The path toward a metabolic health revolution

At a glance

• Nearly 900 million adults around the world are living with obesity, which is a substantial risk factor for at least 20 diseases or conditions that include diabetes, cardiovascular conditions, and brain health disorders. The McKinsey Health Institute (MHI) estimates that obesity will be linked to $2.76 trillion in lost gross domestic product in 2050 due to its effects on labor force participation and productivity.
• The rise of GLP-1s is shifting the discussion of obesity from an intractable issue to a treatable medical condition—a change that is inspiring investment and innovation across industries, including healthcare, medtech, food, and retail.
• Society has two possible paths forward. It can react to obesity by emphasizing medical treatment and weight management drugs, or it can also pursue a broader vision that prioritizes prevention, societal shifts, and metabolic health for all. MHI estimates that the health impact of taking the latter path can be three to four times that of the first path and could lead to a $5.65 trillion annual GDP uplift in 2050 (3 percent of total GDP).
• Achieving metabolic health for all requires five major shifts: (1) advancing scientific understanding of metabolic health, (2) improving transparency through better measurement and tracking, (3) using technology for personalized interventions, (4) aligning economic incentives to make metabolic health more investable, thereby making healthy choices easier and more affordable, and (5) driving societal change through education and community engagement.
• As a first step, MHI proposes that metabolic health be elevated in priority to emphasize preventing chronic disease before it takes hold, enabling better health for all and advancing economies.

Widespread obesity has become a significant public health issue over the past 50 years, with nearly 900 million adults today living with obesity around the world. Obesity increases the risk of diseases like type 2 diabetes, cardiovascular disease, cancers, dementia, and depression. Its root causes are complex and interconnected—including sedentary lifestyles, high-calorie diets, genetics, socioeconomic conditions, and environmental influences. The health and economic impacts of obesity are significant. Six and a half billion years of life will likely be lost globally due to premature deaths caused by obesity’s health effects. The annual obesity-attributable disease burden is 132 million disability-adjusted life years (DALYs), comparable to the burden of all chronic respiratory diseases. Economically, it could be linked to $2.76 trillion in lost GDP each year in 2050.

New weight management drugs, such as GLP-1 receptor agonists, offer new opportunities but also many uncertainties. While data has shown that these medications can be effective at helping individuals lose weight, questions remain about the long-term sustainability, broader benefits, side effects, and behavioral changes associated with these drugs.

This report first explores the issue of obesity, including its prevalence, causes, and health and economic impacts, as well as the emerging role of new weight management drugs. “Section 2: Impact of GLP-1s on all sectors” provides an analysis of the potential impacts of new weight management drugs on different industries. Section 3 challenges stakeholders to think beyond obesity, broadening the lens to metabolic health for all. Decision makers face a choice between path 1 (which focuses on treating obesity without addressing root causes) and path 2 (which focuses on a holistic approach to metabolic health, including prevention and treatment).

Enabling path 2 will require changes across industries that include food, environmental, and social systems. Achieving it demands investment and innovation in five key areas: advancing metabolic health science, improving transparency through better measurement, developing supportive technologies, aligning economic incentives to make metabolic health investable, and empowering communities equitably.

The McKinsey Health Institute invites leaders to consider whether the bold, collective effort of path 2 is worth the investment and risk to achieve a healthier, more equitable future for all.

The approval of weight management drugs such as glucagon-like peptide-1 receptor agonists (GLP-1s) and glucose-dependent insulinotropic polypeptide receptor agonists (GIPs) has expanded the discussion around obesity beyond public health, positioning it as a key economic, societal, and technological priority.¹In this report, the abbreviation “GLP-1s” includes GLP-1 receptor agonist drugs, as well as other combination therapies such as dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) drugs, recognizing that new modalities of drugs may emerge in the future. Obesity is one of the largest human-made epidemics in history. Widespread obesity at a population level has been a relatively recent phenomenon, emerging as a significant public health concern during the last 50 years. As of 2022, one in eight people worldwide was considered to have obesity, totaling 890 million adults.²“Obesity and overweight,” World Health Organization (WHO), March 1, 2024. Global prevalence is trending upward; it has more than doubled in high-income countries and more than tripled in middle-income countries since 1990. Obesity rates are growing unequally worldwide, with lower-income countries demonstrating the highest growth rates in obesity between 2017 and 2022 (Exhibit 1).³In lower-income countries, the double burden of malnutrition is also a serious concern, characterized by the coexistence of undernutrition alongside overweight or obesity. Furthermore, childhood and adolescent obesity is also on the rise, with the prevalence of obesity in children and adolescents tripling between 1990 and 2021.⁴Jessica Kerr et al., “Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021,” The Lancet, March 2025, Volume 405, Issue 10481.

With nearly 900 million adults living with obesity worldwide, the world’s population is effectively carrying an excess 25 billion kilograms⁵Calculated by multiplying the average excess weight per person by the number of people in each class of obesity/overweight. Number of people in each class estimated from WHO obesity prevalence rates. —the equivalent of 700 times the gold reserves in central banks, 75 times the mass of the Empire State Building, or four times the mass of the Great Pyramid of Giza⁶Gold reserves weighed 35,939 tons as of February 2025. Gold Reserves by Country, World Gold Council, 2025. The Empire State Building weighs 365,000 tons. “Facts & figures,” Empire State Building website. The Great Pyramid of Giza weighs about 12 billion pounds, or more than five billion kilograms. “Frequently asked questions about the Great Pyramid and Giza,” Mused. —as a liability for future physical, mental, social, and spiritual health.

