Obesity is a disease, but above all a risk factor. It is a chronic illness that increases the risk of type 2 diabetes, cardiovascular and heart diseases, and even the development of certain cancers, among other deadly conditions. In daily life, obesity also diminishes quality of life, sleep, and mobility. Social and psychological consequences are likewise significant. Moreover, it affects genders almost equally (44% of adult women and 43% of adult men).
“Worldwide obesity and overweight now affect more than 42% of the population, and that figure keeps rising every month”
Obesity is considered not only a disease but also a social malady. Worldwide obesity and overweight already affect more than 42% of the population, and that percentage continues to grow monthly. By 2030 it will reach 50% of the planet’s people. It is estimated that, if the current trend continues, by 2035 they will account for 54% of the global population. These obesity levels are responsible for about 10% of annual deaths worldwide. Most of these people will live in middle-income countries, not so much in the richest nations of the northern hemisphere. Today, 65% of the adult population with obesity lives in middle- and low-income countries. In childhood and adolescence, 80% of those with obesity also live in these countries. Some of them confront both problems at once: malnutrition and over-nutrition.
In childhood and adolescence (ages five to nineteen), overweight has spread dramatically: from 8% in 1990 to 20% in 2022. 19% of girls and 21% of boys are overweight. A portion of the youth population suffers obesity that leads to discrimination, stigma, academic failure (and personal), frequent cases of bullying, low self-esteem, and mental health problems. Obesity increasingly affects people—and countries—with low incomes, which seems paradoxical. In these countries obesity, undernutrition, and poverty coexist.
In Spain, obesity is a serious medical and social problem. The country is at the forefront of the obesity epidemic in Europe and is, moreover, one of the leading countries worldwide in terms of obesity prevalence. This epidemic is more common among men. Obesity among children is also significant, a phenomenon that affects other Southern European countries: Greece, Cyprus, Italy, Malta, Portugal, and Spain. In colloquial terms, one could say that Spain is the European country with the most “fatties”. About 74% of adult men are overweight or obese. On a global scale, the prevalence of male obesity places Spain at 12th among 186 countries for which data are available (almost the entire planet). Moreover, this obesity population is rising at about 1% per year. More than a quarter of the population exercises inadequately. Obesity in Spain is considerably higher among men (than among women) and among children or youths (more than among girls and young women). Additionally, there seems to be a cultural laxity toward male obesity in Spain, and this poor situation calls for drastic social policy.
“Today, the obesity population is increasing faster in middle-wealth countries that imitate the ‘modernity’ of the most developed nations”
Obesity—and, in general, overweight—not only affects developed northern countries. Today the obesity population is increasing more rapidly in middle-income countries that copy the “modernity” of the developed world. In some developing countries obesity coexists with deficient nutrition and, at times, hunger and poverty. There are also countries and regions where overweight is more tolerated or where, culturally, obesity is promoted among the upper classes. These are not necessarily the wealthiest nations.
The twenty countries with the fastest increase in the share of adults with a high body mass index (BMI) —ranging from 3.8% to 2.8% annually between 2000 and 2016— are the following:
- Laos
- Vietnam
- Maldives
- Thailand
- Bangladesh
- Bhutan
- Indonesia
- Timor-Leste
- Nepal
- Myanmar (formerly Burma)
- India
- Afghanistan
- Cambodia
- Burkina Faso
- Sri Lanka
- Rwanda
- Pakistan
- Malaysia
- China
- Angola
What does this list sound like? They are not rich or developed countries. Most are Asian countries that originally did not have much obesity and are now rising sharply. But (and this is an important caveat) China and India are on this list, both with enormous populations.
The World Obesity Atlas presents the best data on obesity (and, in general, overweight) worldwide. I here use the most recent report, the sixth edition, corresponding to 2024. It includes data from 186 countries, basically the entire planet. World Obesity also uses data from the World Health Organization (WHO), the World Bank, and the United Nations Population Division. With all of this we can access a clearer view of the obesity epidemic and its social consequences. Obesity already accounts for more than 10% of deaths worldwide and about 9% of years of life lost among the population. Furthermore, its prevalence does not decline but increases in almost all countries. It was thought to be a problem of the richer countries, but today it is known that the progression is even greater in semi-developed nations.
