3 March 2026
On World Obesity Day, the global community is called on to confront one of the fastest‑growing and most complex public‑health challenges of our time. Obesity is no longer a condition confined to high‑income countries. According to the World Health Organization (WHO), more than one billion people worldwide are now living with obesity, with prevalence rising in almost every country and across all age groups. In 2022 alone, one in eight people globally were affected, while rates among children and adolescents have increased fourfold since 1990.
The burden is increasingly concentrated in low‑ and middle‑income countries (LMICs). The World Obesity Federation estimates that the greatest number of people living with obesity are now in LMICs, with prevalence projected to more than double across these countries compared to 2010, and to triple in low‑income countries by 2030. At the same time, the countries least prepared to respond to obesity through health‑system readiness and policy action are lower‑middle‑ and low‑income nations.
Obesity is also a major driver of non‑communicable diseases. WHO estimates that millions of premature deaths each year are attributable to high body mass index, through conditions such as diabetes, cardiovascular disease and certain cancers, placing long‑term strain on health systems already facing multiple competing priorities.
Francois Venter, a clinician‑scientist based in South Africa
For Professor François Venter, a clinician‑scientist based in South Africa, these trends are both alarming and familiar. “What you’re seeing across low‑ and middle‑income countries is the rise in obesity, and how rapidly it’s happening, tracking the rise of diabetes and hypertension.”
The pattern, he notes, echoes earlier global health crises. “It just feels so similar to HIV : this sudden wave of illness, but no real plan in place.”
As World Obesity Day’s “8 Billion Reasons to Act on Obesity” campaign makes clear, reversing these trends will require more than awareness. It will demand system‑level action — including prevention, care and equitable access to effective treatment — particularly in the countries now carrying the greatest and fastest‑growing burden.
Across LMICs, obesity is rising alongside a cluster of non-communicable diseases, including diabetes, hypertension, cardiovascular disease, kidney disease, and liver disease. Unlike infectious diseases, however, obesity does not have a single cause or a simple intervention.
As Professor Venter puts it, “HIV is just a virus, quite clear how the transmission cycle happens. The context in which obesity is happening is much more complicated.” It is shaped by food systems, urbanisation, poverty, social norms and built environments, factors that interact in complex and poorly understood ways.
Yet complexity cannot justify delay. Obesity is already reshaping disease patterns in LMICs, placing long-term strain on health systems designed for acute care rather than chronic disease management.
“It’s happening, and it’s pretty urgent. And the consequences are going to be living with society for quite some time.”
One of the most persistent barriers to effective obesity care is stigma, particularly the idea that obesity reflects a lack of discipline or personal responsibility.
For Professor Venter, this framing is not only wrong, but harmful.
“The problem with obesity is the way it’s been framed for the longest time, as a failure of will.”
Decades of experience have shown that lifestyle change alone works for only a small minority of people. Yet those voices dominate public discourse, while most people living with obesity remain unheard.
In clinical practice, Professor Venter sees patients who have tried repeatedly diets, exercise programmes, behavioural changes without sustained success. The issue, he argues, is not solely effort, but environment.
The modern food system, particularly in LMICs, makes weight gain the default outcome. Ultra-processed foods are cheap, accessible and filling, while healthy options are often expensive or unavailable. This dynamic plays out in both urban and rural settings.
Recognising obesity as a chronic disease, rather than a personal failure, fundamentally changes how it should be addressed, and what support people need.
Once obesity is understood as a chronic condition, the limits of lifestyle-only approaches become clear. For many people with established obesity, additional support is essential.
“What that tells me as a healthcare practitioner is: you need help.”
That help, Professor Venter argues, now exists in the form of effective medication, particularly GLP-1 based therapies. While the idea of using drugs to treat obesity remains uncomfortable for some, evidence and clinical experience increasingly support their role. “For the first time, that help comes in the form of drugs. And that makes everyone uncomfortable.”
Professor Venter’s perspective is informed not only by clinical practice, but also by his role as a member of the WHO’s Guideline Development Group for the WHO guideline on the use of GLP‑1 therapies for the treatment of obesity in adults.