The causes of obesity are complex and still being studied, but recent GLP-1 clinical trials show promising outcomes for weight loss, as well as reduced risks of major cardiovascular events⁷Hamza Irfan, “Obesity, cardiovascular disease, and the promising role of semaglutide: Insights from the SELECT trial,” Current Problems in Cardiology, January 2024, Volume 49, Issue 1. or kidney issues⁸Helen M. Colhoun et al., “Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial,” Nature Medicine, May 25, 2024, Volume 30. in patients living with obesity. The unprecedented attention to obesity across industries invites a broad question: Are global upward trends in obesity prevalence as inevitable as they seem, and if so, what factors could change that?⁹This report focuses on global trends in obesity and the potential impact of new medications. The authors recognize the evolving nature of GLP-1s and sensitive discussion around weight loss at an individual and population level, including around body mass index as a metric (see sidebar “Terminology”). McKinsey and the McKinsey Health Institute do not provide clinical or medical advice about obesity treatment.

Obesity is complex and associated with other conditions and diseases

Obesity is an extraordinarily complex condition or disease,¹⁰This report refers to obesity as a condition, recognizing that international discussion on the classification of obesity is contentious. Leading groups such as the World Health Organization and World Obesity Federation classify obesity as a disease, while numerous health systems do not (or do not yet). For an important contribution to this debate, see Francesco Rubino et al., “Definition and diagnostic criteria of clinical obesity,” The Lancet Diabetes and Endocrinology, January 2025, Volume 13, Issue 3. with many interrelated causes and risk factors. The condition develops from an interplay of biological, environmental, socioeconomic, psychological, and behavioral factors.¹¹Beenish Masood and Myuri Moorthy., “Causes of obesity: A review,” Clin Med (Lond), July 2023, Volume 23, Issue 4; Sophie Metcalfe and Tom Sasse, Tackling obesity: Improving policy making on food and health, Institute for Government, April 2023; Mahmood Safaei et al., “A systematic literature review on obesity: Understanding the causes and consequences of obesity and reviewing various machine learning approaches used to predict obesity,” Computers in Biology and Medicine, September 2021, Volume 136. Some factors can be considered modifiable, including physical inactivity, use of some medications, and food/caloric intake. However, many factors that contribute to obesity are not easily modifiable, including genetic predisposition and socioeconomic and environmental factors that affect the availability and quality or type of food.¹²Kristen Cooksey-Stowers, Marlene B. Schwartz, and Kelly D. Brownell, “Food swamps predict obesity rates better than food deserts in the United States,” International Journal of Environmental Research and Public Health, November 2017, Volume 14, Number 11; Alexandra Lee, Michelle Cardel, William T. Donahoo, “Social and environmental factors influencing obesity,” Endotext, October 12, 2019. Some research highlights that maternal health plays a critical role in shaping obesity risk later in life. Poor maternal nutrition or obesity can program metabolic dysfunction in offspring through epigenetic mechanisms, influencing lifelong susceptibility to obesity, diabetes, and cardiovascular disease.¹³Ezgi Şanlı and, Seray Kabaran, “Maternal obesity, maternal overnutrition and fetal programming: effects of epigenetic mechanisms on the development of metabolic disorders,” Current Genomics, September 2019, Volume 20, Issue 6. Obesity has often—and inaccurately—been considered a result of individual life choices. This narrow characterization is harmful and impedes effective treatment of the condition. People of all backgrounds and health statuses can experience obesity, driven by a unique combination of factors. While a new class of drugs may make the condition more treatable, these medications are not panaceas that will work for every individual. They need to be used in combination with other interventions to effectively shift obesity rates.

Obesity has impacts on an individual’s physical health across multiple organ systems and is a known risk factor for at least 20 diseases or conditions.¹⁴Approximately 20 known health risks of overweight and obesity are officially noted by the NIH in the US and the NHS in the UK. Some resources have noted that obesity can be associated with over 200 diseases or comorbidities (for example, the American Medical Association). Further research is required to quantify this figure. Elevated body mass index (BMI)¹⁵While body mass index (BMI) is the common metric used to measure overweight and obesity, it has limitations. For details, see sidebar “Terminology.” was associated with an estimated 3.7 million deaths from noncommunicable diseases (NCDs) globally in 2021,¹⁶“Obesity and overweight,” World Health Organization (WHO), March 1, 2024. two-thirds of which were due to cardiovascular disease.¹⁷The GBD 2015 Obesity Collaborators, “Health effects of overweight and obesity in 195 countries over 25 years,” New England Journal of Medicine, 2017, Volume 377, Number 1. High BMI is also an important modifiable risk factor for cancer,¹⁸Hyuna Sung et al., “Global patterns in excess body weight and the associated cancer burden,” CA: A Cancer Journal for Clinicians, March 2019, Volume 69, Issue 2. and it substantially increases the chance of developing type 2 diabetes.¹⁹“Obesity,” Cleveland Clinic, June 13, 2022. Ongoing clinical research is exploring the relationship between obesity and brain health (mental and neurological conditions) and women’s health.²⁰Gregor Alexander Rindler, Anna Gries, and Wolfgang Freidl, “Associations between overweight, obesity, and mental health: A retrospective study among European adults aged 50,” Frontiers in Public Health, July 2023, Volume 11; Cornelia Leontine van Vuurenet al., “Associations between overweight and mental health problems among adolescents, and the mediating role of victimization,” BMC Public Health, May 2019, Volume 19; Christine Emmer, Michael Bosnjak, and Jutta Matta, “The association between weight stigma and mental health: A meta-analysis,” Obesity Reviews, September 2019, Volume 21, Number 1; Phillipe O'Brien et al., “Neurological consequences of obesity,” The Lancet Neurology, June 2017, Volume 16, Number 6; “Obesity and cancer,” Centers for Disease Control, November 7, 2023; Sukanya Pati et al., “Obesity and cancer: A current overview of epidemiology, pathogenesis, outcomes, and management,” Cancers (Basel), January 2023, Volume 15, Number 2; Thomas Barber and Stephen Franks, “Obesity and polycystic ovary syndrome,” Clinical Endocrinology, January 2021, Volume 95, Number 4; Liu Yong, Zhang Weiyuan, “Association between body mass index and endometriosis risk: A meta-analysis,” Oncotarget, January 2017, Volume 8, Number 29. Notably, obesity affects men and women differently, with variations in fat distribution, metabolic consequences, and treatment responses. For instance, women tend to have higher obesity-related risks for conditions like type 2 diabetes²¹Alexandra Kautzky-Willer, Jürgen Harreiter, and Giovanni Pacini, “Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus,” Endocrine Reviews, June 2016, Volume 37, Issue 3. and cardiovascular disease,²²Peter W. F. Wilson et al., “Overweight and obesity as determinants of cardiovascular risk: The Framingham experience,” Archives of Internal Medicine, September 2002, Volume 162, Issue 16. while men may experience greater visceral fat accumulation, which is linked to higher mortality risk.²³Andromeda Nauli and Sahar Matin, “Why do men accumulate abdominal visceral fat?” Frontiers in Physiology, December 2019, Volume 10. Further research is needed to understand how the impacts of obesity may differ across other individual factors that may include gender, genetics, or age.

