BGTHA Journal 17

Is Obesity in an Industrialised World Inevitable?

Magnus Strachan BSc, Medical Student, University of Glasgow

Published on 25/09/2026
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BGTHA Journal Edition 17

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Abstract

In a modern world where we have curtailed much of the harm to humans by infectious diseases, we find our health most vulnerable to lifestyle risk-factor exposure. Obesity is a common risk factor for a multitude of non-communicable diseases and rates are rising faster than ever. As the human environment evolves from times of scarcity to times of plenty, our biology struggles to cope. This article aims to outline how the changes brought on by industrialisation contribute to an environment which encourages obesity and how policy might mitigate the damage.

Introduction

Survival systems in the human genome have kept humans alive during times of scarcity.1 As the environment has transitioned into times of plenty, these systems have been overloaded and now hinder human prosperity. The rapid transition from agrarian to industrialised society has outpaced our ability to manage food surplus. As such, obesity cannot be attributed to individual responsibility but to a mismatch between evolutionary biology and the modern human environment. Despite an ever-growing library of literature focused on causes, effects and temporary cures for obesity, there is a distinct lack of action by national and international organisations to curb the core societal causes of ever-increasing rates of obesity globally.2

Determining factors of obesity

Obesity is inappropriate fat deposition due to a complex combination of physical, social and psychological factors. In simple terms, it is caused by an imbalance between calorific intake and expenditure. An evolving human environment has led people to expend less energy and consume excess calories. Whilst originally presumed to be the responsibility of individuals, it is now understood to be the multifactorial product of factors contributing to an environment where it is difficult for people to make healthy choices – an ‘obesogenic’ environment. This is the primary cause of most cases of obesity, but recent research has shown that biology plays a significant role too.

Biological

Genetics plays a role in the development of obesity; approximately 95% of obesity cases are polygenic. The relevant mutations generally impact the leptin-melanocortin pathway which is responsible for regulating appetite and energy expenditure.3 Breast feeding up to six months has been shown to significantly reduce obesity rates compared to children who were never breast fed, suggesting the environment in early years is crucial to normal metabolic regulation.4 Many endocrine disorders also influence obesity – disordered signalling of thyroid hormone, insulin, glucocorticoids and growth hormone all impact metabolism and thus obesity.5

Social and environmental

Local environment influences the development of obesity. During the growth of a city, urban planning can lend itself to an active or passive transport environment. Public transport and active transport both involve burning of passive calories – calories burned out with deliberate action – and can be considered obesity-protective when compared to car travel. America has often opted to rely on cars for their primary mode of transport, resulting in cities with limited public transport or infrastructure for active transport (Fig. 1). The Netherlands, in contrast, has prioritised cycling infrastructure which has helped keep obesity rates in Amsterdam at half that of Philadelphia (Fig. 2).6

Figures 1 and 2; Cycle routes (Blue and Purple lines)6 in Philadelphia, USA (Population: 11,617/sq mi) and Amsterdam, Netherlands (Population: 12,710/sq mi)7. Maps © www.thunderforest.com, Map Data © www.osm.org/copyright

Food availability can shape obesity rates. Readily available fresh produce provides a balance in nutrients, low in saturated fats and salt. Increased population densities require a higher volume of produce than is possible within the local environment. Food must be transported from other areas so requires processing and preservation to extend shelf-life.

Socioeconomic status (SES) can influence obesity occurrence. Low socioeconomic status groups within emerging economies may not have access to enough resources to become obese. Those with a high SES do have the ability to eat in excess so, in these populations, obesity tends to be a condition of the rich. In industrialised economies people within low SES groups tend to have less access to whole-foods (due to higher cost of production) and instead opt for the cheapest option – processed, nutrient-depleted foods. In England, for example, the most deprived areas have the worst childhood obesity rates; 46% compared to 26% in least deprived communities.8 High SES individuals in industrialised economies have more disposable income to spend on healthy foods, resulting in comparatively lower rates of obesity. These groups do, however, tend to live in cities, work long hours and commute for a significant portion of their day. This results in ‘time poverty’ with a reduced time for cooking healthy foods – creating a more obesogenic environment.

