Imagine a world where battling obesity isn't just about popping a pill or getting an injection—it's about transforming the very culture of what we eat. That's the heart of this urgent discussion: while groundbreaking weight loss drugs like Mounjaro edge closer to becoming accessible through public funding, we're ignoring a critical piece of the puzzle that could make healthy eating a reality for everyone. But here's where it gets controversial—prescribing these meds without tackling the toxic food environment is like treating a symptom while the disease spreads unchecked. And this is the part most people miss: the real change needs to happen upstream, in how we regulate and reshape our diets from the ground up.
As a public health expert, I'm excited to see the health technology assessment (HTA) for Mounjaro nearing publication. This evaluation dives deep into the medical, social, ethical, and economic aspects of this weight loss drug, setting the stage for a big decision: will state-funded injections under medical cards or the HSE’s Drug Payment Scheme become available soon? It's a step toward addressing obesity, which impacts a staggering one in four people here— that's about 1.2 million individuals grappling with this widespread issue.
Health Minister Jennifer Carroll MacNeill has hinted that approval for Mounjaro's reimbursement could come by year's end. Meanwhile, Professor Donal O’Shea, the HSE’s national clinical lead for obesity, predicts a rollout similar to the UK, targeting those with a BMI over 35 plus related complications. This approach might limit access to around 80,000 people, focusing on the most severe cases. On the surface, it seems practical, but let's unpack why this might not be enough.
The core flaw in relying solely on these treatments? They overlook the powerful non-nutritional factors shaping our eating habits—like the seductive pull of low prices, aggressive marketing, endless food variety, and sheer convenience. These elements drive real-world choices and contribute to weight gain far more than we often realize. Picture this: the dream of savoring home-cooked, seasonal, nutritious meals daily is appealing, but in our fast-paced, processed-food-dominated society, it's simply not feasible for most. We need to address these root causes alongside medical interventions to truly combat obesity effectively.
But here's where it gets controversial: some argue that making weight loss drugs widely available could create a false sense of security, diverting attention from personal responsibility or broader societal fixes. What if, instead of just handing out prescriptions, we mandate changes that make unhealthy choices harder and healthy ones easier? It's a bold idea that sparks debate—do we prioritize individual treatments, or revolutionize the entire food system to prevent the problem in the first place?
Fortunately, there are actionable strategies to foster a healthier food landscape, potentially slashing obesity risks and chronic diseases. Let's explore a few, with some extra context to make them crystal clear for beginners.
First, we could mandate reformulation of ultra-processed foods. This means requiring companies to tweak their products by cutting back on hyper-palatable ingredients—like those ultra-sweet, salty, or fatty flavors that hook us—and reducing calorie density. Kevin Hall, a leading expert in human nutrition and metabolism, in his insightful book Food Intelligence, explains that such reforms would slowly retrain our national tastes. Instead of craving the industry's mega-doses of unhealthy additives, we'd shift toward milder, more balanced flavors. Governments could set mandatory targets to slash salt, sugar, refined grains, and saturated fats in these foods. 'All it takes is the political will to get started,' Hall emphasizes, and it's a game-changer for public health.
Building on that, mandatory reformulation would pave the way for healthier versions of once-unhealthy staples. But to make it stick, we must tackle pricing—ensuring nutritious options are competitively priced against their less wholesome counterparts. Hall proposes taxing items that offer little nutritional value and can be cut from diets without health drawbacks, such as sugary sodas, candies, cookies, and chips. Ireland's 2018 sugar tax on drinks is a shining example: it slashed consumption, prompted reformulations to dodge the tax, and has now inspired similar policies in nearly 120 countries. Colombia went further, taxing all ultra-processed foods with poor profiles. To avoid just hiking prices across the board, Hall suggests channeling tax revenue into subsidies for healthy alternatives, making them cheaper, more visible, and easier to grab.
And this is the part most people miss: shifting the burden of better diets to the food supply chain itself, by altering the environment where choices are made.
One potent way is enforcing stricter standards on supermarkets. Today, strolling through one often means navigating towers of holiday treats like chocolates, cookies, and cakes—because ultra-processed food giants pay top dollar for prime shelf spots. We could ban promotions of junk food near entrances, aisles' ends, or checkout counters. Alternatively, tax manufacturers' revenues to incentivize product quality upgrades. Another option? Boost businesses offering affordable, healthy ready-meals. Programs like Nourish Scotland are testing community diners in Nottingham and Dundee by 2026, serving fresh, nutritious meals at a fraction of restaurant prices. New York mayor-elect Zohran Mamdani is championing municipal grocery stores across the city's boroughs, funded by taxes on unhealthy foods, to correct market failures and make wholesome eating accessible. It's a controversial counterpoint to laissez-faire capitalism—should governments intervene directly in food retail to ensure equity?
Hall envisions even more possibilities, like regulating restaurant chains to meet minimum menu quality standards for prepared foods. Or, consider how companies like Google provide free healthy meals to employees, fostering community, boosting productivity, and cutting healthcare costs. It even improves job retention—who wouldn't enjoy a workplace where good food makes the day more pleasant? What if we treated access to tasty, convenient, healthy meals as a fundamental right, akin to clean water, rather than a luxury perk?
Ultimately, achieving this requires a cultural overhaul—a neglected aspect of the food environment. Drawing from successful anti-smoking campaigns that outlawed and stigmatized public puffing, Hall suggests regulations like ads promoting fruits and veggies or mandatory education on nutrition. Japan, for instance, has mandated over two decades of school teachings on nutrients, healthy eating, and food appreciation as part of its chronic disease reduction strategy. The food industry has normalized habits like eating on the run, ditching cooking for ready-mades, constant snacking, and oversized portions—just as tobacco marketed smoking as cool and desirable. 'We must counter this to flip the norms,' Hall urges.
In summary, making obesity meds like Mounjaro available via prescription is long overdue and could ease complications for recipients. Yet, it must coincide with a radical cultural pivot, making healthy food the default—affordable and ubiquitous. We need widespread, population-level transformations; otherwise, it's an enormous squander of public funds.
Dr. Catherine Conlon is a dedicated public health doctor and former director of human health and nutrition at Safefood.
What do you think—should we prioritize drug treatments or systemic food reforms to tackle obesity? Is government intervention in our diets an overreach, or a necessary evil? Share your views in the comments; I'd love to hear agreements, disagreements, or fresh perspectives!
Readers like you are keeping these stories free for everyone...
A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation.