It remains a very clear problem in the United States and in China. Some countries are especially prone to the obesity epidemic, particularly the islands of the South Pacific. The gender differences (women and men) are small but meaningful. Among other cultural factors, one must measure and analyze the laxity of various societies toward obesity. Other essential factors are the lack (or inadequacy) of physical exercise, the consumption of unhealthy foods, and the intake of sugary drinks. Younger people with obesity often become adults with obesity. Therefore, the incidence of obesity in childhood and adolescence is a key factor.
“Obesity is a social and medical responsibility, even more than an individual responsibility. For now, however, it remains a virtually invisible problem”
The discovery of medicines that reduce obesity could represent a major shift in fighting this disease. It will also be a huge business, since it would apply to about half of the world’s population and to more than a third of the child and adolescent population. Given its initial price, it will not reach everyone. Moreover, these are drugs that must be taken for life. The disease and its treatment will be an additional driver of social inequality in the future. But the solution is not solely in new drugs, but also in a drastic change of habits: extend breastfeeding, drastically reduce the consumption (and industrial production) of sugary drinks, address tobacco addiction and excessive alcohol consumption, reduce ultra-processed foods, increase preference for fruits and vegetables, limit screen time, ensure rest, and promote regular physical activity. Among other policies, we must reduce the advertising and distribution of foods high in sugars, fats, and salt, especially targeted at children and adolescents. Obesity is a social and medical responsibility, even more so than an individual responsibility. For now, however, it remains a virtually invisible problem, typical of a happy and affluent world.
The New Social Disease
In the world there are annually more than fifty million deaths, of which 10% are attributed to overweight and obesity. Of those five million deaths, 42% are attributed to diabetes, 19% to coronary heart diseases, and 5% to deadly cancers. Obesity causes a loss of 9% of adult years of life.
In this article I combine the different gradations or levels of the body mass index (BMI, in English). As shown in Table 1, there are gender differences: women and men. The table refers to the adult population (twenty years and older). For women, the twenty countries with the highest obesity range from 71% in Mexico to 87% of the female population in Tonga (the Pacific archipelago). Several Pacific islands stand out, such as Tonga, Samoa, and even Fiji. There are no European countries, except Turkey. There are also no Latin American countries, except the Bahamas and Mexico. Obesity among women is notable in Arab and Asia Minor countries.
The variation in obesity is slightly smaller for men (ranging from 73% to 80%). The top two positions belong to the Pacific: the Kingdom of Tonga and Samoa. Immediately after (third place), the country with the highest male obesity is the United States. Of the twenty countries with the highest obesity in the world, eight are in Europe. There is also presence in North America (the United States and Canada) and Oceania (in addition to Polynesia, Australia and New Zealand). There is a lot of male obesity in Kuwait, Israel, Qatar, Saudi Arabia, Jordan, and Lebanon. The current percentages in this twenty-country list are remarkably high. Overall, however, North America’s lax attitude toward male obesity—just like in some European countries—produces mortality problems and years of life lost. That partly explains gender life expectancy gaps (women live longer).
“Spain is the country in the entire European Union—and Europe—with the most overweight or obese men; it is the 12th country in the world for male obesity”
Spain is the European Union—and Europe—country with the most overweight or obese men; it is the 12th country in the world for male obesity (not so much for women). Other European countries with exaggerated male obesity are Malta, the United Kingdom, the Czech Republic, Greece, Bulgaria, Iceland, and Montenegro. With the exception of the United Kingdom, these are not the most developed European nations and thus challenge the idea that the most developed countries have the highest obesity. This leads to a first hypothesis: the most developed countries—except the United States—are not the most obese, but rather the less advanced or poorer. The United States faces a sharp cultural problem that favors obesity, especially among men.