Epidemiology

Obesity is a common risk factor for many non-communicable diseases (NCDs). First described around 25BCE, obesity has been present throughout history.8 Within the last 100 years, however, rates of obesity have increased rapidly and obesity-related deaths totalled 5,185,364 in 2019 with a prediction of 7,397,615 by 2030.10 Between 2000 and 2021, high Body Mass Index (BMI 25+; overweight and obese) has risen from 2.5% of total lost global disability adjusted life years (DALY) to 4.5%. This, represents a near-doubling of global burden, the largest increase of all 25 most-prevalent risk factors for disease.11 When assessing the 5 most prevalent risk factors across five divisions of economic development, obesity-related factors are present in all but the lowest quintile, with increasing burden related to SDI progression (Fig. 3).

Figure 3: Top 5 risk factors for DALYs lost 2000 – 2021 by SDI (Socio-demographic Index) quintile (Data from Brauer)11

Emerging economies tend to be agrarian, relying on subsistence farming in rural populations accounting for up to 54.8% of workforce output.12 Farm-based economies remain scattered. Rural agrarian settlements generally do not require a commute so active transport is commonplace. Less access to convenience technology means more time spent doing manual tasks and passively burning calories. These factors are obesity-protective and so obesity rates in these countries are low.

Upper and Lower Middle-income countries (UMIC/LMICs) have started the transformation to industrialisation, with populations based both in rural areas and obesogenic urban environments. The combination of remnant vulnerability to infectious diseases (IDs) whilst also experiencing the development of obesity-related NCDs renders these countries with a ‘Double Burden’. Healthcare systems, optimised to treat IDs, must also tackle NCDs. As countries industrialise and enter the global economy, their citizens can be targeted by global fast-food corporations which market cheap, low-nutrient, high-calorie food. With further industrialisation, labour costs rise and the cheapest source of nutrition becomes factory-processed foods. There is then a shift of obesity burden from higher to lower SES.13

Heavily industrialised economies tend to be service-focused. Continued increases in labour costs and mechanisation of food production results in a diet transition from whole foods to ultra-processed high-calorie foods. Urbanisation and decreased focus on agriculture causes whole-food scarcity in cities and further exacerbates the shift to processed foods with long shelf lives. A transition to service-focused labour results in sedentary lifestyle. This, combined with urbanisation, pushes consumers towards convenience foods low in nutritional value and high in calories. There is a potential plateau of increasing obesity rates with industrialisation as medical intervention allows for the treatment of obesity. Costly bariatric surgery and recent introduction of weight-loss drugs allow for the negative impact of obesity to be curbed, though without treating the root causes.

Clinical relevance

The impact of obesity is significant across many levels of industrialisation and socioeconomic standing. Of the top seven most significant risk factors for reduction in DALY’s in 2021, four were closely related to overweight and obesity.11 Obesity significantly increases risks of cardiovascular disease (CVD) which is currently the leading cause of death by NCDs.14 Obesity is also closely tied to the development of type 2 diabetes which is set to impact approximately 15% of Americans by 2030.15 Obesity has also been shown to have links to some cancers and has musculoskeletal implications. During the COVID-19 pandemic, it became apparent that obesity had an impact on susceptibility to infectious diseases, and obese people were more likely to die from COVID that those with normal BMIs. This is of particular concern to emerging economies experiencing the double-burden effect as the impact of these diseases will be multiplied as obesity rises.16

 Economic relevance

The cost to the global economy in 2019 was estimated to be 2.19% global GDP ($1.94Tn) and is set to rise to 3.29% by 2060.17,18 Most of these costs are due to premature mortality rather than healthcare costs. The economic group to see the largest cost are UMICs, which may hamper their ability to industrialise and fully participate in the global economy (Fig. 4).17

