Weight management and the wellness economy: structural implications for public health, prevention policies and health system sustainability
Keywords:
weight management, urban health, wellness economy, health systems sustainabiliy, non-communicable disease preventionAbstract
Background and aim: The rapid expansion of the global wellness economy represents one of the most profound structural transformations in contemporary health-related systems. Within this evolving landscape, weight management has shifted from an individual behavioral concern to a systems-level determinant of public health, deeply interconnected with non-communicable diseases (NCDs), environmental exposures, urban design, social inequities and health system sustainability. This work aims to analyze weight management as a structural infrastructure of preventive health policy embedded within the broader economic and governance architecture of the wellness economy.
Methods: We conducted a multidisciplinary analysis drawing on literature published between 2010 and 2024, macroeconomic analyses and international policy frameworks. We examined weight management through a systems lens integrating environmental epigenetics, urban health, pharmacological innovation and planetary health governance.
Results: The wellness economy currently exceeds USD 6.8 trillion globally and offers unprecedented preventive potential. However, it also risks fragmentation, inequity and over-medicalization if not aligned with public health principles. Our analysis demonstrates that obesity and metabolic risk must be reframed as structural determinants requiring regulatory alignment, environmental risk mitigation, equity safeguards and integration across public and private actors.
Conclusions: Weight management should be recognized as a core component of health system resilience and long-term sustainability. Repositioning weight management as a structural determinant of planetary health represents a necessary paradigm shift for 21st-century prevention strategies. Effective governance requires coordinated action across multiple sectors to ensure equitable access and sustainable implementation.
References
1. World Health Organization. Global status report on noncommunicable diseases 2023. Geneva: WHO; 2023.
2. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49. doi:10.1016/S0140-6736(20)30752-2
3. OECD. Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023. doi:10.1787/7a7afb35-en
4. Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100(4):590-5. doi:10.2105/AJPH.2009.185652
5. Global Wellness Institute. Global Wellness Economy Monitor 2023. Miami: GWI; 2023.
6. McKinsey & Company. Future of Wellness Survey 2023. New York: McKinsey; 2023.
7. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-14. doi:10.1016/S0140-6736(11)60813-1
8. Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13-27. doi:10.1056/NEJMoa1614362
9. Sassi F. Obesity and the economics of prevention. Paris: OECD Publishing; 2010.
10. Marmot M. The health gap: the challenge of an unequal world. Lancet. 2015;386(10011):2442-4. doi:10.1016/S0140-6736(15)00150-6
11. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31(1):219-30. doi:10.1016/j.jhealeco.2011.10.003
12. World Obesity Federation. World Obesity Atlas 2024. London: WOF; 2024.
13. Roberto CA, Swinburn B, Hawkes C, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385(9985):2400-9. doi:10.1016/S0140-6736(14)61744-X
14. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125-45. doi:10.1111/j.1749-6632.2009.05333.x
15. Rydin Y, Bleahu A, Davies M, et al. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet. 2012;379(9831):2079-108. doi:10.1016/S0140-6736(12)60435-8
16. Münzel T, Sørensen M, Gori T, et al. Environmental stressors and cardio-metabolic disease: part II-mechanistic insights. Eur Heart J. 2017;38(8):557-64. doi:10.1093/eurheartj/ehw294
17. Rappaport SM, Smith MT. Environment and disease risks. Science. 2010;330(6003):460-1. doi:10.1126/science.1192603
18. Heindel JJ, Blumberg B. Environmental obesogens: mechanisms and controversies. Annu Rev Pharmacol Toxicol. 2019;59:89-106. doi:10.1146/annurev-pharmtox-010818-021304
19. Vrijheid M, Slama R, Robinson O, et al. The human early-life exposome (HELIX): project rationale and design. Environ Health Perspect. 2014;122(6):535-44. doi:10.1289/ehp.1307204
20. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
21. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-16. doi:10.1056/NEJMoa2206038
22. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet. 2015;386(10007):1973-2028. doi:10.1016/S0140-6736(15)60901-1
23. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: UN; 2015.
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Copyright (c) 2026 Federico Serra, Walter Ricciardi, Carlo Signorelli, Roberta Siliquini, Stefano Capolongo, Claudio Cricelli, Giuseppe Novelli, Attilio Parisi, Annamaria Colao, Andrea Lenzi
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