Abstract
Obesity has emerged as one of the most pressing public health challenges of the 21st century, impacting millions worldwide and contributing to serious health complications such as type 2 diabetes and cardiovascular diseases, as well as a diminished quality of life. This editorial explores the multifaceted nature of obesity, emphasizing the interplay between genetic predisposition, environmental constraints and behavioral drivers. Key contributors, such as the rising consumption of ultra-processed foods, increasingly sedentary lifestyles and psychosocial stressors, are explored in detail, along with their combined impact on the escalating global obesity rates. The editorial highlights the far-reaching consequences of obesity, including its economic burden, societal implications and the ripple effects on healthcare systems. Priority areas for action are proposed, including public health policies, education and the creation of environments that support active lifestyles. The importance of clinical interventions, such as early screening, personalized treatment strategies and the inclusion of dietitians within multidisciplinary care teams, is emphasized as vital for enhancing patient outcomes and managing obesity effectively. This editorial calls for a comprehensive, systemic response to address the global obesity epidemic, advocating for evidence-based interventions that are tailored to individual needs while addressing societal and environmental determinants. By fostering collaboration across sectors and prioritizing prevention and treatment, meaningful progress can be made in combating this escalating crisis.
Key words: lifestyle, BMI, overweight, obesity, health promotion
Introduction
Obesity has become one of the most pressing public health challenges of the 21st century. According to the World Health Organization (WHO), over 650 million adults were obese worldwide in 2016, accounting for nearly 13% of the global adult population.1 More recent estimates suggest that this figure will continue to climb in the following years. The rapid rise in obesity prevalence affects not only high-income countries but also low- and middle-income nations, highlighting a global crisis that demands urgent, coordinated action.2
Key statistics and global context
Obesity has reached unprecedented levels globally, emerging as one of the most critical public health challenges of our time. According to a pooled analysis of global trends from 1990 to 2022, the number of individuals affected by obesity worldwide reached 1 billion in 2022. Compared to 1990, the prevalence of obesity has doubled among adults and quadrupled among children and adolescents (aged 5–19 years). In the same year, 43% of adults were classified as overweight. The burden of obesity has now surpassed underweight in the majority of countries, with significant increases observed across all age groups.3 This dramatic escalation underscores the global “nutrition transition,” driven by population over nourishment due to shifts toward diets that are energy-dense and nutrient-poor, as well as factors such as urbanization and a more sedentary lifestyles.2, 3
The health impacts of these shifts are equally concerning. It is estimated that possessing a higher body mass index (BMI) contributed to 4 million deaths globally in 2015, nearly 40% of which occurred among individuals who were not classified as obese but were still overweight. Cardiovascular disease accounted for the majority of these deaths, highlighting the wide-reaching consequences of elevated BMI.2 These findings are further supported by analyses of the obesity transition, which demonstrate how the prevalence of obesity initially rises among wealthier groups before becoming more widespread among lower socioeconomic populations as the epidemic matures.4
Europe exemplifies this pattern, with Poland offering a case study in the shifting burden of obesity. According to WHO data and national surveys, over 62% of Polish men and 43% of women are classified as overweight or obese, reflecting broader trends observed across Europe.5 Among children aged 7–9 years in Poland, 29% are classified as overweight and 12% as obese, with boys consistently more affected than girls. The COVID-19 pandemic exacerbated these trends, contributing to reduced physical activity, prolonged screen time and unhealthy dietary patterns across all age groups.6
Main causes and contributing factors
Several factors have been identified as contributing to the rising prevalence of obesity.
Dietary shifts
The increased consumption of ultra-processed, energy-dense foods is a primary driver of excessive caloric intake.7, 8 Diets high in sugar-sweetened beverages, refined carbohydrates and saturated fats promote weight gain while offering limited nutritional value.9 Notably, data suggest that even relatively small but consistent surpluses in daily caloric intake can lead to significant weight gain over time. For example, the average increase in daily caloric intake between 1971 and 2000 was 168 kcal for men and 335 kcal for women, which theoretically could result in annual weight gains of 8 kg and 16 kg, respectively, without adaptive changes in energy expenditure.10 These findings underscore the role of both dietary excess and declining physical activity in creating an environment that favors energy imbalance and, consequently, rising obesity rates.
