Obesity as a Main Threat to Future Improvements in Population Health: Policy Opportunities and Challenges

Centennial Issue
Population Health

Policy Points:

  • Obesity has emerged as a main threat to future improvements in population health, and there is little evidence that the epidemic is retreating.
  • The traditional model of “calories in, calories out,” which has guided public health policy for decades, is increasingly viewed as far too simple a framing to explain the evolution of the epidemic or guide public policy.
  • Advances in the science of obesity, coming from many fields, highlight the structural nature of the risk, which has provided an evidence base to justify and guide policies toward addressing the social and environmental drivers of obesity.
  • Societies and researchers need to play the long game in that widespread reductions in obesity in the short run are unlikely.
  • Nonetheless, there are opportunities. Policies specifically targeting the food environment such as taxing high-calorie beverages and foods, restricting the marketing of junk foods to children, enhancing food labeling, and improving the dietary environment at schools may yield long-run benefits.

The United States and many other countries have achieved immense improvements in life expectancy and the general health profile of their populations over the past half century. These improvements have spanned virtually all stages of the life course, including marked reductions in mortality among infants and children as well as among those over the age of 85 years.1 Particularly noteworthy has been the rapid decline in deaths from cardiovascular disease and improvements in the overall functioning of the population in the form of reduced disability.2,3

Against this positive backdrop has been the emergence and persistence of the obesity epidemic. The most recent figures for the United States are startling (even for an obesity researcher): 42% of US adults were classified as being obese in 2017.4 Among children and adolescents aged 2–19 years, the prevalence was 20%.5 Some of the same economic and technological forces that have led to long-run health improvements have produced, as an unwanted byproduct, the obesity epidemic.


  1.  Crimmins EM. Lifespan and healthspan: past, present, and promise. Gerontologist. 2015;55(6):901-911. https://doi.org/10.1093/geront/gnv130
  2. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970–2002. JAMA. 2005;294(10):1255-1259. https://doi.org/10.1001/jama.294.10.1255
  3. Schoeni RF, Freedman VA, Martin LG. Why is late-life disability declining? Milbank Q. 2008;86(1):47-89. https://doi.org/10.1111/j.1468-0009.2007.00513.x
  4. Obesity is a common, serious, and costly disease. Centers for Disease Control and Prevention. July 20, 2022. Accessed February 10,2023. https://www.cdc.gov/obesity/data/adult.html
  5. Childhood obesity facts. Centers for Disease Control and Prevention. July 27, 2022. Accessed February 10, 2023. https://www.cdc.gov/obesity/data/childhood.html

Mehta NK. Obesity as a Main Threat to Future Improvements in Population Health: Policy Opportunities and Challenges. Milbank Q. 2023;101(S1): 460-477.