What is striking is that, worldwide, the highest obesity rates are found in the South Pacific islands. Tonga, for example, has 87% of women with obesity and 80% of men. The reasons are not entirely clear, likely cultural and historical. Artificial intelligence (Perplexity) points to some explanations:
“In many Pacific islands obesity is so common because several factors have converged: a drastic shift in diet toward cheap, ultra-processed foods, reduced physical activity, some genetic susceptibility to weight gain when exposed to high-calorie diets. Also, cultural norms do not penalize overweight, all within small economies heavily dependent on imports.”
Dietary change and ‘nutritional transition’. For generations, the base was fish, roots (taro, cassava, sweet potato), coconut, and fruit, with little sugary foods or refined flours. Since the mid-20th century many islands have become dependent on white rice, flour, processed meats (for example, spam, corned beef, mutton flaps, turkey necks) and imported sugary drinks, because they are cheap, highly caloric, and well-preserved. This hypercaloric, fiber-poor pattern fosters a chronically positive energy balance and increases obesity and diabetes risk.
Less daily physical activity. Previously, a large portion of the population worked in fishing, farming, and physically demanding tasks, which demanded high energy expenditure. With urbanization and a shift to service, administrative, and tourism jobs, work has become far more sedentary while diet grew more caloric. Moreover, in hot, humid tropical climates people tend to avoid outdoor exercise, so leisure-time activity does not compensate for declines in work-related activity.
Genetic and biological factors. Studies in Polynesian and Melanesian populations describe a disproportionately high prevalence of obesity and diabetes compared to other regions with similar levels of economic development, suggesting genetic susceptibility to weight gain with hypercaloric diets. In the past, during times of scarcity, energy storage efficiency may have been favored evolutionarily, but in an environment of abundant, cheap food this ‘savings’ becomes a risk.
Culture, status, and health education. In many Pacific cultures, a large body has traditionally signified prosperity, health, and beauty, and community feasts involve large banquets now based on energy-dense imported products. Add weak nutritional education and inadequate food regulation, which facilitate the penetration of sugary drinks and ultra-processed foods without a clear sense of health risk.
Small economies and reliance on imports. Limited arable land, geographic isolation, and vulnerability to climatic events make it difficult to stably produce a varied range of fresh foods. As a result, locally produced healthy foods can be relatively expensive or scarce, while cheaper imports are often the ones rich in sugar, fat, and salt, feeding a structural obesogenic environment across many Pacific islands.
“Western domination has shattered cultural traditions (for example, in diet and physical exercise), replacing them with the apparent Western modernity, which generates obesity and deaths”
Indeed, current data indicate sugar consumption is highest in some South Pacific countries: Fiji reaches 144 kilograms of sugar per person per year; Australia reaches 104 kilograms per person per year. This compares with Spain, which consumes around 31 kilograms of sugar per person per year (Portugal is 23). But AI does not sufficiently highlight the effects of colonialism and European protectorates on those Pacific islands. Western domination has disrupted cultural traditions (e.g., diet and physical activity), replacing them with apparent Western modernity, which generates obesity and deaths. This explains why those archipelagos have obesity rates around twice the world average (42%).
Although sugar consumption is not excessively high in Spain, it is clear that something must be done to reduce the country’s obesity rate. The imitation of the United States’ lifestyle and diet is disastrous. This is what is referred to as the American way of life: fast-food excesses, ultra-processed foods, lack of physical exercise, overuse of cars, etc. The situation for women is not as negative, either in the United States (and Canada) or in Australia and New Zealand. Obesity is a ‘men’s problem’, echoing a slogan from a famous Spanish alcoholic beverage. Another hypothesis is the social permissiveness that allows childhood to become overweight, particularly the permissiveness with adult men in many contemporary societies.
From Cradle to Grave
In obesity, it is crucial to study the situation of childhood and adolescence. Young people with obesity often become adults with obesity. Early-life conditions foreshadow what will come later. It is, thus, a “hereditary” disease: childhood obesity today translates into adult obesity tomorrow. World Obesity Atlas statistics include detailed data on obesity among five- to nineteen-year-olds.
