Obesity as a chronic multifactorial disease: public health challenges, development mechanisms, and modern approaches to intervention

Introduction

Obesity has long ceased to be just a consequence of an “unhealthy lifestyle”. Today it is considered a chronic, relapsing disease, formed under the influence of biological, behavioral, social and environmental factors. In the 21st century, obesity has become one of the key threats to public health systems in the world.

According to the World Health Organization, in 2022, more than 890 million adults worldwide were living with obesity. This condition significantly increases the risk of developing cardiovascular disease, type 2 diabetes, some cancers, and reduces the length and quality of life. In addition to the medical consequences, obesity places significant economic pressure on national health systems.

Approach to problem analysis

This article is based on a review of current scientific publications on the epidemiology, pathogenesis, prevention, and treatment of obesity. The focus is not only on clinical aspects, but also on the significance of the problem for public health and public policy.

The analysis includes scientific papers from 2005–2025, as well as strategic and advisory documents from the World Health Organization.

Epidemiology of obesity: global scale

The global prevalence of obesity has more than doubled since 1990. The increase is particularly rapid in low- and middle-income countries. This is due to:

• transformation of food systems;
• the increasing availability of ultra-processed foods;
• urbanization;
• a decrease in the level of physical activity.

Thus, obesity ceases to be a “disease of affluence” and becomes a universal social challenge.

Pathophysiological mechanisms: more than just excess calories

Modern science views adipose tissue not as a passive energy depot, but as an active endocrine organ. It produces adipokines, hormones, and pro-inflammatory mediators that affect the metabolism of the entire body.

Key mechanisms for the development of obesity include:

• chronic low-level inflammation;
• neuroendocrine dysregulation of appetite and satiety;
• intestinal microbiota disorders;
• disruptions in circadian rhythms (sleep, light, diet).

This explains why simple recommendations to “eat less and move more” often prove ineffective in the long term.

Modern therapeutic strategies

Pharmacotherapy

Over the past decade, obesity treatment has made significant progress. Of particular interest are the new generation of drugs:

• GLP-1 receptor agonists (in particular semaglutide);
• dual GIP/GLP-1 agonists such as tirzepatide.

These drugs demonstrate unprecedented results in weight loss and improved metabolic performance, changing the approach to the medical treatment of obesity.

Bariatric surgery

For patients with severe obesity, bariatric surgery remains the most effective treatment. It provides not only sustained weight loss but also long-term metabolic benefits, including remission of type 2 diabetes.

Prevention at the public health level

No single therapy can stop the obesity epidemic without population-based prevention measures. Key strategies recommended by the WHO include:

• taxation of sugary drinks;
• restricting the marketing of unhealthy foods to children;
• creating an urban environment that encourages physical activity;
• educational programs on food literacy.

Obesity is not just an individual choice, but a result of the environment in which a person lives.

Discussion: between biomedicine and politics

Combining biomedical innovation with effective public health policies offers a real opportunity to reduce the burden of obesity. However, critical questions remain:

• availability of modern drugs;
• their cost;
• long-term effectiveness and safety;
• social inequality in access to treatment.

Without systemic solutions, these factors can limit the potential impact of even the most effective interventions.

Analysis limitations

The material is review-based and based on narrative data synthesis, which poses a risk of publication bias. Further systematic reviews and meta-analyses are needed to form more rigorous evidence-based recommendations.

Conclusions

Obesity is a complex, multifaceted public health challenge that can only be effectively addressed through the integration of preventive policies, modern pharmacotherapy, and surgical treatments.

Without a comprehensive approach, obesity will continue to be one of the key threats to public health in the 21st century.

Authors:

Lyevda T.V., Gyhko A.P., Vygovskyy V.E., [Yarosh О.К.]