IN A NUTSHELL Author's NoteThe WHO’s recent decision to consider anti-obesity drugs as essential medicines occurs in a world marked by profound contradictions: persistent global undernutrition, widespread overconsumption, accelerating ecological degradation, and unprecedented corporate concentration in the agri-food and pharmaceutical sectors. Industrial food systems generate vast ecological harm and animal suffering while driving both obesity and hunger. This article analyzes the ethical, ecological, and equity implications of medicalizing obesity, drawing on global health ethics, political ecology, and the author’s earlier work on sustainable health equity, as well as the principles articulated in the Sustainable Health Equity Movement (SHEM) webinars. It argues that pharmaceuticalizing a structurally produced problem risks perpetuating an economy of excess—of calories, material throughput, wealth accumulation, and ecological destruction—while deflecting attention from the structural transformations needed to achieve equitable and sustainable global health
By Juan Garay
Co-Chair of the Sustainable Health Equity Movement (SHEM)
Professor/Researcher of Health Equity, Ethics and Metrics (Spain, Mexico, Cuba, Brazil)
Founder of Valyter Ecovillage (valyter.es)
By the same Author on PEAH: see HERE
Beyond Obesity Pills
Ethical Imperatives for a World of Excess, Hunger, and Ecological Breakdown
Introduction
Today, the world confronts a fundamental ethical paradox: nearly one billion people lack sufficient nutrition, while another billion experience conditions of excess, especially obesity linked to ultra-processed and animal-dense diets (FAO, 2023; WHO, 2024). These phenomena are not isolated but interconnected outcomes of global systems that prioritize economic accumulation over health, justice, and ecological balance.
The author’s earlier work on sustainable health equity emphasized that inequities emerge from structural determinants—economic concentration, ecological overshoot, precarious living conditions, and food systems designed around profit rather than well-being. The Sustainable Health Equity Movement (SHEM) further elaborates these principles, arguing that health equity can only be achieved when economic, social, and ecological inequities are addressed together, as interdependent dimensions of one crisis.
It is in this context that the WHO’s decision to incorporate anti-obesity drugs into essential medicines lists must be critically examined.
Structural Roots of Global Nutritional Inequity
Hunger amid systemic abundance
Global hunger persists primarily because of inequitable distribution, political marginalization, conflict, and poverty, not because of inadequate food production (Sen, 1981; FAO, 2023). SHEM highlights that inequity is systemic: institutions, markets, and power structures create conditions in which hunger is reproduced generation after generation.
Overconsumption as a structural outcome
In many countries, obesity is fueled by:
industrial overproduction of cheap calories
aggressive marketing of ultra-processed foods
subsidies for livestock and monocultures
socioeconomic stressors and precarity
weakened regulatory institutions
These dynamics form what Stuckler and Nestle (2012) call the corporate determinants of health, in which harmful consumption patterns are shaped—and normalized—by powerful economic interests.
Ecological destruction and animal suffering
Industrial animal agriculture contributes to:
high greenhouse gas emissions
deforestation and biodiversity loss
water contamination
antibiotic resistance
the suffering of billions of sentient beings
SHEM emphasizes that ecological degradation and health inequity are inseparable: the communities most harmed by environmental damage are typically those with the least political and economic power.
Medicalization of Obesity
Addressing symptoms while ignoring causes
Pharmaceutical treatment of obesity, though beneficial for individuals, risks reinforcing a paradigm that focuses on downstream biomedical interventions rather than upstream determinants. The author’s earlier work on sustainable health equity argues that health cannot be sustainably improved if structural drivers remain unaddressed.
Expansion of pharmaceutical dependence
Anti-obesity drugs have become a rapidly expanding global market, propelled by:
industry lobbying
medicalization of structurally produced conditions
narratives that emphasize individual responsibility
This dynamic, as some critics argue, risks entrenching long-term dependence on costly pharmacological interventions while diverting attention from prevention and systemic reform.
Ethical concerns about essential medicine designation
Key risks include:
deepening inequities when expensive treatments remain inaccessible
normalizing unhealthy dietary patterns
reinforcing economic structures that benefit from systemic overconsumption
deprioritizing ecological and social determinants of health
Ethics of Sustainable Health Equity
Interdependence of health, ecology, and economy
SHEM proposes that equitable health outcomes require equity in economic distribution and ecological impact, because health cannot be sustained in contexts of concentrated wealth and ecological overshoot.
Planetary boundaries and moral responsibility
Human health relies fundamentally on ecological stability. The crossing of planetary boundaries undermines long-term determinants of health, including food security, water access, and climate resilience (Whitmee et al., 2015; IPCC, 2021).
Redistribution as ethical and ecological necessity
Hunger and obesity represent two faces of the same structural maldistribution of:
food
economic resources
ecological capacity
SHEM emphasizes that sustainability requires reducing excess—not only in dietary intake but also in economic accumulation, resource extraction, and environmental degradation.
Pathways Beyond Pharmaceutical Dependency
Transition to plant-rich and agroecological food systems
Plant-based and agroecological systems:
improve health
reduce chronic disease
lower environmental pressure
eliminate most animal suffering
enhance food sovereignty (Willett et al., 2019)
Strengthening public-interest food governance
Effective interventions include:
regulating harmful food environments
restricting ultra-processed food marketing
fiscal measures that discourage unhealthy consumption
supporting regenerative and community-based agriculture
Reducing corporate concentration
Excessive corporate power in agriculture, food production, and pharmaceuticals undermines equity, democracy, and ecological sustainability (Clapp, 2021)
Integrating sustainable equity metrics into health governance
Inspired by the author’s earlier work and the SHEM framework, essential medicines policies should incorporate:
ecological impacts
distributive justice
structural determinants of demand
long-term sustainability of interventions
This approach helps avoid embedding unjust structures into global health policy.
Conclusion
The rise of anti-obesity medication as an essential global health intervention reflects a world shaped by structural excess and structural deprivation. While pharmacological tools may provide relief for some, they risk reinforcing the economic models and ecological trajectories that produce both hunger and obesity.
Achieving sustainable and just global health requires transforming—and not merely medicating—the conditions of excess consumption, inequality, ecological degradation, and corporate concentration. Sustainable health equity demands rebalancing human nutrition within ecological limits, reducing avoidable suffering (human and non-human), and ensuring that all people have access to nutritious, ethically produced food.
Only by addressing these systemic drivers can global health move toward a future grounded in justice, sustainability, and compassion.
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