the issue, particularly in Black, Hispanic, Indigenous, and low-income communities. Dr. Ng emphasised that addressing these structural factors is critical. “We recognise a lot is beyond the individual and beyond what can happen in the exam room,” said Dr. Sarah Hampl, professor of paediatrics at Children’s Mercy Kansas City and the University of Missouri-Kansas City School of Medicine.

At the individual level, interventions may include lifestyle modifications, medication, or bariatric surgery, though not all individuals will require every treatment. However, access to effective options remains a significant challenge. Health insurance often does not cover evidence-based interventions, such as intensive health behaviour programmes, GLP-1 receptor agonist medications like Wegovy and Zepbound, or bariatric surgery. While these newer drugs show promise, their high cost and uncertain long-term effects raise questions about their accessibility and sustainability as widespread solutions. “They’re not going to be the magic silver bullet to address the problem,” Dr. Ng cautioned.

Structural reforms are essential to reversing these trends. Policy measures such as subsidies for healthy foods, taxes on sugar-sweetened beverages, and stricter regulations on food marketing could significantly influence population-wide dietary behaviours. However, implementing such measures would require coordinated efforts across local, state, and federal levels.

While the rate of increase in obesity prevalence has begun to slow, the sheer magnitude of the epidemic remains concerning. Dr. Ng noted that with rates approaching 80% among adults, the problem has reached a saturation point. “If it’s reaching that level, there really isn’t much further it can go,” she said.

This research serves as a wake-up call for policymakers, healthcare providers, and communities. Obesity is a complex condition, influenced by genetic, physiological, environmental, and social factors. Tackling it will require comprehensive strategies that go beyond individual responsibility, focusing on systemic changes and equitable access to resources and treatments. Without such efforts, the health and economic toll of obesity will continue to escalate, with dire consequences for future generations.

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