Unlike many health challenges, obesity and cardiometabolic disease aren’t primarily solved in the consulting room. Preventing them calls for a multi-sectoral approach.
We are used to thinking of doctors and nurses as the guardians of our health. But in reality, even those with a well-resourced health system spend little time with a health professional. Consider the numbers. In Germany, where global health experts gather this week for the World Health Summit, people spend more time with a doctor than the European average, but still only about an hour a year. In Bangladesh, the average consultation is estimated to last under a minute.
No longer "rich" nations' disease
The main factors shaping our health are the food we eat, access to parks and other green spaces, and whether we are physically active. We’re not doing too well on many of these fronts. Obesity - a significant driver of cardiometabolic disease - is a worldwide health challenge and is no longer just a problem for developed economies. According to WHO, in 2022 more than 1 billion people were living with obesity, including 160 million children and adolescents aged 5–19. If current trends continue, the global cost of treating obesity-related disease is projected to reach US$3 trillion per year by 2030.
These numbers are rising fastest in low- and middle-income countries, least equipped to absorb the cost of treating chronic disease. In Bangladesh, for example, WHO reports that obesity among adults increased 17-fold between 1975 and 2016, with health policy makers attributing it, at least in part, to a rise in sugar consumption.
All-of-society approach
As WHO puts it, the “factors driving obesity are many and complex - deeply embedded in social, environmental and governance systems.” In simple terms: agriculture affects what gets produced, schools affect what children eat and how much they move, planning and transport affect the food environment and whether people can walk, cycle and play safely, finance ministries control taxation, health systems identify and treat risk.This division of responsibility calls for a united effort across these sectors and systems that shape our health every day of the year.
When everyone has a stake, there is a danger that no one is accountable.
That is the crux of the argument for multisectoral collaboration, and the reason WHO's Acceleration Plan to Stop Obesity calls for an all-of-society approach to reversing the rise in overweight and obesity, "a social movement," rather than a series of government interventions. This is also where the WHO Foundation plays a role. WHO provides countries with the evidence, guidance and frameworks to tackle the rise in obesity and cardiometabolic disease. Turning that guidance into action requires governments, health systems, civil society, philanthropy and the private sector to move together.
That was the purpose of Living Healthier for Longer – An Open Dialogue on Cardiometabolic Prevention, co-hosted by the WHO Foundation and Novo at this year’s World Health Summit. It brought leaders from across sectors together — including the Cities for Better Health Program — to examine what is working, how collaboration helps, where inequities persist, and what it will take to scale effective solutions.
Prevention through cross-sector collaboration
A well-documented, successful example of cross-sector collaboration is Finland’s North Karelia project. It brought together health services, farmers, food manufacturers, schools and community organizations to prevent heart disease. Food producers reduced saturated fat and salt, schools and workplaces improved meals, and health services strengthened blood pressure screening. As prevention expanded nationally, deaths from coronary heart disease among middle-aged adults fell by 84% between 1972 and 2014, largely reflecting lower cholesterol, blood pressure and smoking, alongside improved treatment. The lesson for cardiometabolic prevention is clear: collaboration works when it changes everyday conditions and makes healthier choices easier.
Evidence also shows that people take advantage of policy moves to make it safer, cheaper or easier to exercise. In Paris, for example, when the number of safe cycle lanes increased, bicycle use rose by more than 50% - activity that has been shown to drive down rates of obesity, cardiovascular disease, cancer and Type 2 Diabetes.
Latin America is a pioneer in mandatory front-of-pack labeling of food products. Research suggests the practice has led to producers in Peru altering their recipes to reduce the quantities of sugar, salt and fat in ready-made foods. In Chile, the warning labels have proven to effectively reduce sales of these products.
Eswatini (formerly Swaziland), where obesity rates are rising, shows what a comprehensive approach looks like. With support from WHO's Acceleration Plan, the country has launched its first national cross-sectoral obesity roadmap, focusing on physical activity, early childhood nutrition, food in schools, neighborhood meal zones for orphaned children, and a tax on sugary soft drinks. The goal is to cut overweight and obesity across all age groups from 27% in 2023 to 19% by 2030.
A question of equity
Any discussion of cardiometabolic disease is contested ground. Surely, the skeptic says, people could simply choose better lifestyles.
Some could. But the playing field is not level. You can't easily exercise in a park if the neighborhood that has one is beyond your rent. A cheap, calorie-dense meal is often easier to find, pay for, and prepare than a bag of vegetables. The idea that obesity is purely an individual's responsibility, rather than one that involves governments and wider society, is part of what holds progress back. Equity and access considerations need to be built into every effort to tackle heart disease, stroke, diabetes and obesity.
The road ahead
Many cardiometabolic diseases can be prevented or delayed. By working across sectors, we can slow disease progression, improve quality of life and extend our healthy years. The benefits of long-lasting health return to our communities as social and economic gains, not simply savings for a government or health insurer. Collaboration is the starting point. The end goal is a more equitable, healthier lifespan for each of us.
