Fixing a Dysfunctional Food System

In “The Ozempic Era Could Shift Blame for Obesity From Individuals to Commercial Food Systems” (Issues, Spring 2025), Laura A. Schmidt and Luc L. Hagenaars argue that GLP-1 drugs might shift views away from thinking of obesity as a matter of personal responsibility. They propose instead that it might lead policymakers to focus on addressing societal responsibility for having created a food environment that encourages people to consume ultra-processed food products rather than real food.

Such a shift is long overdue. Three-quarters of American adults are overweight or obese, a trend that rose sharply between 1980 and 2000. What happened around 1980 to make that happen? Genetics did not change; the food environment did. Food became ubiquitous, even in places where it had never been previously allowed: clothing stores, bookstores, libraries. Portion sizes of muffins, bagels, soft drinks, and restaurant servings tripled or quadrupled, and so did their calories. People increased their calorie intake by 300 or so a day.

I see three causes of such changes. The first was the change in agricultural policy in the 1970s, from paying farmers to not grow food to providing incentives to grow as much food as possible. Farmers responded by growing more food. Calories in the food supply went from 3,200 per capita per day to 4,000, roughly twice population need. Food companies had to find ways to sell those calories.

Second was the advent of the shareholder value movement to provide immediate, higher returns on investment, and to increase those returns every quarter. This movement was responsible for the outsourcing of labor to low-resource countries and the drastic reduction of manufacturing in America, but it also affected food companies. It forced them to compete even more to sell products in an environment that already offered twice the calories anyone needed. The third cause was the election of President Ronald Reagan, whose deregulatory agenda gave food companies a break; it removed restrictions on marketing, especially to children.

Food companies responded by developing new ultra-processed products designed to be irresistible (if not addictive), and to make it socially acceptable for everyone to eat everywhere, often, and in large amounts. Anyone trying to maintain a healthy weight in this environment is up against an entire industry doing all it can to encourage eating more, not less.

When people do not eat healthfully, several industries profit—food, drug, and diet, for starters. Eating healthfully means taking on all of them. Countering this environment is impossibly difficult for individuals. That’s why we need societal support to make healthful food choices easier and more affordable. Poor health is a systems problem. GLP-1 drugs may help, but they cannot address dysfunctional food systems.

Marion Nestle

Laura A. Schmidt and Luc L. Hagenaars rightly highlight how the wide-spread adoption of the new GLP-1 drugs could shift the blame for obesity from individuals to commercial food systems. I welcome their analysis and would like to highlight some tendencies that may arise during this new era.

It is increasingly acknowledged that the obesity pandemic stems from the commercial interests of food and beverage firms that normalize unhealthy diets, as well as automotive and fossil-fuel corporations that promote sedentary lifestyles. While these industries do not intend to make society obese, their business models depend on doing so.

Even though the obesity pandemic is claiming lives, lowering productivity, and pushing up health care costs, health-harming industries operate within the boundaries of the law. A great paradox of our time is that while societies depend on a healthy population to function, the legal framework allows actors within society to undermine public health for private gain.

Viewing obesity as a societal rather than an individual challenge requires regulating its primary risk factors—not merely “curing” it once it has manifested. Yet in practice, we see that governments, faced with significant lobbying and campaign finance from health-harming industries, are often reluctant to regulate the obesogenic environment. In the Ozempic Era, this reluctance may be further aggravated, as hesitant politicians might point to weight loss drugs as a cure-all for the obesity pandemic.

But the market cannot solve the obesity pandemic. With trillions of dollars at stake, health-harming industries are innovating to survive. Food manufacturers are already formulating products designed to appeal even to individuals on weight loss drugs. In the years ahead, we may see an arms race: ever more potent weight loss drugs on one side, and ever more irresistible foods on the other.

With so much profit to be made, commercial entities have little incentive to reduce obesity. Health-harming industries and pharmaceutical firms may seem like unlikely bedfellows, yet in profiting from both the causes and the treatment of obesity, they are a match made in heaven.

Regardless of how effective weight loss drugs may be, they should not serve as an excuse to avoid regulating the obesogenic environment. Confronting the obesity pandemic requires a whole-of-society approach. First, market prices and societal costs of health-harming goods need to be aligned. Second, the normalization of unhealthy diets and practices through advertising, sponsorship, and endorsement must be curbed. Third, spatial planning must put human movement at its core—whether through walking, cycling, or public transport.

The Ozempic Era offers new tools, but ultimately, only political courage will determine whether we merely manage the obesity pandemic—or truly overcome it.

Jochen O. Mierau

For years, many of us in public health have been frustrated by people who have continued to blame the ongoing obesity epidemic solely on the individual. The persistent claim that obesity is simply the result of a person eating too much and not exercising enough has undermined efforts to enact needed changes such as addressing all the ultra-processed foods laden with sugar, salt, and artificial ingredients that have infiltrated our food supply. And with the burgeoning popularity of glucagon-like peptide-1 agonists such as Ozempic, a major concern has become that this whole put-the-burden-on-the-individual will simply get worse. After all, rather than enact business or policy changes, might people just say, “Take Ozempic and everything will be fine”?

Well, Laura A. Schmidt and Luc L. Hagenaars offer a different take on what might happen. And by different, we mean the opposite. They think the rise of GLP-1 agonists could eventually shift blame away from the individual and more toward the problems with our food systems. They argue that since GLP-1s can help quell cravings and food noise, more and more people may become aware of the role of ultra-processed foods as a major barrier to weight loss. The result could be more interest in treating food addiction like we treat tobacco and alcohol addiction. Schmidt and Hagenaars also believe that “the widespread use of GLP-1s could drive down demand for ultra-processed foods, eventually causing food companies to reformulate products.”

This is certainly an intriguing and refreshing take on what the so-called Ozempic Era has in store for society. It would be yet another example of unintended consequences that can result when some kind of change is thrown into a complex system. Our Public Health Informatics, Computational, and Operations Research team has emphasized in both scientific and lay publications how obesity and the obesity epidemic are complex systems problems, influenced by a wide range of biological, behavioral, social, environmental, and economic factors. This means that rather than a single policy change or intervention, a combination of strategies is needed to tackle obesity. But it’s been difficult to convince public, industrial, or philanthropic funders to invest in and implement such combinations in big part because of the bias toward blaming the individual for obesity. Might GLP-1 agonists inadvertently be the trigger to a cascade of positive changes? Perhaps. The pessimist might say that food companies may simply find new ways to drive up cravings and food noise. Ultimately, it is very difficult to predict the future accurately.

Regardless, Schmidt and Hagenaars have the right idea. When any significant change does occur, whether good or bad, it is an opportunity for further positive change as long as the necessary actions are taken. While the future is uncertain, one thing’s for certain: Ignoring the opportunity for positive change leaves open the opportunity for further negative change.

Bruce Y. Lee

Jessie Heneghan