Obesity can also affect an individual’s mental, social, and spiritual health, as it often leads to stigma and discrimination in many cultures. Obesity has long been considered a “choice,” wherein individuals “lack control” with food consumption or are “too lazy” to exercise. Studies have shown that people with obesity are discriminated against in both healthcare and workplace settings, with tangible effects. People with obesity are more likely to receive lower-quality care than people without obesity, due to strong negative provider perceptions.²⁴S. M. Phelan et al., “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity,” Obesity Reviews, March 2015, Volume 16, Number 4. This leads to individuals with obesity being less likely to seek care and less likely to trust and adhere to the care they receive.²⁵S. M. Phelan et al., “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity,” Obesity Reviews, March 2015, Volume 16, Number 4. Discrimination in the workplace manifests as people with obesity being less likely to be hired and promoted,²⁶Stuart W. Flint et al., “Obesity discrimination in the recruitment process: ‘You’re not hired!’” Frontiers in Psychology, May 2016, Volume 7, Number 647; Jay Bhattacharya and M. Kate Bundorf, “The incidence of the healthcare costs of obesity,” Journal of Health Economics, May 2009, Volume 28, Issue 3. which can then affect their socioeconomic status. In turn, the stress resulting from stigma and discrimination can further increase an individual’s risk of obesity, reinforcing the cycle²⁷Melody Fulton, Sriharsha Dadana, and Vijay N. Srinivasan, “Obesity, stigma and discrimination,” StatPearls, October 26, 2023. (Exhibit 2).

The disease burden of obesity on individuals with the condition and on society at large is substantial. A typical adult living with obesity today can expect to live approximately 35 years with the condition,²⁸Calculated by dividing the total expected years that the global adult population with obesity would live with the condition by the total population with obesity (2019 data). in addition to common comorbidities. In total, more than 132 million DALYs annually are attributable to high BMI, equivalent to the annual burden of all chronic respiratory diseases (108 million DALYs)²⁹IHME Global Burden of Disease, 2021 data. and about half of the annual burden for all cancers (252 million DALYs) ³⁰IHME Global Burden of Disease, 2021 data. (Exhibit 3). For context, this is equivalent to three times the estimated DALYs burden of the global COVID-19 pandemic (43 million DALYs between January 2020 and April 2021).³¹Chiao-Yun Fan et al., “Estimating global burden of COVID-19 with disability-adjusted life years and value of statistical life metrics,” Journal of the Formosan Medical Association, June 2021, Volume 120, Issue 1. Data collected until April 2021. If obesity were to be eliminated as a global public health concern, an extra 6.5 billion years of life could be gained globally.³²IHME Global Burden of Disease 2021 data was used to calculate the expected individual average life expectancy difference for individuals with high BMI and individuals without (per five-year age category). The potential to gain 6.5 billion years is the sum-product of the life expectancy difference per age category, multiplied by the total population per age category. Calculations assumed the 2021 population.

At an individual level, moderate obesity can reduce one’s life expectancy by about three years, while severe obesity can reduce life expectancy by about ten years.³³Prospective Studies Collaboration, “Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies,” The Lancet, March 2009, Volume 373, Issue 9669. Moderate obesity is defined as BMI of 30 to 35. Severe obesity is defined as BMI of 40 to 50. For comparison, cigarette smoking reduces life expectancy from seven to 10 years.³⁴Martinette T. Streppel et al., “Mortality and life expectancy in relation to long-term cigarette, cigar and pipe smoking: The Zutphen study,” Tobacco Control, April 2007, Volume 16, Issue 2; Prospective Studies Collaboration, “Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies,” The Lancet, March 2009, Volume 373, Issue 9669.

Beyond the impact on quality of life and the disease burden, obesity also has an economic impact. Addressing the obesity-related disease burden could lead to an estimated GDP impact of $2.76 trillion every year globally in 2050,³⁵Based on calculations using GDP (using constant prices and exchange rate, with reference year 2022) per employed individual, YLDs and deaths associated with high BMI by age and country. The model does not consider any adjustments (other than labor force participation rate and unemployment rate) and assumes all other factors that might affect this amount remain constant. These estimates represent the GDP uplift of better health through workforce additions, meant to illustrate what would be at stake if high-BMI or metabolic risk disease burden were non-existent, assuming all else equal. It does not take into consideration the impact trade-offs to make this happen. Other organizations (e.g., World Obesity Federation) have used different methodologies, including the consideration of direct medical costs from high BMI. roughly equivalent to the current GDP of Switzerland or Poland, primarily driven by increased labor force participation and productivity.

Data shows that novel weight management drugs are effective, but many aspects need clarification through further research

GLP-1s are a class of drugs that were originally developed for type 2 diabetes and have now demonstrated effectiveness in clinical trials to help individuals living with obesity lose weight. While effectiveness varies, individuals have typically experienced greater than 10 percent weight loss, with some losing more than 20 percent from their baseline weight.³⁶Gretchen E. White et al., “Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study,” Obesity (Silver Spring), February 2023, Volume 31, Issue 2; Areesha Moiz et al., “Long-term efficacy and safety of once-weekly semaglutide for weight loss in patients without diabetes: A systematic review and meta-analysis of randomized controlled trials,” American Journal of Cardiology, July 1, 2024, Volume 222.