The twenty countries with the highest rates of obesity in children and adolescents do not coincide with those with the highest adult obesity. The variability is greater among girls: in the top twenty countries it ranges from 38% to 72%. In boys it ranges from 42% (specifically Spain) to 63%. In Table 2 you can see which twenty countries have the most obesity in these age groups, differentiated by gender: girls and boys. The patterns are somewhat different. In the case of girls, the countries with the most cases (including overweight) are in the South Pacific islands: Tonga, Samoa, Fiji, Vanuatu, and New Zealand. In Tonga, obesity in girls reaches 72%. After them, six of the twenty countries with the highest obesity in girls are in Latin America: El Salvador, Costa Rica, Mexico, the Bahamas, the Dominican Republic, and Panama.
By contrast, obesity in children varies a bit more. The Pacific islands remain in the lead, with peaks in Tonga, Samoa, and also New Zealand (45% of New Zealand’s children are obese). Incidentally, the overwhelming data on this disease in New Zealand casts doubt on the idyllic, pro-nature image of that country. Most striking is the situation in the United States (51% of children with obesity, compared to 46% of girls) and also China (46% of boys with obesity). Thus, it does not seem to be a problem confined to development and the marketing of a diet through the proliferation of fast-food restaurants, but also in countries that until recently faced famine and malnutrition, such as China. China’s one-child policy likely favored obesity among these so-called “little emperors.”
“There are six European countries with childhood obesity, but they are not the central, most advanced nations; they are in Southern Europe, including Italy, Portugal, and Spain”
In childhood obesity there are six European countries, but they are not the central, most developed ones; they are in Southern Europe, including Italy, Portugal, and Spain. These are some of the countries with the highest childhood obesity in the world. Therefore, the much-touted “Mediterranean diet” does not seem to protect very much. A key hypothesis is social permissiveness. This is clear in the South Pacific countries, but we did not realize that it also occurred in male childhood in Southern Europe. It would be useful to analyze this permissiveness hypothesis more carefully in our environment. Interestingly, this permissiveness does not affect girls in the same way, for whom Mediterranean expectations still demand “keeping in line.” In Latin America this expectation for girls is not present. In the South Pacific islands permissiveness is prevalent for all.
What is certain is that overweight and obesity (the most extreme overweight) cause death. In wealthy countries the obesity epidemic is a constant. Yet, in poor countries, obesity—also present, but less extensive—coexists with poor nutrition, undernourishment, poverty, and even hunger. In Table 3 I present mortality and years of life lost by World Bank income groups. Low-income countries have obesity-attributable mortality of 6%. As countries become richer, that mortality doubles to 11%. One in ten people who dies today does so due to obesity and overweight. Years of life lost account for 9% and follow a similar pattern: 5% in poor countries to 10% in rich countries.
For all these reasons, obesity is not a trivial matter: it is a disease that kills. This table shows that there remains a positive correlation between development and obesity.
The twenty countries with the greatest increase in obesity (and overweight) among children and adolescents between 2000 and 2016 are:
- Vietnam
- South Africa
- Laos
- India
- Maldives
- Sri Lanka
- Nepal
- Bhutan
- Lesotho
- Cambodia
- Namibia
- China
- Swaziland
- Timor-Leste
- Burkina Faso
- Afghanistan
- Bangladesh
- Myanmar
- Indonesia
- Thailand
These are mostly Asian and African developing countries. But it also includes large countries like China, India, and Indonesia. This rapid rise in childhood obesity between 2000 and 2016 ranges from 6.5% to 10.0%, well above the increase in the adult population. Many of these cases are neither diagnosed nor treated.
Childhood obesity (in childhood and adolescence) increases school rejection, cases of bullying, worse grades, aggression by students and even teachers, school failure, mental health problems, low self-esteem, and sometimes suicide. But the life-and-death problem is obesity-related mortality, which accounts for 10% of annual deaths. By region—for the WHO—this 10% is distributed as follows:
The deadly impact of obesity is more evident, for now, in the more developed North Hemisphere. But this distribution could change in the future.
