Beyond calories structural clinical and policy perspectives on the obesity epidemics in the United States

This literature review synthesizes five decades of evidence on the U.S. obesity epidemic, tracing its rise from ~13% adult prevalence in the 1960s to >40% today and examining why the burden falls disproportionately on socioeconomically disadvantaged communities. The presentation begins with definitional basics (adult and pediatric BMI cutoffs) and a high-level epidemiology update, then unpacks the multifactorial drivers that sustain obesity across the life course. We will review diet and physical-activity trends (energy-dense, ultra-processed foods; larger portions; sedentary work and transport), neighborhood and commercial determinants (food deserts, targeted marketing, car-centric design), and biologic contributors (genetics, gut microbiota, pregnancy exposures, neurobehavioral factors). Economic and clinical consequences are summarized, including cardiovascular disease, type 2 diabetes, cancer risk, maternal- child health impacts, reduced life expectancy, and the substantial direct and indirect costs to the health system and productivity.

Building on this foundation, the talk critically appraises public-health and clinical responses to date: federal nutrition programs (WIC/SNAP-Ed), FDA labeling reforms, school and community-based initiatives, primary-care counseling, behavioral therapies (CBT/MI), and bariatric surgery, highlighting where these strategies work, why impact has been uneven, and how equity gaps in access, funding, and implementation dilute outcomes. We will also address the recent inflection point in pharmacotherapy, including GLP-1–based agents (e.g., semaglutide), clarifying their promise, limitations, and the risk of mistaking individual-level tools for population-level solutions.

The session closes with actionable, systems-oriented recommendations. These include multisector policy alignment (health, education, transportation, housing, agriculture), place based interventions that improve healthy food access and active-living infrastructure, and equity first approaches that confront structural barriers and cultural context. We will briefly explore emerging enablers, telehealth, wearables, risk stratification, and behavioral-economics factors with attention to ethics, bias, and scalability. Attendees will leave with a clear, evidence-based map of what has driven the epidemic, which interventions have the strongest signal, and a practical framework for integrating clinical care with community and policy levers to bend the curve on obesity sustainably and equitably.