GLP-1 drugs mimic the action of the natural GLP-1 hormone, which is produced in the gut in response to eating. GLP-1 normally functions to slow gastric emptying, increase insulin production, and increase satiety, that is, the feeling of fullness (for further details, see sidebar “More about GLP-1 drugs”).³⁷Arne Astrup, “Reflections on the discovery GLP-1 as a satiety hormone: Implications for obesity therapy and future directions,” European Journal of Clinical Nutrition, June 18, 2024, Volume 78. Therefore, GLP-1 and drugs that mimic the effect of GLP-1 in the body increase the feeling of fullness and slow the processing of food, contributing to weight loss.

Beginning in the mid-2000s, the insulin-stimulating properties of GLP-1 drugs—including brand names such as Byetta (exenatide), Victoza (liraglutide), Ozempic (semaglutide), and Mounjaro (tirzepatide)—led to their approval for type 2 diabetes management. More recently, GLP-1 drugs have also been approved for weight loss. The drugs approved for weight loss, including the brand names Saxenda, Wegovy, and Zepbound, use the same active ingredients as those for diabetes management, with some at different dosages.³⁸This report uses Mounjaro as the brand name for tirzepatide for diabetes treatment and Zepbound as the brand name for tirzepatide for obesity treatment. In some jurisdictions, Mounjaro is the brand name for both diabetes and obesity treatment. While effective for weight loss, GLP-1 drugs can have multiple adverse effects, including severe nausea and dizziness, which have resulted in some people being unable to continue treatment.³⁹Reema Mody et al., “Adherence, persistence, glycaemic control and costs among patients with type 2 diabetes initiating dulaglutide compared with liraglutide or exenatide once weekly at 12-month follow-up in a real-world setting in the United States,” Diabetes, Obesity and Metabolism, April 2019, Volume 21; Christopher K. Rayner et al., “Gastrointestinal adverse events with insulin Glargine/Lixisenatide fixed-ratio combination versus glucagon-like peptide-1 receptor agonists in people with type 2 diabetes mellitus: A network meta-analysis,” Diabetes, Obesity and Metabolism, January 2021, Volume 23, Issue 1. In addition, the rapid weight loss can be associated with other physical consequences, such as loss of muscle mass.⁴⁰Carla M Prado et al., “Muscle matters: The effects of medically induced weight loss on skeletal muscle,” The Lancet Diabetes & Endocrinology, November 2024, Volume 12, Issue 11.

As of February 2025, the number of GLP-1 drugs has increased, with 11 on the market for diabetes and weight loss combined and over 40 in the pipeline.⁴¹“GLP-1 pipeline update table,” Prime Therapeutics, February 2025, accessed March 19, 2025. While only Wegovy (semaglutide), Saxenda (liraglutide), and Zepbound (tirzepatide) have been approved for weight loss, the entrance of multiple new drugs, particularly generic versions, and new modes of delivery will pave the way to a rapidly growing treatment landscape (Exhibit 4).

GLP-1 drugs are still a relatively new drug class, especially when used for weight loss, so evidence on long-term effectiveness, secondary effects, and side effects is still emerging. Also still evolving is our understanding of the potential impacts of GLP-1 drugs on other body systems or for treatment of other diseases (for example, cardiovascular disease, kidney disease). Further research will be required to clarify the true, longer-term impacts and risks of GLP-1s. Moreover, questions of access and equity are important considerations that will affect their potential adoption and population-level health impacts.

A new class of weight management drugs not only offers individuals a path to lead healthier lives but also gives all stakeholders a chance to create financially viable solutions, encouraging greater economic activity and investment in health. Since 2021, leading pharmaceutical companies involved in the production of GLP-1s targeting obesity have experienced between 135 and 250 percent increases in market capitalization, partly reflecting the market's response to the anticipated impact of GLP-1s.⁴²Analysis focuses on Eli Lilly and Novo Nordisk as the only companies with approved GLP-1 drugs as of October 2024. Market capitalization data is taken from publicly available sources. Additionally, GLP-1s are attracting interest outside of pharmaceutical companies. Analysis of fourth-quarter 2024 earnings transcripts of 30 US and EU pharmaceutical and consumer staples companies showed 144 mentions of “GLP-1,” “obesity,” or “weight loss product”—10 percent more than in the previous year.⁴³Analysis of fourth-quarter 2024 and fourth-quarter 2023 earnings call transcripts from the 15 largest EU and US pharma companies by market capitalization and the 15 largest EU and US consumer staples companies by market capitalization, based on publicly available data.

This section explores the relevance of obesity for and potential impacts of GLP-1s on key stakeholder groups: individuals, pharmaceutical companies, primary and secondary healthcare providers, medtech companies, payers, employers, wellness companies, and food and consumer companies. Obesity and its health effects, as well as the increasing adoption of GLP-1s, are highly relevant to each group of stakeholders. The potential impact of GLP-1s is based on analysis of current consensus scenarios for GLP-1 uptake and effectiveness from leading financial analysts at major banks (see sidebar “Calculation of stakeholder impact”).⁴⁴This report does not focus on market reactions or analyst forecasts, nor should it be considered a definitive and predictive forecast of potential impacts. The discussion on GLP-1 medications is evolving. This report does not speculate on a maximalist scenario of adoption, nor should it be interpreted as recommending any clinical treatment for obesity.

Many industries are affected by obesity, its causes, or its consequences (Table 1). Every chief executive officer or public-sector leader needs to consider the implications of new weight management drugs on their business and portfolios.