There is also a clear difference in the years of life lost per person due to obesity or overweight. Globally it represents 9% of years of life lost per person. But it is higher in the more developed countries (10%), compared to 9% in upper-middle-income countries, 8% in lower-middle-income countries, and 5% in the least developed. For now the negative impact of obesity is greater in the wealthier countries, but it may shift toward middle-income countries.
It Is a Problem in All Countries Worldwide
The obesity (and overweight) epidemic will have a negative effect on developing nations. The World Obesity Atlas includes an analysis of almost two hundred countries and highlights several important factors. In Table 4 I include a selection of countries which helps understand what is happening and compare, for instance, Spain’s situation. First, you can observe the annual growth in obesity rates between 2020 and projected values through 2035. In adults the annual increase is positive in all countries. The annual increase in China is high (2.8%), as it is in other Asian countries: Pakistan 5.2%, the Philippines 4.3%, Taiwan 4.2%, India 4.1%, and Indonesia 4.0% per year. These are countries with relatively low adult obesity but rising quickly. Conversely, the South Pacific nations show very high rates (the highest in the world) but grow somewhat slower, around 2% annually.
Obesity rates in Europe grow slowly, from 0.1% in Hungary and Russia to 2% in Ireland. Spain has an annual growth rate of 0.9%. These rates are comparable to the United States, which grows at 1.4% per year. Canada does so at 1.7% per year. In other words, the most developed countries show moderate growth in obesity, while middle- and lower-income countries experience much faster increases. In Africa the rates are varied, but high, with 5.5% in Nigeria and 2.9% in Egypt. In Latin America the rates are moderate, with a maximum in Ecuador (2.8% annually). In Mexico the increase is 2.1% annually. Thus, patterns are shifting: high in developed countries, but now growing more rapidly in less developed ones. In the South Pacific archipelagos, growth cannot rise much further.
“Of the 47 countries in this general table, seven show negative growth in childhood obesity (ages five to nineteen), including Spain (-0.6%)”
Among the 47 countries in this general table, seven show negative growth in childhood obesity, including Spain (-0.6%). No explanation is provided for Spain’s case. The other countries with negative increases are Italy, Belgium, Greece, Kuwait, Japan, and South Korea. In Africa, some countries experience explosive growth in childhood obesity: Nigeria 8.0% annually, South Africa 6.2%, and Egypt 3.5%. The South Pacific countries continue to grow in childhood obesity, especially Samoa (3.4%). The most striking growth occurs in Asia: Pakistan (7.1%), India (6.2%), the Philippines (5.6%), and Indonesia (5.6%). Asia and Africa are substantially increasing childhood obesity, which will become adult obesity in the future. The less developed countries undergo a catching-up process, while Europeans maintain their rates. The prevalence of obesity is thus shifting from developed nations toward others with lower levels of development. This is an effect of dependent countries’ “modernization” and the gradual lifting of poverty and hunger in minorities. They are two distinct, negative paths—poverty and obesity—leading to mortality and hardship.
The advance of obesity is best seen in the evolution of childhood obesity in two countries. United States has 48% of youth with obesity in 2020 and a projection of 60% by 2035. The most explosive situation is in China, which rises from 37% in 2020 to 72% in 2035. Spain, for its part, starts at 38% in 2020 and will rise to 46% in 2035, almost half.
Compare with South Africa, which increases from 31% in 2020 to 71% in 2035. By 2035 the highest rates will be in the South Pacific: in Tonga obesity in children will reach 87% and in Samoa 84%. The future clearly points to Asia, which starts from a moderate rate of childhood obesity—likely coupled with malnutrition—and rises to exceed half in 2035: Malaysia 65%, Thailand 61%, Indonesia 53%. These are countries where childhood malnutrition and poverty give way to high levels of childhood obesity. A low starting point does not guarantee moderate obesity levels. Nearly all Asian countries double or triple childhood obesity within fifteen years. Even India, despite malnutrition issues, goes from 9% to 24% by 2035. The catching up of childhood obesity rates seems, therefore, clear and promises to reshape the world as we know it.