How determining factors vary with economic development

Urbanisation

During industrialisation, city populations tend to increase, driven by availability of high paying jobs. As space becomes a premium this can result in an environment with little choice for spending leisure time outdoors, burning calories. Infrastructure including walking paths, cycle lanes and public transport require allocation of space in an expanding city to provide opportunities for residents to thrive. In the largest cities, long commute times have become commonplace. A study at University College London found that the average one-way commute to campus was 54 minutes, worsening time poverty and increasing reliance on convenience foods with poor nutrient profiles.19

Food availability

At different stages of industrialisation both the cost and quality of food can be highly variable. Emerging economies with agrarian settlements provide a variety of high-nutrient whole foods to the general population. These countries also tend to have cheaper labour costs and so the production costs of whole foods, even within larger settlements, make food relatively affordable. Processed foods here are comparatively more expensive due to the lack of production within the country and reliance on imports. As a nation industrialises, whole foods become more expensive due to increased labour costs and processed foods become cheap due to increased mechanisation. A food desert can occur in low-income urban environments in industrialised nations.20 Whole-food distributors resist establishing outlets in these areas due to perceived reduced profitability.21 There is also a high proportion of fast-food outlets in deprived areas.22 These obesogenic factors make it difficult for residents to make healthy decisions.

Sedentary lifestyle

The level of passively burned calories varies through stages of economic development. The mechanisation of labour and household tasks reduces the obesity-protective burning of passive calories.23 Convenience technologies increase leisure time, but this is often spent watching TV or using smartphones. In industrialised nations, the economy is service-focused and labour is far less physical with much of the workforce desk-bound. The normalisation of remote working following the covid pandemic has further exacerbated this effect.

Medical interventions

Emerging economies tend to have few resources for healthcare so the effects of obesity are felt more acutely than in industrialised economies.24 Clear advice on diet and physical activity can (but often does not) help. When it doesn’t, there are interventional options including bariatric surgery.25 In the UK approximately 10,000 weight loss operations are performed each year; this number is due to fall due to the introduction of weight loss drugs.26 Since 2022 these have been the primary route of treatment for obesity with approximately 1.6m people in the UK estimated to have used weight-loss drugs within the last year and a further 3.3m who would like to within the next year.27 These strategies are expensive and are not available in many emerging economies.

Figure 5: Summary table of changes and implications of emerging vs industrialised economies

Policy

Individual intervention

Whilst the emphasis on personal responsibility for obesity is waning, individual level policy can still prove effective. Education can guide individuals to make informed and healthy lifestyle decisions. The UK government supplies information on healthy eating (Fig. 6) and exercise (Fig. 7) which communicates healthy habits in a clear and accessible format.28,29

Figure 6: Eatwell guide showing dietary guidance, from Public Health England28

Figure 7: Physical activity guidelines from the UK

Department of Health and Social Care29

This information is clear and relevant and yet it is poorly adopted with less than 1 in 5 adhering to dietary advice.30 This highlights that responsibility lies not just in the individual but in the regulation of the obesogenic environment. One area of success on individual level is the promotion of park runs in the UK which have seen a near 300% increase in attendance in the last decade.31

Population

Policy decisions can create an environment in which healthy decision-making is easier. Taxation on high-risk foods can remove the financial incentive of unhealthy foods. Sugar tax in the UK led to a reduction of 11g in daily sugar consumption per adult, though this tax disproportionally impacts the poor.32 Clear food labelling can enable informed choices over the content of food improving healthy choices by around 18%.33 Restricting marketing of foods high in fat, salt or sugar (HFSS) has been implemented in the UK within the last year to protect children from influence of advertising. Though the policy has not been in place long enough to obtain data, it is clear that marketing has a strong impact on healthy food choices.33,35 In Japan there are remarkably low rates of obesity, for many reasons including food choices and physical activity.36 The Metabo law is Japanese policy which mandates the measurement of the waists of employees, utilising early lifestyle changes to stabilise obesity rates.37

 Environmental

Urban planning can direct the primary mode of transport. If investment is made in cycling infrastructure and public transport, residents can spend a larger portion of their day burning calories. In an agricultural setting, increased government intervention to reduce production costs can be linked to reduced obesity rates.38

 Challenges

Many of these policies require significant investment. Political pressure can cause governments to prioritise short-term gains – creating a healthcare model in which diseases are treated rather than prevented. The modern world is becoming less geopolitically and environmentally stable – causing health policy to be a lower priority across the globe.