The arrival of GLP-1s as an effective tool for weight loss has pushed societal discourse toward recognizing that obesity is a treatable chronic condition. A much larger question follows: Could society muster the leadership, energy, and resources to reverse—and even eventually eliminate—obesity as a global public health concern? Can we capture the full health and economic benefits to individuals, societies, and businesses?

Two alternative paths: Reduce obesity or achieve metabolic health for all

Assuming that the global attention on obesity is not a passing fad, society is at a fork in the road, with two paths to choose from. Both will improve human health, but at very different scales. Path 1 will follow the trail of innovation initiated by weight management drugs with a promise to help improve the health and lives of people currently living with obesity. Path 2 is the big climb toward a metabolic health revolution. Rather than reacting to obesity on a case-by-case basis, stakeholders on this path work together to prevent obesity and its related health problems at a societal level. On this path, society tackles metabolic health comprehensively by addressing obesity along with multiple, interconnected systems such as cardiovascular health, kidney function, and markers such as cholesterol and blood sugar. The health improvements at play on the second path are much larger, requiring significant cross-sector action (Table 2).

Research suggests that path 2 could generate up to 3.5 times the health impact of path 1, with the global disease burden associated with metabolic risk factors being 469 million DALYs annually (Exhibit 5).⁴⁵Calculated using burden of disease attributed to high BMI (path 1, 132 million DALYs) and all metabolic risk factors (path 2, 469 million DALYs), respectively. It could also eventually lead to a $5.65 trillion GDP uplift in 2050, representing about 3 percent of global GDP. On both paths, equity and access considerations are crucial to ensure that the benefits of these advancements are accessible to all, as groups from lower socioeconomic backgrounds often face greater barriers to both pharmacological treatment and preventive interventions. Addressing disparities through equitable policies that expand access to treatment while investing in systemic changes like improved food environments and public health initiatives is essential for achieving true metabolic health for all.

Path 1: Follow the trail of emerging innovation to reduce obesity

The advent of weight management drugs is already sparking additional innovation in medicine, technology, healthcare, and more. Effective investments will yield ever-better tools to support individuals with obesity and capture the benefits of weight loss. Innovation may improve the management of obesity but fail to sufficiently address the underlying drivers of obesity. On this path, society would continue to respond to obesity after it occurs and focus on treating its symptoms, rather than preventing it and its broader impacts. There are likely to be additional generations of weight management drugs with new accompanying interventions to curtail obesity globally. Making this happen will require only limited structural changes.

Path 2: The big climb to metabolic health for all

On path 2, the lens is broadened from obesity response to obesity prevention and improvement of overall metabolic health. Society moves beyond therapeutics to imagine economies and communities that tackle the root causes of obesity and where better metabolic health is embedded into all aspects of how people live and work. While weight management drugs play a role, coordinated action across all aspects of industrial, environmental, and social systems enables individuals to preserve and optimize metabolic health, capturing up to 6.5 billion additional years of life. It also makes metabolic health, beyond obesity alone, an area more tangible and investable as an opportunity. The aspiration of path 2 is greater but does not require abandoning path 1, which will lay the groundwork for future progress.

Envision a metabolic health revolution where metabolic health is accessible to everyone, irrespective of geography, age, gender, or weight. This requires a much broader perspective than the current focus on BMI or waist circumference, incorporating new research into body composition, biomarkers, relationships between the environment and the microbiome, and other factors.

Path 2 is more ambitious, more complex, and more challenging but would allow societies to capture even larger health and economic benefits. This would involve a fundamental shift in the choices available for everybody, providing everyone with health literacy and precise understanding of their own metabolic condition to optimize health.

Within health systems, this means shifting from biomedical to behavioral interventions and from reactive treatment to prevention at three levels—preventing the onset of metabolic conditions like obesity, diabetes, and cardiovascular disease; preventing the progression of these conditions; and preventing complications—maximizing health for all, rather than just managing disease. Success will require increased training of medical professionals and systematic changes to how metabolic health is addressed.

On an individual level, changes on path 2 would make it easier for individuals to enjoy lives anchored in good metabolic health. They would receive appropriate education about metabolic health and healthy lifestyles and would have access to health-promoting products and services. With healthier nutrition and lifestyle choices becoming the default, individuals would experience improved physical, mental, social, and spiritual health.

Adding 6.5 billion years of additional life from obesity reduction would be an enormous boon to populations, societies, and economies. The scale of the opportunity in metabolic health is even greater: between three and four times the gain in healthy years lived that would result from addressing obesity alone, and a potential $5.65 trillion annual GDP uplift. This represents three percent of total GDP in 2050. Achieving this vision is on par with the boldest collective efforts to address complex global challenges. Using climate change as an analogy, path 1 is akin to addressing climate change by funding specific technologies around carbon capture and energy production, while path 2 is analogous to wholesale societal mobilization needed to curb carbon emissions.

Five shifts toward greater metabolic health for all

What does metabolic health for all look like in practice? Path 2 goes far beyond implementing the existing evidence-based interventions to address obesity—for example, those published by the McKinsey Global Institute ten years ago,⁴⁶Richard Dobbs et al., “Overcoming obesity: An initial economic analysis,” McKinsey Global Institute, November 2014. which are still largely valid today, such as promoting active transport, improving food labeling, and public health campaigns. While the basics of improving metabolic health remain the same, succeeding on path 2 requires genuine innovation in order to create broad, societal-level change, shifting incentives for all stakeholders. This means expanding beyond obesity response and prevention into improving the metabolic health of all (including health conditions such as obesity, cardiovascular disease, kidney disease, and diabetes). It requires that leaders of the private, public, and social sectors and organizations all play their part to achieve five shifts that would jointly amount to a genuine metabolic health revolution (Exhibit 6). Through these shifts, stakeholders can be challenged and encouraged to advance the health of populations and societies to a new level beyond what we know today.

