Neglecting obesity in the 2025 NCD agenda will leave one billion people behind

The obesity epidemic is one of the most pressing challenges of the 21st century. Yet the draft political declaration of the 2025 UN General Assembly high level meeting on the prevention and control of NCDs falls short in confronting the obesity crisis.1

Analysis by authors working in the UN system saw a continual weakening of the previous political declaration on NCDs (2018) in relation to both the nature of commitments and the specificity of interventions.2 The authors blamed industry influence on the process for the weakening of the political declaration.3 The current third draft of the 2025 political declaration provides stronger language related to action that is people centred and approaches that are based on human rights—both critical to an effective response to obesity.4 However, we remain concerned about the draft’s failure to recognise obesity as a chronic disease, which drives other NCDs, and to reflect key interventions and approaches that have been recommended by the World Health Organization.4

Obesity remains visible yet neglected in global health discourse. Over 1 billion people worldwide are currently living with the disease. Obesity is a major contributor to the global burden of NCDs—it accounts for approximately 43% of type 2 diabetes cases, up to 78% of hypertension cases, and plays a role in at least 13 different types of cancer.567 However, obesity must not be seen simply as a risk factor for NCDs.

Since the 2018 high level meeting, obesity has been classified as a chronic disease that is caused by the complex interplay of genetic, metabolic, behavioural, and environmental factors.8 This definition is important from a public health perspective and a political perspective because it shifts the narrative from personal failing to societal responsibility. The current draft political declaration fails to acknowledge these developments. Left unchanged, the 2025 political declaration will let governments off the hook for failing to exercise systemic action on obesity, which could have catastrophic consequences.

The costs of obesity are projected to reach $4.3tn (£3.2tn, €3.7tn) a year globally by 2035.9 WHO estimates that every $1 invested in obesity prevention yields $6 in returns by reduced burdens on healthcare systems and higher productivity.10 But fewer than 20% of countries have integrated obesity prevention in primary care. Many interventions that are related to food systems are absent globally, perpetuating cycles of inequity.11 The personal, health, and economic benefits of vigorously committing to an obesity response are evident in the countries that have adopted interventions recommended by WHO.

Failing to reflect the centrality of obesity in the political declaration would be a missed opportunity. Taxes on sugar sweetened beverages, for example, have been proven to be effective in all income level settings in reducing obesity and the risk of NCDs.12 Despite this, the most recent draft of the political declaration omits explicit reference to such taxes and has weaker language on the level of ambition on policies to prevent NCDs than the first two drafts. As it stands, the political declaration will not serve to reinforce countries’ obligations to adopt proven, impactful, and widely supported policies that could tackle the obesity epidemic and benefit economies.

Despite its devastating impact, obesity remains neglected in national policies worldwide.9 For example, Indonesia excludes obesity from its national insurance coverage, leaving millions without care;13 and many countries with some of the highest prevalence of obesity, such as Tonga and New Zealand, have yet to implement a national tax on sugar sweetened drinks. These gaps persist even though WHO’s 2022 recommendations provide a clear roadmap in relation to fiscal and regulatory actions and strengthening health systems through a primary healthcare approach to obesity.4

The final negotiations in the lead up to the fourth UN high level meeting on NCDs provide crucial opportunities to rectify the shortcomings in the current draft political declaration and its failure to recognise the significance of the obesity epidemic. We urge member states to work towards making meaningful progress by ensuring that the following are covered in the declaration. Firstly, acknowledge obesity as a chronic, complex, multifactorial disease that is a major driver of multiple other NCDs. Secondly, commit to implementing WHO obesity related recommendations, including measures to ensure healthy food environments, and particularly reducing the availability of ultra processed foods. Thirdly, commit to integrating obesity prevention into primary care.

The obesity crisis needs to be reframed as a consequence of failure of political will. Millions of premature deaths and trillions of dollars are at stake by denying obesity’s centrality in the global NCD crisis. World leaders must prioritise obesity now or their populations will pay a heavy price in the years to come. The political declaration must not leave people living with obesity behind.