Japan contains its rates, from 17% to 20% in fifteen years. Meanwhile, in the European context, southern countries—and others—reach 50% and even higher by 2035. In that context, Russia slows down childhood obesity (31% in 2035). From the evolution of this trend, as well as the capacity to contain its growth, the future of this pandemic and the associated excess mortality depends.
“South Pacific countries, with very high obesity levels, maintain relatively high physical activity (Samoa 13% of the population with insufficient physical activity; 17% in Fiji and Tonga)
In the same table I associate two factors with obesity: the proportion of adults not engaging in enough physical activity and sugar consumption (in kilograms per person per year). The United States not only has substantial obesity—exported worldwide with its soft power—but also has 40% of the population with insufficient physical activity (Canada is 29%). In Spain this percentage is 27%. Other European countries exceed the United States’ inactivity levels: Germany, Italy, and Portugal. In other cases inactivity is even higher: Saudi Arabia 53% or Kuwait 67%. However, the South Pacific countries, with extremely high obesity levels, maintain relatively high physical activity (Samoa 13% of the population with insufficient physical activity; 17% in Fiji and Tonga).
Obesity is a multicausal phenomenon and, for that reason, difficult to solve. The dominant Western culture spreads patterns of fast food, ultra-processed consumption, insufficient physical activity, and obsessive advertising of weight-gaining products. Perhaps social permissiveness is also exported. Latin American and Arab countries increasingly adopt these patterns. Asian countries, which until recently had contained obesity, are moving ever closer to Western patterns each year. China is a typical case, and also one with a huge population. India, soon to be the world’s most populous country, starts from very low levels but is experiencing very high growth (in both adults and children). Thus, we face a social problem that is expanding and difficult to control.
Relationship Between Economic Development and Obesity
The behavior of various countries raises the hypothesis of a relationship between economic development and obesity. For now there is an association between higher GDP and the prevalence of overweight and obesity. This association is somewhat stronger in adults (r=+0.41) than in children and adolescents (r=+0.35). In turn, urbanization (more people living in cities) reshapes the availability and consumption of processed foods, as well as the use of plastics. There is more animal protein consumption and greater use of sugars. At the same time, urbanization is associated with insufficient physical activity. Middle- and low-income countries experience rising obesity rates. The correlation between high BMI prevalence and urban population is +0.57; with sugar consumption it is +0.49; and with the share of adults with insufficient physical activity it is +0.48. The industry promotes the production of cheap food and inappropriate beverages. Globally there is environmental damage, contributing to climate change. Sociologically, obesity generates stigma, and youth with obesity face more school difficulties and often suffer bullying in educational settings. The most negative aspect is that public health systems (public) have tended to ignore obesity problems among the population.
“It is likely that in the future the problem will not be concentrated in the wealthiest countries, but rather in middle-development countries, which will vary with the introduction of obesity-reducing (or containing) medicines”
In Table 5 I divide the world into four groups by income, according to World Bank statistics. In 2020 high-income countries have 61% of the adult population with obesity. By contrast, low-income countries “only” have 25%. The developmental differences are thus decisive: 2.4 times between high and low income. The correlation between development and adult obesity remains in the 2035 projections, though the gap between extremes narrows (1.9 times). For childhood and adolescent obesity the differences between extremes are larger: 3.1 times. Also in 2035 childhood obesity declines at the extremes of income. But there is one exception to highlight: according to projections, in 2035 middle-high-income countries will exceed the obesity levels of high-income countries (59% vs 48%). It is likely that in the future the problem will not be concentrated in the wealthiest nations, but in middle-development countries. This evolution—necessarily gradual—will vary with the introduction of obesity-reducing medicines.