Science: Advancing our understanding and definition of metabolic health

There is an opportunity for the scientific and medical communities to better understand and define metabolic health. BMI is not only an imperfect measure of obesity but also an incomplete indicator of an individual’s metabolic health.⁴⁷Jiang-Shui Wang et al., “Trends in the prevalence of metabolically healthy obesity among US adults, 1999–2018,” JAMA Network Open, March 9, 2023, Volume 6, Number 3. There is not yet consensus on a broadly accepted definition of metabolic health, but components could include body composition (including visceral fat, bone, and muscle), blood sugar, blood lipids, blood pressure, kidney function, and others, such as insulin resistance, inflammatory markers, and liver function (Table 3).⁴⁸Luca A. Lotta et al., “Definitions of metabolic health and risk of future type 2 diabetes in BMI categories: A systematic review and network meta-analysis,” Diabetes Care, November 2015, Volume 38, Number 11.

In the future, metabolic health will not be defined solely as “the absence of metabolic syndrome” or “the absence of obesity.” Health exists on a spectrum with a negative and a positive or optimal end. Optimal metabolic health could represent a balance between a multitude of biological factors that are well regulated, in a system that supports a person’s energy, mobility, and overall well-being. Further research will be required to uncover new biomarkers, potential mechanisms of metabolic processes, and variability from person to person.

Ways to get started on this aspirational journey:

• Medical researchers and scientists can drive investigation of metabolic health and work toward a consensus on its measurement, spanning endocrinology, nutrition, genetics, and behavioral science, with a shared sense of urgency and broad support.
• Medical societies and patient groups can define metabolic health in a standardized way that expands the definition beyond BMI.
• Innovators and policymakers can support research on metabolic health (and its drivers) through funding, policies, and other mechanisms to advance discovery and implementation.

Transparency: Rigorously measuring and tracking metabolic health for individuals and populations

Measuring and tracking metabolic health indicators across individuals and populations can help identify progress and areas of need. Unlike weight loss (which has a unidirectional focus applicable to individuals with overweight and obesity), metabolic health is a goal that can be meaningfully improved for everyone at any weight. While a large share of the population may have a “normal” BMI, they may not be metabolically healthy. Conversely, a share of the population may have an “overweight” BMI but be in good metabolic health.⁴⁹Hannah Mathew, Olivia M. Farr, and Christos S. Mantzoros, “Metabolic health and weight: Understanding metabolically unhealthy normal weight or metabolically healthy obese patients,” Metabolism, January 2016, Volume 65, Number 1. Aiming for improved metabolic health across multiple dimensions is a meaningful health aspiration for everyone. What would that look like on an individual and population level?

On an individual level, better access to personal health information can offer valuable insights and promote adherence to medical advice. For example, there is evidence that continuous biofeedback (individualized data that a person can access about their bodily systems) can improve health outcomes for some individuals.⁵⁰David C. Klonoff et al., “Use of continuous glucose monitors by people without diabetes: An idea whose time has come?” Journal of Diabetes Science and Technology, July 20, 2022, Volume 17, Number 6; Ty Ferguson et al., “Effectiveness of wearable activity trackers to increase physical activity and improve health: A systematic review of systematic reviews and meta-analyses,” Lancet Digital Health, August 2022, Volume 4, Number 8. For example, continuous glucose monitoring (CGM) can lead to personal metabolic health improvements for some individuals as they realize which foods lead to large spikes in their blood glucose levels. More stable blood glucose is crucial for metabolic health.⁵¹Anna Hjort, David Iggman, and Fredrik Rosqvist, “Glycemic variability assessed using continuous glucose monitoring in individuals without diabetes and associations with cardiometabolic risk markers: A systematic review and meta-analysis,” Clinical Nutrition, April 2024, Volume 43, Issue 4. Similarly, emerging technologies such as continuous cortisol monitoring offer real-time insights into stress levels, helping individuals manage chronic stress,⁵²“Corti set to disrupt the health wearable market with the first real-time, continuous monitor for cortisol and melatonin hormones, the key stress and sleep hormones,” EnLiSense press release, April 4, 2024. which is closely linked to metabolic dysfunction, weight gain,⁵³Cristina Rabasa and Suzanne L. Dickson, “Impact of stress on metabolism and energy balance,” Current Opinion in Behavioral Sciences, June 2016, Volume 9. and insulin resistance.⁵⁴Robert A. Rizza, Lawrence J. Mandarino, and John E. Gerich, “Cortisol-induced insulin resistance in man: Impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor defect of insulin action,” Journal of Clinical Endocrinology & Metabolism, January 1, 1982, Volume 52, Number 1. Continuous gut microbiome monitoring can provide ongoing feedback on digestion, nutrient absorption, and inflammation, allowing users to optimize their diet for better digestive and metabolic health.⁵⁵Walker Drawas, “Pendulum Therapeutics and BiomeSense launch pioneering study on gut microbiome using continuous sampling technology,” Pendulum Therapeutics press release, August 23, 2024. While the broader impact and applicability of these technologies is an open question,⁵⁶Robert H. Shmerling, “Is blood sugar monitoring without diabetes worthwhile?” Harvard Health Publishing, April 2024. it is nonetheless an instructive example of how individuals can keep track of their metabolic health.

On a population level, improved measurement and tracking of metabolic health could be integrated into routine primary-care touchpoints, employee health checks, and insights drawn from individual health-tracking solutions. For example, the UK’s National Health Service (NHS) is introducing metabolic health screenings, including blood pressure, BMI, and cholesterol, for middle-aged employees in high-risk industries to detect early signs of cardiovascular diseases and diabetes.⁵⁷“Over 130,000 people to benefit from life-saving health checks,” UK Department of Health and Social Care press release, August 30, 2024. The NHS also has plans to enhance its app with exercise tracking, allowing doctors to leverage smartphone data for personalized therapy and preventive care.⁵⁸Kath Hudson, “Doctors plan to use exercise data from smartphones to initiate health interventions,” Fit Tech, March 11, 2024. Additionally, the All of Us research program by the US National Institutes of Health (NIH) is utilizing Fitbit data to study how lifestyle factors like activity levels, sleep, and heart rate affect metabolic health at a population level.⁵⁹“Research roundup: All of US participants’ Fitbit data drive new research,” National Institutes of Health, August 22, 2023. Emerging methods of monitoring population-level health—such as wastewater analysis, large-scale consumer purchasing analysis through store data, and data from “smart” city infrastructure that can transmit information about movement—can also provide breakthrough insights as technologies mature. By responsibly aggregating and analyzing population-level data, decision makers can gain insight into metabolic trends over time and allocate interventions and resources effectively to address the areas of highest need.

