The Past, Present and Future of Obesity Care

by Ted Kyle, RPh, MBA

Winter 2025

Obesity is one of the most pressing health challenges of our time. Its prevalence has grown steadily over the past century, transforming from a rarity to a widespread global concern. Addressing it has been a winding journey – one that has evolved from simplistic solutions to a deeper, science-driven understanding of this complex condition. By examining the history, current state and future of obesity care, we can appreciate how far we’ve come and where we’re headed.

The History of Obesity Care

In the early 20th century, obesity was largely viewed as a moral failing or a sign of prosperity, not a medical condition. People with obesity were often told to simply “eat less and move more.” This oversimplified approach spawned countless diet fads, each promising miraculous weight loss results. From the grapefruit diet of the 1930s to the obsession with the low-carb Atkins diet at the end of the century, these fads reflected society’s obsession with quick fixes and often ignored the underlying drivers of obesity.

Meanwhile, the prevalence of obesity continued to climb. By the 1980s, it was clear to scientists that obesity was not just a matter of willpower. Researchers began uncovering biological factors that influence body weight. The discovery of leptin in 1994 marked a turning point. This hormone, produced by fat cells, helps regulate hunger and energy balance. Its discovery revealed that obesity is not just a behavioral issue but also a condition influenced by biology. Despite all of this new science, clinical care for obesity focused almost exclusively on advising patients to lose weight through diet and exercise. This emphasis created a perfect environment for a succession of faddish diets to flourish on the strength of unrealistic expectations for “fast and easy weight loss.”

In parallel, bariatric surgery emerged as a transformative option for individuals with severe obesity. Procedures like gastric bypass and sleeve gastrectomy provided effective and lasting weight loss for many patients. These surgeries also offered insights into how weight loss affects metabolic health, further challenging the simplistic “calories in, calories out” narrative. Despite these advancements, the stigma surrounding obesity persisted, and access to care remained limited.

The Current State of Obesity Care

Today, obesity care is in the midst of radical change. On one hand, our understanding of obesity has grown exponentially. It is now widely recognized as a complex, chronic disease influenced by genetics, environment, and physiology. This shift in perspective has been bolstered by groundbreaking treatments like GLP-1 receptor agonists, including medications such as semaglutide and tirzepatide. Originally developed for diabetes, these drugs have demonstrated remarkable effectiveness in controlling obesity by reducing appetite and improving metabolic health. For many patients, these medicines are nothing short of life-changing.

In addition to the emergence of better science and better treatments for obesity, the elevation of lived experience with this disease has been a critical driver of the progress we are seeing. The Obesity Action Coalition has brought patient advocates into a central role for health policy relating to obesity. Patient advocates have done amazing work to put a spotlight on the prevalence and harm of weight bias. Without an appreciation for the lived experience of obesity, much of the progress today would not have been possible.

The patient voice is also responsible for scientific progress. For example, patients have brought attention to the phenomenon of “food noise” – which advanced obesity treatments have proven to be so effective for quieting.

However, significant challenges remain. Access to obesity care is far from equitable. Many health insurance plans do not cover obesity treatments, including medications and bariatric surgery, leaving millions without affordable options. This lack of access disproportionately impacts marginalized communities, exacerbating health disparities. For example, people in lower-income households or communities of color often face higher rates of obesity but fewer opportunities for effective care.

Stigma also continues to be a major barrier – as well as a source of harm. Despite growing awareness of obesity as a disease, individuals with obesity often encounter bias from healthcare providers, employers, and society at large. This stigma can discourage people from seeking care and undermine the effectiveness of treatment. Addressing these systemic issues is essential for progress.

The Future of Obesity Care

The future of obesity care is full of promise. Scientific advances are poised to deliver even more effective and diverse treatment options. Next-generation obesity medications are already in development, with the potential to offer even greater weight loss and fewer side effects. Innovations in gene therapy and personalized medicine may one day allow for highly tailored approaches based on an individual’s unique biology.

Beyond treatment, the future will also see an emphasis on more effective strategies for prevention. Insights into the drivers of obesity, from early childhood nutrition to environmental factors, will inform better prevention strategies – strategies that can actually move the needle on prevalence. Schools, workplaces and communities will play a critical role in creating environments that support healthy lifestyles and reduce the risk of obesity.

Equally important is the need to scale up obesity care to match the scope of the problem. This means training more healthcare providers in obesity medicine, expanding insurance coverage and addressing stigma at every level. Public health initiatives must work hand-in-hand with medical advancements to ensure that care is accessible to all who need it.

Finally, as we deepen our understanding of obesity, we may uncover entirely new ways of thinking about weight and health. The concept of “health at every size” has already challenged traditional weight-centric approaches, emphasizing the importance of holistic well-being over arbitrary weight goals. Increasingly, obesity care is incorporating some of this perspective, focusing not just on weight loss but more on improving quality of life and reducing the health risks associated with obesity.

Conclusion

The journey of obesity care has been marked by significant progress, persistent challenges, and boundless potential. From the diet fads of the past to today’s advanced treatments, each step reflects our growing understanding of a condition that affects hundreds of millions worldwide. As we look to the future, the key to success will lie in embracing science, addressing systemic barriers, and fostering a more compassionate and inclusive approach to care. By doing so, we can ensure that everyone can live a healthier, more fulfilling life – regardless of the challenges obesity presents.

About the Author:

Ted Kyle, RPh, MBA is a pharmacist and healthcare innovator living in Pittsburgh. He’s also a tireless advocate for people living with obesity who served as the OAC Chair and on the Board of Directors for more than a decade. His widely-read daily commentary, published at Conscienhealth.org/news, reaches a diverse audience of thought leaders in health and obesity.

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