Rethinking obesity through a systems lens: identifying and addressing structural drivers

Obesity is rising in every region of the world, and has become one of the most significant public health challenges of this century. This continued increase, even with expanding clinical options such as nutrition counseling, pharmacotherapy, and bariatric surgery, shows that medical treatment alone cannot counter the broader forces that shape population-level weight gain. The most powerful drivers of obesity are structural. Food systems that promote processed foods, limited access to safe spaces for physical activity, economic insecurity, and policy choices that shape daily living conditions influence risk far more consistently than individual motivation or knowledge. Recognizing obesity as a conditioned rooted in social, economic, and environmental contexts is essential for understanding why traditional strategies have had limited impact. Preventing and treating obesity requires a coordinated system-level action that reshapes food environments, reduce inequities, and strengthen community resources. This commentary highlights the need for sustained policy change, cross-sector collaboration, and equity-centered strategies to shift current trends. Obesity remains one of the most pressing public health challenges of our time. Despite an expanding toolkit, including nutrition counseling, pharmacotherapy, and bariatric surgery, obesity rates continue to increase worldwide. This pattern highlights that drivers of obesity extend far beyond individual behavior or the availability of medical interventions. We inhabit what has been termed an “obesogenic environment,”1 in which environmental and structural conditions strongly influence nutrition and physical activity. Food availability and affordability, neighborhood infrastructure, cultural norms, media influence, and policy decisions1 collectively constrain individual choice. In such settings, structural barriers often outweigh personal motivation or clinical interventions. In the United States, projections indicate that by 2030, more than half of adults in most states will be living with obesity, and nearly 1 in 42 will have severe obesity (BMI > 35). Similar patterns exist across Europe. Estimates suggest that obesity will reach its maximum levels between 2030 and 2052 among men, and between 2026 and 2054 among women, with the highest projected rates in the United Kingdom and lowest in the Netherlands and Denmark.3 The World Obesity Federation projected that 1 billion people would be living with obesity by 2030, yet global data indicate that this milestone was reached several years earlier.4,5 Collectively, these findings signal that current strategies will remain insufficient unless they are strengthened and redesigned. Obesity does not affect all populations equally. Socioeconomic and demographic factors interact to create widening disparities. Wealth and education remain strong predictors of health. Lower-income and lower-educational attainment reduce access to healthy food, safe environments, and consistent health care. These factors also shape work conditions, stress exposure, and time available for healthy behaviors. In the United States, women with lower income and education levels experience the largest increases in obesity.6 This reflects the combined influence of limited resources, caregiving responsibilities, food insecurity, and reduced access to supportive environments. For men, low-socioeconomic status is linked to higher obesity risk, although physically demanding jobs in some lower-income settings appear to mitigate weight gain.6 Across Europe, similar trends are seen. In a study across 6 European countries,7 about half of adults living in low-socioeconomic areas were overweight or obese, with 1 in 6 criteria for obesity. Women faced a disproportionate burden: the likelihood of having a higher BMI increased with each disadvantage, including unemployment, low education, or income insecurity. In these communities, nearly half of the adults reported economic insecurity, and this was closely associated with higher BMI.7 Disparities in obesity are driven by the intersection of sex, age, race/ethnicity, income level, education, geography, occupation, gendered social roles, and rural/urban classification. They reflect layered, systemic, and structural forces that shape people's opportunities to live healthier lives. Understanding these forces is essential for designing interventions that are effective and equitable. Furthermore, we must address other barriers, including language access, digital literacy, and cultural disconnects, that hinder some groups from benefiting from available care. As shown in Figure 1, addressing obesity requires shifting the focus from individual behavior to community-level and policy-based solutions that target systemic barriers. Overcoming socioeconomic factors contributing to obesity requires a collective, multi-level approach. Mediators of socioeconomic differences in obesity. Addressing obesity requires shifting the focus from individual behavior to community-level and policy-based solutions that