Ways to get started on this aspirational journey:

• Healthcare providers can consider including a more comprehensive status of metabolic health assessment in standard physical exams.
• Researchers can create more robust evidence on the opportunity of continuous biofeedback and the conditions to achieve positive outcomes for different population segments.
• Innovators have an opportunity to develop an intuitive and evidence-backed approach to measuring metabolic health that becomes integrated into daily small talk, similar to today’s conversations about steps counted.

Technology: Developing new tools or innovations to enable individuals to understand and optimize precision metabolic health

The typical advice to keep or improve metabolic health is one-size-fits-all: at least 150 minutes of exercise per week,⁶⁰“WHO guidelines on physical activity and sedentary behaviour,” WHO, November 2020. five portions of fruits and vegetables per day.⁶¹“WHO healthy diet,” WHO, April 2020. The only factors typically addressed in a BMI calculation are height and weight. This is a tremendous simplification of factors underlying metabolic health. Research suggests that a myriad of individual and ecosystem factors influence what interventions are best to improve metabolic health: microbiome archetypes,⁶²Lars Christensen et al., “Microbial enterotypes in personalized nutrition and obesity management,” American Journal of Clinical Nutrition, October 2018, Volume 108, Issue 4. genetics,⁶³J. Alfredo Martínez and Fermin I. Milagro, “Genetics of weight loss: A basis for personalized obesity management,” Trends in Food Science & Technology, April 2015, Volume 42, Issue 2. culturally coded dietary and activity habits,⁶⁴Maria Carlota Dao et al., “Cultural influences on the regulation of energy intake and obesity: A qualitative study comparing food customs and attitudes to eating in adults from France and the United States,” Nutrients, December 28, 2020, Volume 13, Issue 1. sleep patterns,⁶⁵Jean-Philippe Chaput and Angelo Tremblay, “Sleeping habits predict the magnitude of fat loss in adults exposed to moderate caloric restriction,” Obesity Facts, July 27, 2012, Volume 5, Issue 4. household structures,⁶⁶Joseph A. Skelton et al., “Rethinking family-based obesity treatment,” Clinical Obesity, December 2023, Volume 13, Issue 6. food availability,⁶⁷Elisa Pineda et al., “Food environment and obesity: A systematic review and meta-analysis,” BMJ Nutrition, Prevention & Health, April 21, 2024, Volume 7. occupation categories, personality types,⁶⁸Tian-Yu Huang et al., “Personality traits and the response to lifestyle interventions for adult obesity: A systematic review and meta-analysis,” Personality and Individual Differences, March 2024, Volume 219. education levels, and more. People digest differently, have different default behaviors, detractors, budgets, support, and capabilities. Even a simple cup of coffee is digested differently by different individuals (with a half-life ranging between 1.5 and 9 hours), affected by their genetics, gender, and medications.⁶⁹Sara Berg, “What doctors wish patients knew about the impact of caffeine,” American Medical Association, accessed on December 13, 2024.

Technological innovations could offer significant potential to personalize and improve health information, provided that appropriate and equitable access to these innovations is available to all. For example, advances in precision medicine (such as genetic, metabolic, and proteomic profiles) could enable people to receive specific diagnoses and targeted information to manage their metabolic health.⁷⁰Mojgan Gharipour et al., “Precision medicine and metabolic syndrome,” ARYA Atherosclerosis, July 2022, Volume 18, Number 4. There is increasing innovation in the field, with two times as many publications on novel biomarkers for metabolic disease in 2024 as in 2010.⁷¹PubMed annual results for publications matching relevant keywords: (novel biomarker), (novel mechanism), (biomarker) and (obesity), (metabolic disease), (metabolic syndrome) and (diagnostic), (preventative), (prognostic), (predictive). Results showed 18,108 publications in 2010 and 38,665 publications in 2024. Moreover, the cost of “omics” testing has significantly fallen in recent years, increasing accessibility.⁷²Sequencing cost data from National Human Genome Research Institute, accessed October 2024. More specific diagnoses could allow individuals to tailor their subsequent treatment.

On the product and intervention side, an increasing array of technological innovations is emerging with the potential to enhance individuals’ health outcomes. Examples include monitoring and tracking technologies like wearables, home testing kits, and monitoring devices; personalized nutrition and exercise services; and digital health platforms that increase transparency or access between individuals and their healthcare providers. While these solutions hold immediate promise, technology and science are constantly evolving, and new innovations are likely to transform how metabolic health is managed on a day-to-day basis. The future will offer many possibilities we have yet to imagine. Will AI-powered assistants assess our nutrition and exercise? Could there be products that instantly calculate and analyze our body composition? Could fitness centers or gym equipment provide data to healthcare providers to monitor every person’s metabolic health indicators?

The horizon of potential advancements is vast and holds the promise of making metabolic health more accessible and achievable. However, for broad adoption, innovations need to be affordable and user-friendly. New technologies need to fit seamlessly into an individual’s life, not complicate it. Currently, a relatively limited group of individuals (mostly in high-income countries) is at the forefront of adoptions of new technologies to manage metabolic health. The financial investment required and the mental effort needed to use these technologies effectively are barriers to broader adoption. Future innovation will need to address affordability and user-friendliness.