Sedentary lifestyles
Modern life has become increasingly sedentary, marked by prolonged hours in desk-based occupations, reliance on personal vehicles, and reduced physical activity at home. Urban infrastructure in many regions often fails to provide accessible and safe environments for walking, cycling or recreational sports, contributing to a decline in daily energy expenditure and exacerbating the obesity epidemic.11, 12 Sedentary behavior, defined as activities with energy expenditure below 1.5 metabolic equivalents, such as sitting or lying down, is associated with significant health risks, including increased rates of abdominal obesity and chronic disease.13 Research highlights a combined sedentary behavior prevalence of up to 31% among individuals with obesity, with correlations to reduced physical activity and heightened risk of multi-morbidities.12, 13 Addressing these challenges through urban planning, workplace interventions and public health initiatives is critical to counteract the detrimental effects of sedentary lifestyles.
Genetic and epigenetic influences
While lifestyle remains the predominant factor, genetics can predispose certain individuals to obesity.14 Studies estimate that genetic factors may account for approx. 40–70% of obesity cases in the general population.15 Genome-wide association studies (GWAS) have identified numerous genetic loci associated with obesity, the majority of which are involved in neural pathways that regulate appetite control and energy homeostasis.15 Research on epigenetics, including the role of gut microbiota, is uncovering additional mechanisms that may influence weight regulation.16 In addition to genetic factors, epigenetic modifications such as DNA methylation and histone modifications play a crucial role in regulating gene expression related to metabolism.17 Maternal obesity during pregnancy has been linked to persistent epigenetic changes in offspring, which may contribute to an increased risk of obesity and metabolic disorders in later life. Evidence suggests that epigenetic alterations occurring during the pre- and perinatal period may influence metabolic programming, increasing susceptibility to obesity in adulthood.18 Experimental studies suggest that prenatal exposure to high-fat diets may lead to altered DNA methylation patterns, predisposing offspring to excessive weight gain and insulin resistance.17 One such mechanism that has been explored is the ways in which epigenetic modifications influence how DNA is transcribed in spite of no alterations to its sequencing (TBD).19 However, genetic predisposition alone does not fully account for the rapid rise in obesity rates – environmental and behavioral factors remain critical.
Psychosocial elements
Stress, psychological distress and emotional eating significantly contribute to obesity. Research shows that chronic stress, often exacerbated by stigma or adverse environments, can trigger increased cortisol production, which drives appetite and leads to fat accumulation, particularly in the abdominal region. In high-stress settings with limited mental health support, individuals may rely on maladaptive coping mechanisms such as binge-eating or turning to energy-dense “comfort foods”.20 These behaviors are closely linked to increased obesity risk and its associated complications.
Health and social consequences
Owing to its complex etiology, obesity has far-reaching consequences.
Physical comorbidities
Obesity is closely associated with an increased risk of numerous medical conditions, including, among others, type 2 diabetes, hypertension, dyslipidemia, and various cardiovascular pathologies.21, 22, 23 Excess body weight also increases the risk of certain cancers, including breast, colon and endometrial cancers.24 The resultant healthcare expenditures can be staggering, putting significant strain on both public and private health systems.
Psychological well-being
The psychological burden of obesity includes depression, anxiety and lower self-esteem, often exacerbated by social stigma and discrimination.25 This may create a vicious cycle where psychological distress complicates efforts to adopt healthier lifestyles.
Community and societal impact
Communities with high obesity rates often see reduced productivity and increased reliance on healthcare and social services.26 The ripple effects include diminished workforce capacity and higher insurance premiums, affecting entire economies.