Crucially, these medicines work best when embedded in broader care. Lifestyle interventions remain important, but medication can make those efforts sustainable. In his experience, medication alone can lead to modest weight loss, but results are far stronger and longer lasting when drugs are combined with structured dietary and exercise support. This perspective is also shaped by extensive HIV clinical trial experience in South Africa, including landmark studies that documented weight gain and metabolic complications associated with modern antiretroviral therapy, as well as his contribution to peer‑reviewed research examining the potential role of GLP‑1–based therapies for people living with HIV.
Despite the growing need, obesity medicines remain largely inaccessible in LMICs. Professor Venter points to two closely linked barriers: the limited affordability of treatment and the need to further strengthen delivery systems to support longterm care. As a result, effective GLP‑1 based therapies remain out of reach for most people who could benefit from them, particularly in public health settings. As he warns: “If you don’t start dealing with access to affordable medication, we’re not going to get on top of the epidemic.” Without addressing both access to treatment and the systems needed to deliver it, he argues, the benefits of scientific progress will remain confined to a small fraction of the population.
This is where organisations like the Medicines Patent Pool (MPP) play a critical role, addressing intellectual property barriers and enabling competition to bring prices down to levels compatible with public health use.
Obesity is often associated with urbanisation, but Professor Venter notes that in South Africa and many LMICs, rates are also rising sharply in rural areas. The driver is not geography, but food access. In many rural communities, fresh produce is scarce or expensive, while ultraprocessed foods are cheap and readily available. As obesity increases, so too does the burden of associated diseases, reinforcing the need to address obesity as a central driver of ill health, not a secondary concern.
From an economic perspective, Professor Venter is confident that obesity medicines will become cost-effective, particularly as prices fall. In South Africa, private insurers already cover GLP-1 based therapies for diabetes, and some are actively planning for future obesity coverage as prices decline. The mistake, he argues, would be to wait. “We shouldn’t be waiting. We should be thinking now about what the minimal care package needs to look like.” Building delivery systems in advance will determine whether countries are ready to act once affordability improves.
While injectable GLP-1 based therapies dominate today, the development pipeline is expanding rapidly. Oral formulations and next generation agents may further reduce barriers to access and improve patient choice. Importantly, these medicines are not only about weight. “They’re often framed as weight-loss drugs, but they’re really metabolic agents.” Their potential spans multiple conditions, including heart, liver and kidney disease, reinforcing their relevance for LMIC health systems facing complex, overlapping disease burdens.
Asked about access strategies, Professor Venter emphasises the importance of voluntary licensing as part of a coordinated approach. Once governments include medicines in national formularies, they create markets that encourage generic entry and drive prices down, often with regional benefits. “We saw this with antiretrovirals. The knock-on effect was enormous.”
Without such public health-oriented mechanisms, price reductions are likely to be marginal, leaving medicines effectively inaccessible to those who need them most.
If access is not addressed, the outcome is predictable. Obesity medicines will exist, but only for a small, wealthy minority. Professor Venter is blunt about what this means in practice. “Otherwise, this is just going to be available to the rich.” Without deep price reductions and scalable care systems, obesity treatment will remain out of reach, and health systems will continue to absorb the far higher costs of untreated disease.
For World Obesity Day, Professor Venter’s message aligns closely with the campaign’s call for system-wide action. Food systems must change. Built environments must support physical activity. Prevention must start early. But for people already living with obesity, medication is not optional. “For people with established obesity, they’re not going to be able to do this by themselves.”
World Obesity Day reminds us that obesity is not a marginal issue, nor a future threat. It is already reshaping global health, especially in low- and middle-income countries.
Professor François Venter’s perspective is clear: without affordable, effective medicines, supported by strong care systems, the obesity epidemic will continue unchecked.
There are eight billion reasons to act. The challenge now is to ensure that action is fast, coordinated and equitable, so that the benefits of scientific progress are not limited by geography or income.
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