Conclusion

So, is obesity an industrialised world inevitability? It is not. It is, however, the seemingly natural progression when combining the excess and convenience associated with modern capitalism and our ingrained tendency towards weight gain. Without policy interventions, obesity is likely to continue to plague societies as they transition through industrialisation.

References

  1. OʼRourke RW. Metabolic Thrift and the Genetic Basis of Human Obesity. Annals of Surgery. 2014 Apr;259(4):642–8.
  2. Hebert JR, Allison DB, Archer E, Lavie CJ, Blair SN. Scientific Decision Making, Policy Decisions, and the Obesity Pandemic. Mayo Clinic Proceedings. 2013 Jun;88(6):593–604.
  3. Tirthani E, Said MS, Rehman A. Genetics and Obesity. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK573068/
  4. Rito A, Buoncristiano M, Spinelli A, Salanave B, Kunešová M, Hejgaard T, et al. Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017. Obesity Facts. 2019;12(2):226–43. https://www.karger.com/Article/FullText/500425
  5. Park HK, Ahima RS. Endocrine disorders associated with obesity. Best Practice & Research Clinical Obstetrics & Gynaecology. 2023 Aug 1;90:102394 https://www.sciencedirect.com/science/article/abs/pii/S1521693423001025
  6. https://www.opencyclemap.org/. Copyright licence agreement; openstreetmap.org/copyright
  7. World Population Review. Largest Cities by Population 2024. Worldpopulationreview.com. 2024. https://worldpopulationreview.com/cities (Accessed February 2026)
  8. Jawad A, Reed E. Holding us back: tobacco, alcohol and unhealthy food and drink. 2021 Nov. https://ahauk.org/wp-content/uploads/2023/11/Holding-us-back-report-FINAL.pdf
  9. Malomo K, Ntlholang O. The evolution of obesity: from evolutionary advantage to a disease. Biomedical Research and Clinical Practice. 2018;3(2)
  10. Chong B, Jayabaskaran J, Kong G, Chan YH, Chin YH, Goh R, et al. Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019. eClinicalMedicine. 2023 Mar 1;57(101850). https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00027-5/fulltext
  11. Brauer M, Roth GA, Aravkin AY, Zheng P, Kalkidan Hassen Abate, Yohannes Habtegiorgis Abate, et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 1;403(10440):2162–203
  12. LDC Indicator Bar Chart | Economic Analysis and Policy Division. Un.org. 2018 [cited 2026 Feb 1]. https://policy.desa.un.org/themes/least-developed-countries-category/ldc-indicator-bar-chart (Accessed February 2026)
  13. Ford ND, Patel SA, Narayan KMV. Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annual Review of Public Health. 2017 Mar 20;38(1):145–64
  14. World Health Organization. Noncommunicable diseases. World Health Organization. 2024. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (Accessed February 2026)
  15. Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Population Health Management. 2017 Feb 1;20(1):6–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278808/
  16. Nyberg S. Adult obesity and risk of severe infections: a multicohort study with global burden estimates. The Lancet. 2026 Feb 9 [cited 2026 Feb 10];https://www.sciencedirect.com/science/article/pii/S0140673625024742
  17. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Global Health. 2022 Sep;7(9)
  18. World Bank Open Data. World Bank Open Data. 2015 https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?end=2024&start=1960&view=chart (Accessed February 2026)
  19. De Vos J. What makes a commute enjoyable: A duration close to the ideal, or far below the maximum tolerable? Travel Behaviour and Society. 2025 Oct;41:101095
  20. Beaulac J, Kristjansson E, Cummins S. A Systematic Review of Food Deserts, 1966-2007 Preventing Chronic Disease. 2009 Jun 15;6(3): A105. https://pmc.ncbi.nlm.nih.gov/articles/PMC2722409/