Priority areas for action: A call to action
Public health policies
Comprehensive policy measures, such as taxes on sugar-sweetened beverages, clear front-of-package labeling and stricter regulations on junk food advertising, particularly to children, can help shape healthier consumer choices.27 Governments can also invest in ensuring that schools and community centers provide balanced meals and opportunities for regular physical activity. Recognizing the urgent need for global action, the WHO has developed key strategies to combat obesity, including the Acceleration Plan to Stop Obesity and the Commission on Ending Childhood Obesity (ECHO). These initiatives advocate for comprehensive policies that include fiscal measures, marketing restrictions, school-based nutrition programs, and improvements in urban infrastructure to promote physical activity.28, 29 A comprehensive approach to obesity prevention requires coordinated efforts, including fiscal policies such as sugar taxes, stricter regulations on food marketing, improved food labeling, and public education campaigns promoting healthy lifestyles. Long-term success depends on sustained government commitment and cross-sector collaboration. By integrating these evidence-based strategies into national health policies, governments can strengthen their response to the growing obesity epidemic.
Education and awareness
Initiatives that promote nutrition literacy, home economics, and cooking skills are essential for empowering individuals to make informed, healthier dietary choices and fostering long-term behavioral change.30 Schools should integrate physical education programs that are both engaging and adaptable to different fitness levels.
Environment and infrastructure
Creating safe, walkable neighborhoods and expanding public green spaces encourage daily physical activity. Bicycle lanes, pedestrian-only zones and accessible recreational facilities have the potential to transform sedentary communities into active, health-conscious environments.31
Clinical interventions
Healthcare providers should be trained to screen for obesity early using comprehensive and person-centered assessments that go beyond BMI. While BMI remains a useful tool for general categorization, it should be complemented by measurements such as waist circumference, waist-to-hip ratio or waist-to-height ratio to better evaluate fat distribution and associated health risks.32, 33 These combined metrics allow clinicians to assess obesity-related comorbidities, such as metabolic syndrome or cardiovascular risks, with greater accuracy.
The goal of early screening and assessment is to guide appropriate interventions tailored to individual needs. These interventions include nutritional counseling focused on achieving a sustainable caloric deficit, behavioral therapy to address psychological barriers and, when necessary, pharmacological treatments such as the glucagon-like peptide-1 (GLP-1) receptor agonists or other anti-obesity medications. For individuals with severe obesity or obesity-related complications, metabolic and bariatric surgery should be considered as a viable and effective option.32, 33 Alongside lifestyle modifications, obesity management strategies should integrate medical and psychological support, ensuring access to multidisciplinary care. Expanding healthcare services to include individualized treatment plans can significantly improve long-term outcomes.
Moreover, effective management of obesity requires a multidisciplinary approach. Teams comprising physicians, dietitians, psychologists, and exercise specialists play a pivotal role in delivering personalized care. This includes developing individualized treatment plans that integrate dietary modifications, increased physical activity and behavioral strategies, alongside medical or surgical interventions when indicated. The overarching aim is not only to reduce body weight but also to improve overall health, mitigate obesity-related complications and enhance quality of life.33, 34, 35 Initiatives should also focus on better education medical and healthcare professionals on how they can be sources of education on healthy eating to their patients. Many medical and healthcare professional education programs have incorporated “culinary medicine” into their curriculums to accomplish this goal.36
Conclusions and appeal
Addressing the global obesity epidemic demands a multifaceted approach that acknowledges all factors promoting or contributing to obesity. It is not enough to focus solely on the individual; society at large must rally around policies and programs that make healthy eating and active living the default choices. Researchers, clinicians, educators, and policymakers each play a vital role in this endeavor.
A key component of this effort is the enhancement of multidisciplinary care systems. Healthcare teams must be empowered to integrate diverse expertise, with particular emphasis on the crucial role of dietitians in assessing nutritional needs, creating individualized meal plans, and educating patients on sustainable dietary practices. Enhancing the role of dietitians within multidisciplinary teams – alongside physicians, psychologists, nurses, physiotherapists, health promotion specialists, and other allied professionals – can significantly improve obesity outcomes by ensuring that interventions are individualized, evidence-based and culturally sensitive.
By investing in collaborative, system-wide solutions and expanding access to skilled healthcare professionals, we can dismantle the barriers that perpetuate obesity and work toward a healthier future for all. The time to act is now – if we fail to address obesity, its repercussions will resonate for generations to come. However, there is no single solution that fits all populations. Each country must identify and implement the most effective strategies based on its unique socio-economic, cultural and healthcare landscape. A successful approach requires flexibility, ongoing evaluation and adaptation to local needs while maintaining a strong commitment to evidence-based policies and interventions.