target systemic barriers. Created in BioRender. Alba, D. (2026) https://BioRender.com/93kxseh. Globally, there are already policies, programs, and partnerships that are showing us what is possible. Measures that recognize and address deeper systemic causes of obesity are an important part of any comprehensive response. One example is food systems. Our food system, as it stands, incentivizes the production and aggressive marketing of processed foods and sugary drinks, products that are cheap, long-lasting, and profitable, but detrimental to public health. Several European countries have responded by experimenting with policies to rebalance food environments. France's Nutri-Score front-of-pack labeling system, for example, classifies packaged products based on nutritional quality. It has emerged as the leading candidate for standardized labeling across the European Union, improving consumers’ ability to identify healthier products at the point of purchase.8 Meanwhile, the United Kingdom has passed legislation restricting the marketing of unhealthy food on television before 9 pm and banning paid online advertisements, although full implementation is still pending.9 These measures reflect a growing recognition that reshaping the food environment is essential to tackling obesity at its roots. Amsterdam and South Australia10 have also restricted the advertising of unhealthy foods in public spaces. Chile provides an important global case study that goes even further. The 2012 “Food Act” introduced a package of reforms:11 front-of-pack warning labels, higher taxes on sugary drinks, and comprehensive restrictions on the marketing of unhealthy products to children. Within a year of implementation, consumption of foods high in sugar, sodium, and calories declined substantially.11 However, even with these structural reforms, overall obesity rates have not dropped in a sustained way, and overall rates of obesity in Chile continue to rise,12 highlighting the complexity of this epidemic. Food policies can influence behaviors and foster equity. Still, their impact depends on sustained implementation, integration with other health measures, and the political will to prioritize public health over industry pressure. Interventions often target specific behaviors, such as reducing the purchase of sugar-sweetened beverages (SSBs), without addressing broader socioeconomic and cultural barriers. Industry adaptation and loopholes further undermine impact, as companies reformulate products to meet labeling criteria while continuing to push ultra-processed options. Successful efforts must combine regulation with community engagement, public health education, and investments in local food systems. For example, raising taxes on SSBs can improve health if accompanied by pro-tax communication campaigns that raise awareness. In Mexico, public demonstrations and multimedia strategies highlighted the links between sugary drinks and diabetes, shaping public opinion ahead of the implementation of the SSB tax.13 In Berkeley, California, student and community-led campaigns framed SSBs as harmful well before implementation, with sales on the UC Berkeley campus dropping even before prices rose.14 Similarly, in South Africa, purchases of sugary drinks fell by 26% compared with the projected pre-tax trend during the post-announcement period,15 before the national SSB tax was enacted, reflecting the influence of widespread media coverage and health-focused advocacy. Countries around the world have an opportunity not only to expand labeling and marketing restrictions, but interventions must target communities where the burden of obesity is highest by prioritizing high-risk and under-resourced populations. Partners across sectors, including healthcare, education, housing, transportation, public advocacy, and food systems (Figure 1), must collaborate rather than operate in silos. Initiatives need to implement culturally grounded strategies to reflect community realities, including stigma, language, and cultural food traditions. Lastly, it could become beneficial to leverage innovation; for example, advances in Glucagone-Like Peptide-1-based therapies, microbiome science, and food-as-medicine approaches offer opportunities, but only if access is equitable. The socioeconomic contributors to obesity are not incidental; they are structural, entrenched, and global. Addressing these barriers requires reframing obesity from a condition driven primarily by individual responsibility and recognizing that it reflects broader policy, economic, and environmental conditions. Feasible solutions lie in combining clinical tools with systemic reform, community partnerships, and equity-driven strategies. To reverse current trends, initiatives should not focus solely on incremental change; all parties must act with the urgency and coordination this crisis demands. None. Valeria Landa-Rosales (Conceptualization, Writing—original draft, Writing—review & editing), and Diana L. Alba (Conceptualization, Investigation, Supervision, Writing—original draft, Writing—review & editing) We have not received funding to perform this opinion letter.