In 2020 obesity and overweight already affect 42% of the world’s adult population and 22% of children and adolescents, but the best estimates indicate that more than half of the population will be affected before 2035, and by that year it will reach 39% of children and adolescents. The original differences are substantial. In Table 6 I use the World Health Organization (WHO) regions. Regional differences persist. The Americas concentrate the highest numbers, reaching 77% of the adult population by 2035 and more than half of the child and adolescent population (53%). Europe and the Eastern Mediterranean maintain very high rates. The anomaly is the Western Pacific, where childhood obesity will surpass all other regions by 2035 (60%). In the long run, that obesity will modify adult obesity levels, which remain intermediate, but by 2035 will exceed half (51%). The world map of obesity will evolve according to these trends. This concerns— and worries—WHO and the public health services of all countries. It should also worry because one hypothesis is that obesity—as an “invisible disease”—has not generated enough responsibility in national health systems, nor in the medical profession.
The Business of the Century
Obesity is a complex chronic disease. Imagine a business model that sells a drug to half of the world’s population, a costly medication (initially injectable) that must be taken for life. It is, moreover, an expensive medicine: a month’s supply could amount to about half the minimum wage. It is hard to imagine national health systems can shoulder such a treatment for half their population. It would also need to be started in childhood for those with obesity or overweight, who currently account for 39% of that age group. Equality measures would change dramatically. Imagine also the cultural shift such a treatment would entail for the world’s population.
“These medicines could save two or three million lives per year already. For now they are mainly used in developed countries”
Medications to control and reduce obesity have proliferated: Mounjaro, Ozempic, Wegovy, Zepbound, etc. They are also known as GLP-1 drugs, originally indicated to treat diabetes and later obesity. Currently there is research toward producing pills (with fewer side effects than weekly injections, but more convenient) and monthly doses, instead of weekly. The pills do not require refrigeration and would be accessible in poorer countries. These medicines could save two or three million lives per year already. For now they are mainly used in developed countries. Two-thirds of sales are currently in the United States. They already reach more than 12% of the U.S. population and concentrate around 70% of the world market. Even now, the price exceeds 400 euros per month per medication, not counting the cost of medical care and pharmaceuticals.
A recent press headline states: “The World Health Organization recognizes weight-loss drugs as essential. The international organization recalls that obesity, which caused 3.7 million deaths in 2024, is a chronic disease that must be treated for life.” This means that the WHO has already included them as “essential medicines,” i.e., applicable to a basic universal health system in each country. Today there are 532 medicines on that list. The objective is to ensure treatments are accessible, but also affordable. The director-general of the WHO states that “our new guidelines recognize that obesity is a chronic disease that can be treated with lifelong, comprehensive care.” Medical supervision is also required. Thus, it is a treatment for nearly a billion people worldwide. WHO is aware of the social inequalities that this disease and its treatment can generate.
In Spain, one of these drugs can cost about 450 euros per month. Moreover, injections or pills are not the only solution: they must be combined with dietary changes, physical activity routines, and medical follow-up which, in turn, costs money. Many patients abandon the treatment within the first year. Then obesity or overweight reappears. An additional problem is the black market and fraudulent online businesses.
Artificial intelligence notes that “none of the obesity-specific medications is currently funded by the National Health System for weight-loss indications; patients pay out of pocket unless they are used for another funded indication (for example, diabetes in the case of Ozempic). The amounts are high, especially for GLP-1 agonists, and amount to hundreds of euros per month.
“Until recently, obesity was a Western characteristic, but today it is a more global problem, especially in less developed countries that imitate Western modernization”
Until recently, obesity was a characteristic of “the West,” i.e., the developed countries of the northern hemisphere. It was not even considered a complex health issue. Today it is a more global problem, especially in less developed countries that imitate the supposed Western modernization. Overeating is no longer an indicator of a new, happy world. Obesity is a global pandemic, responsible for other diseases, and causing several million deaths. It is also a disease—and its treatment—that is already increasing social and regional inequalities.
The treatment of obesity must be a responsibility of health systems. In Spain there is a tendency for the health system to act irresponsibly toward the population with obesity. It is time for this to change.