Ways to get started on this aspirational journey:

• Researchers across disciplines have an opportunity to further the understanding of different metabolic phenotypes or profiles and how they impact health (via different reactions to food and the environment).
• Investors and funders have an opportunity to accelerate progress toward precision metabolic health by funding more new innovations in the area, especially as new business models emerge.
• Innovators across research and industry can explore new collaborations with a goal of fast-tracking accessible, personalized metabolic health solutions.

Economy: Making healthy choices affordable, available, and desirable through innovation and structural change

Most people know that vegetables are healthy and that sugar, salt, and fat are not. The challenge is that unhealthy choices are often the most attractive. These foods might be cheaper, easier, or less time-consuming to access, or more physically or emotionally appealing. This is not only true of food and beverages but also applies to many day-to-day situations, like transport and physical activity.⁷³Sally Davies and Jonathan Pearson-Stuttard, Whose Health Is It, Anyway? Oxford University Press, 2020.

Food choices in a metabolically healthier future illustrate what is needed to appeal to individuals across several dimensions, striking a balance between consumers’ needs and wants:

• Affordability. An individual’s limited budget does not direct them to less healthy alternatives.
• Availability. The healthy alternative does not take extra time to prepare or purchase. It is easily available.
• Desirability (and tastiness). The healthy alternative is tasty and therefore psychologically alluring and desirable.

These three dimensions do not apply only to food and nutrition. Any service to enhance physical activity needs to be as attractive as streaming the latest TV series. Any active or public transport option needs to be as easy as taking a car or a taxi.

Private-sector innovation can play a crucial role in developing novel, attractive choices that embody these attributes. For example, the food offered by workplace or school canteens or food vendors determines whether freshly prepared meals are available to employees and commuters. Food companies know how to make products that stimulate and satisfy people’s taste buds. Achieving a balance between producing healthier foods that appeal to consumers and managing potential cost impacts across the value chain is essential for driving meaningful change. Finally, marketing is a powerful tool to make any option, healthy or unhealthy, more appealing in people’s minds. Therefore, companies that engage in advertising can play a role in promoting healthier choices. Harnessing the full potential of the private sector in the pursuit of greater metabolic health is a critical success factor.

Ways to get started on this aspirational journey:

• Food and consumer companies can reserve a part of the R&D budget to develop attractive choices with clear health benefits supported by evidence. They can also target and progressively increase the share of healthy products in the portfolio.
• Philanthropists can set up competitions and prizes to raise visibility for the best healthy-living interventions.
• Regulators, researchers, and industry can make the healthiness of various choices more transparent, based on the best available evidence.

Society: Empowering individuals and communities in an equitable way

To achieve large-scale health improvements, it is essential to improve understanding and access to healthier ways of living, starting with building blocks in local communities to ensure that individuals can actively participate in health-improving activities within their own neighborhoods. All stakeholders can come together around this issue to build sustainable and accessible solutions. For example, safe physical spaces can allow people to engage in physical exercise. School education programs can improve health education and health literacy for children and adolescents, especially given the importance of tackling youth obesity and overweight. Community activities and organizations can improve knowledge and access to healthier foods. Public discourse and institutional choices can heavily influence the role that food plays in individuals’ lives. Although some of these developments may already be occurring in certain areas, barriers to access, implementation, or adoption often remain. Broader success will depend on multistakeholder collaboration, including the public sector (across national, regional, and community governments), private sector, employers, nongovernmental organizations (NGOs), academia, charities or philanthropies, and many others.

Understanding the unique context and challenges of each community is vital for tailoring solutions to the local needs and context. This approach would enable all members of each community, regardless of their background, to have equitable opportunities to achieve and maintain metabolic health, fostering a more inclusive and sustainable health movement.

Ways to get started on this aspirational journey:

• Every school can offer education programs focused on healthy lifestyles and evidence-based habits for food and nutrition and physical activity.
• The government or the private sector can launch initiatives to improve access to every community’s public spaces, such as parks or urban green spaces, community centers, gyms, pools, biking and hiking trails and paths, beaches and waterfronts, and playgrounds.
• Community activities and programs can shift attitudes about metabolic health at a grassroots level and enable sustainable ways for all community members to incorporate healthier choices.

This is truly a big climb to accomplish, but it can lead to metabolic health for all and the benefits that come with it. Is it worth the effort? Public health achievements in the past, such as increased seat belt usage and reduced rates of smoking, can serve as a source of inspiration because they show that large-scale change is possible.

Who will lead the metabolic health revolution?

Every organization needs to determine what it means to be a leader in metabolic health within their industry and find creative ways to work with others to bring about real change. Metabolic health for all will not happen without a concerted effort energized by a unified sense of urgency. The current scenario may yield some meaningful reduction of obesity but will stop far short of delivering the 6.5 billion additional years of life and population-wide metabolic health. Achieving this goal will require coordinated collective action with novel collaborations across sectors. The private and public sectors, philanthropists, and society have an opportunity to come together and create a new reality in which everyone can be metabolically healthy.

This cross-sector mobilization will not be without its challenges. Every stakeholder brings their own shorter-term motivations. The private and public sectors respond to different market or constituent needs, while individuals are generally focused on their direct benefit. These motivations may not change, but that does not mean we are stuck. We can still work together across all sectors to achieve meaningful, large-scale societal change.

As a first step, the McKinsey Health Institute proposes to raise the issues of obesity and metabolic health for all to the top of the agenda of large global forums, bringing it to the attention of decision makers at the World Economic Forum, the World Health Assembly, the United Nations General Assembly, the G7, the G20, and several other formats that are civil-society led or regional.

Metabolic health for all is more than reducing obesity. While that is an ambitious vision, the larger goal is for individuals to flourish with physical, mental, social, and spiritual health. Achieving this vision will require substantial leadership attention and investment. But that future—one in where every person has an opportunity to add “years to life and life to years”—is possible.