  21. USDA. Access to Affordable and Nutritious Food-Measuring and Understanding Food Deserts and Their Consequences: Report to Congress | Economic Research Service. Usda.gov. 2025.https://www.ers.usda.gov/publications/pub-details?pubid=42729 (Accessed February 2026)
  22. Maguire ER, Burgoine T, Monsivais P. Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990–2008. Health & Place. 2015 May;33(33):142–7
  23. Propper C. Why economics is good for your health. 2004 Royal Economic Society Public Lecture. Health Economics. 2005;14(10):987–97
  24. Giplaye H. Healthcare Delivery System in Developed, Developing and Underdeveloped Countries. Texila International Journal of Nursing. 2019 Apr 10;(2520-3126):95–101
  25. National Institute for Health and Care Excellence. Medicines and surgery | Overweight and obesity management | Guidance | NICE. Nice.org.uk. NICE; 2025 https://www.nice.org.uk/guidance/ng246/chapter/Medicines-and-surgery (Accessed February 2026)
  26. Byrne J. Severe obesity and current treatment in the UK: a call for radical reshaping of services. Bulletin of The Royal College of Surgeons of England. 2024 Sep 1;106(6):330–3
  27. Jackson SE, Brown J, Llewellyn C, Mytton O, Shahab L. Prevalence of use and interest in using glucagon-like peptide-1 receptor agonists for weight loss: a population study in Great Britain. BMC Medicine. 2026 Jan 8;24(1)
  28. Public Health England. The Eatwell Guide. Gov.uk. Public Health England; 2016. https://www.gov.uk/government/publications/the-eatwell-guide (Accessed February 2026)
  29. Department of Health and Social Care. Physical activity guidelines: adults and older adults. GOV.UK. 2019. https://www.gov.uk/government/publications/physical-activity-guidelines-adults-and-older-adults (Accessed February 2026)
  30. Office for Health Improvement & Disparities. National Diet and Nutrition Survey 2019 to 2023: report. GOV.UK. 2025. https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-2019-to-2023/national-diet-and-nutrition-survey-2019-to-2023-report (Accessed February 2026)
  31. Parkrun. results | parkrun UK. www.parkrun.org.uk. https://www.parkrun.org.uk/results/historicalchart/ (Accessed February 2026)
  32. Taylor L. UK sugar tax led to fall in consumption in children and adults. BMJ. 2024 Jul 10;386:q1518. https://www.bmj.com/content/386/bmj.q1518.full
  33. Cecchini M, Warin L. Impact of Food Labelling Systems on Food Choices and Eating behaviours: a Systematic Review and meta-analysis of Randomized Studies. Obesity Reviews. 2015 Dec 23;17(3):201–10. https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.12364
  34. The Scottish Government. Food and drink high in fat, sugar and salt – out of home advertising restrictions: rapid evidence review. Gov.Scot. The Scottish Government; 2025. https://www.gov.scot/publications/restrictions-out-home-advertising-food-drink-high-fat-sugar-salt-rapid-review-evidence-united-kingdom/pages/2/ (Accessed February 2026)
  35. Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutrition Reviews. 2012 Oct 4;70(10):571–93.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495296/
  36. L. Reynolds S, Hagedorn A, Yeom J, Saito Y, Yokoyama E, M. Crimmins E. A Tale of Two Countries – the United States and Japan: Are Differences in Health Due to Differences in Overweight? Journal of Epidemiology. 2008;18(6):280–90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013295/
  37. Ahmed SK, Mohammed RA. Obesity: Prevalence, causes, consequences, management, preventive strategies and future research directions. Metabolism Open. 2025 Jun 12;27:100375. https://www.sciencedirect.com/science/article/pii/S2589936825000313
  38. Loureiro ML, Nayga RM. International Dimensions of Obesity and Overweight Related Problems: An Economics Perspective. American Journal of Agricultural Economics. 2005 Dec;87(5):1147–53