In public health, our focus is on the “social determinants of health,” the social and environmental factors that are generally outside of the individual’s control, but that impact our ability to thrive physically, mentally, emotionally and socially.  They can include socio-economic status, racism, sexism, size-ism, immigration status, educational opportunities and more.  While public health may be part of or involved in encouraging and helping people to change their individual behaviors or lifestyle, we know that we will not be successful in improving population health in the long-term unless we improve the underlying social determinants.

Social determinants can impact individual health primarily through two pathways: access and chronic stress.  People with few resources and/or dealing with barriers such as racism, poverty, immigration status, anti-fat bias or homophobia have less access to things like:

• Preventive and stable ongoing health care
• Culturally appropriate health care
• Quality education
• An affordable variety of foods
• Time and resources for regular physical movement
• Stable, living-wage employment
• Safe and stable housing

In addition to the high cost of these drugs, the WHO document repeatedly refers to the need for a “capacitated” or fully functional health system in order to maintain ongoing treatment. This would include “supporting governance, training of health workers, monitoring and evaluation, referral systems, procurement and supply chain, and financial coverage.” Realistically, this would only be available to a privileged minority of the world’s population. It is definitely not a widespread option in the U.S. healthcare system.

Secondly, when a person is dealing with the above issues on a consistent basis, the stress response is constantly activated.  This results in harmful health impacts from elevated cortisol and adrenaline, such as cardiovascular dysfunctions, diabetes, cancer, depression and anxiety (Mariotti, 2015).  (Also see Stress 101.)  Research shows that when controlling for exposure to weight stigma (a chronic stressor), the association between weight and health is reduced.

With all of the inequities in our world at this time, it seems misplaced for the WHO to be focusing on access to weight-loss drugs, rather than access to the above social and environmental determinants of health.  A more “upstream” public health approach would concentrate time and resources to solving the pressing issues that create so much of the chronic stress that harms health, such as reliable access to food and shelter, capacitated health systems, education and employment.  This also includes the chronic stress that results from weight stigma and that plays a role in the negative health outcomes that the WHO attributes to body size.

1. We do not directly link to items that we feel are harmful and/or misleading. Generally, a quick online search will get you to this information, if you want.  We want people to feel confident and safe when clicking through the links on this website.
2. In 2025, the Novo Nordisk Foundation, which owns a controlling interest in Novo Nordisk, pledged $57 million to the WHO to help the organization cover the deficit that will happen when the U.S. withdraws its support in 2026. (“Novo Nordisk Foundation Pledges $57 Million to WHO amid US Funding Gap,” 2025)
3. In February 2026, the FDA sent a letter to Novo Nordisk, maker of Wegovy, a letter warning them about false and misleading advertising. https://www.fda.gov/media/191020/download?attachment