The river was swift and unrelenting, its currents carrying victim after victim downstream. Local villagers responded by stringing nets across the water to prevent further drownings. Yet, despite their efforts, the death toll continued to rise.
Eventually, a newcomer to the village asked a simple yet critical question: “Why are people falling into the river in the first place?” Following the water upstream, the villagers discovered the source of the problem: a crumbling bridge sending person after person into the rapids.
This “upstreeam parable” illustrates the folly of America’s response to obesity.
Like the villagers, Americans have relied on reactive, downstream solutions to combat the problem. Bariatric surgery and, more recently, weight loss drugs like Ozempic and Wegovy have helped people lose significant weight, but they don’t address the reason people become obese in the first place. Similarly, decades of well-intentioned government efforts—food labeling, public health campaigns and exercise programs—have failed to stem the tide.
Addressing the root causes of obesity requires a shift away from today’s reactive measures. Enter Robert F. Kennedy Jr., the controversial nominee for Secretary of Health and Human Services. While his nomination raises significant questions, it also offers a rare opportunity to confront the drivers of the obesity epidemic. If confirmed, Kennedy could alter the trajectory of this growing crisis.
Obesity: Why The Root Of The Problem Matters
Obesity rates in the United States have surged over the past 30 years. According to The Lancet, the percentage of American adults classified as overweight or obese has more than doubled, rising among women from 22.5% to 45.6% and among men from 18.6% to 41.5%.
For adolescents, the situation is even more alarming. During the same period, obesity rates tripled, with the CDC reporting a fivefold increase in children aged 6 to 11 since the 1960s.
The health consequences extend far beyond weight gain. Obesity is a major driver of diabetes and cardiovascular disease. The American Cancer Society identifies it as a factor in 40% of all cancer cases and 50% of cancer deaths, with clear links to malignancies of the uterus, esophagus, kidney, liver and gallbladder.
But despite the rapid emergence of the obesity epidemic over just a few decades, public health leaders increasingly describe it as a genetic and biological condition. The Obesity Medicine Association calls it a “chronic, relapsing, multifactorial, neurobehavioral disease,” and the American Academy of Pediatrics frames childhood obesity as “a chronic and complex disease with lifelong health ramifications.
While most organizations acknowledge multiple contributing factors, their focus on biological explanations and medical treatments—like drugs and surgery—has overshadowed the true driver of the epidemic. A doubling of obesity in just 30 years can’t be explained by genetics or biology; human DNA evolves over millennia, not decades.
The primary culprit is the food industry and its deliberate manufacturing and marketing of ultra-processed, calorie-dense products packed with refined sugars and unhealthy fats.
Genetics do play a role in obesity. The FTO gene, which increases susceptibility to overeating, helped early humans survive periods of scarcity by encouraging calorie storage during times of abundance. Over the past three decades, however, the food industry has exploited this evolutionary holdover for profit. By engineering products that trigger dopamine releases in the brain, manufacturers have created addiction-like behaviors to food that leads to overconsumption.
The result is a population increasingly dependent on nutrient-poor, high-calorie foods. Today, 42% of U.S. adults are obese, costing the healthcare system $173 billion annually.
While GLP-1 weight-loss drugs offer effective treatment for those already struggling with obesity, they require lifelong use to maintain results. Nearly half of all patients discontinue these medications within two years, and the drug’s annual cost—exceeding $10,000 per person—places immense strain on patients and payors, soon to include Medicare.
Without changes to food manufacturing and marketing, the chronic disease crisis—which is responsible for 30-50% of preventable heart attacks, strokes, kidney failures and cancers—will only worsen.
To improve our nation’s health and make medical care more affordable, the next HHS secretary will need to force this change.
Robert F. Kennedy Jr.: A Controversial Hope
RFK Jr., who’s awaiting Senate approval as president-elect Trump’s designate for HHS secretary, is a polarizing figure. Kennedy has a history of promoting scientifically debunked theories, such as the claim that vaccines cause autism or that COVID-19 was “targeted to attack Caucasians and Black people” while sparing Jewish and Chinese people.
While these troubling positions cannot be overlooked, neither should we dismiss his advocacy for chronic disease prevention, food reform and the value of primary care. If confirmed as HHS secretary, Kennedy has the potential to push for transformative changes in the food industry—tackling the root cause of obesity more aggressively than any of his predecessors.
Kennedy has been outspoken in his criticism of the Food and Drug Administration, accusing the agency of suppressing access to products that “advance human health but can’t be patented by” pharmaceutical companies. He has also voiced opposition to the widespread use of GLP-1 weight-loss drugs, describing them as a shortsighted approach to combating obesity. Kennedy has gone so far as to posit that Novo Nordisk, the maker of Ozempic, markets the drug to Americans “because we are so stupid and so addicted to drugs.”
Looking to the Past for Cures
Having promised to confront the food industry and revive America’s health, the question now is “How might Kennedy achieve these ambitious goals?”
History offers a two-part blueprint: prohibition and taxation.
In the 1970s, research linked lead in gasoline to severe neurological damage in children. In response, the Environmental Protection Agency phased out leaded gasoline by 1986, a policy credited with reducing lead levels in children by over 90%. Similarly, eliminating lead in paint and pipes demonstrated the power of regulatory prohibitions to drive public health improvements.
More recently, local governments in Berkeley, California, and Philadelphia implemented soda taxes to reduce sugary beverage consumption, cutting sales by as much as 38%. Despite resistance and heavy lobbying from the beverage industry, these measures show how financial disincentives can effectively promote healthier choices.
The Path Forward
As long as high-calorie, processed foods dominate grocery stores, school cafeterias and restaurant menus, the nation’s health will remain in crisis.
A realistic solution lies in taxation. If sugar- and fat-laden products contribute hundreds of billions in healthcare costs, those expenses should be reflected in their prices. Revenue from these taxes, coupled with future savings from reduced obesity-related healthcare spending, could subsidize healthier food options for low-income families.
This dual approach—discouraging harmful choices while promoting affordable, nutritious alternatives—has the potential to reshape America’s food environment and improve public health for generations to come.
I’ve never met Robert F. Kennedy Jr., so I can’t explain his most controversial and unscientific health positions. But if his nomination is confirmed and his tenure transforms the food industry into a force for health, I will applaud his efforts to fight the root causes of obesity.
Within the halls of Congress, Kennedy has an opportunity to garner bipartisan support. Democrats have long championed nutritional improvements for disadvantaged families, while Republicans could support reforms that reduce healthcare spending and improve population health.
The time has come to move upstream—to repair the crumbling bridge of American health rather than relying on the safety nets of downstream solutions. The next HHS secretary will face significant resistance from the food industry in pursuing this course, but bold and decisive action is essential. Strong leadership can turn the tide of the obesity epidemic and deliver a stronger, healthier future for our nation.
