The Economics of Pollution, Obesity, Health, and Wealth

A perverse economic environment is, arguably, propelling us toward an overwhelming health problem with obesity that is becoming a wealth issue. Nick Triggle reports in depth for the BBC and makes a strong case for the idea that advanced obesity medicines are turning obesity into a wealth issue. People with the least wealth have the greatest need for these medicines and obesity care that goes with them. But increasingly,  it is one’s wealth that determines whether a person can access such medical care.

Good Health as a Luxury

With both detailed data on obesity in the UK and case studies of individuals who need care for it, Triggle offers a compelling narrative. A growing number of people in the UK need obesity care and the need is greatest in segments of the population with the least wealth. Obesity is 85% more prevalent in the England’s most deprived areas.

The National Health Service offers both Wegovy and Zepbound to its patients but local areas make the decisions about setting thresholds for access to care. Increasingly, this is an economic decision. Thus in areas with the greatest burden of obesity, access to care can become impossibly difficult.

The result is that a growing number of people turn to private obesity care and pay out of pocket – if they have sufficient wealth to afford it. Wealth and health become perversely linked in this way. A spokesperson for Novo Nordisk, the maker of Wegovy, sums up the concern:

“This has led to a large proportion of people needing to pay out of pocket, an option which is out of reach in areas of deprivation where obesity rates are significantly higher.”

Pollution That Puts the Poorest at Risk

One of the reasons that economic deprivation puts people at higher risk for obesity is the burden of exposure to pollution that disrupts metabolic health. In Current Obesity Reports, Seda Nur Köktürk and  Hülya Yardımcı offer a detailed narrative review of the often hidden burden of pollution in obesity. They describe how pollutants contribute to weight gain and metabolic disruptions – particularly in vulnerable populations. They acknowledge gaps in the data on this issue. But they call for action to reduce the harm that is clearly considerable.

As we have seen from the failure to curb plastic pollution, this is a hazard driven by economic interests.

A Profound Challenge

“We cannot allow good health to become a luxury for the wealthiest by limiting access to weight-loss drugs to those who can pay privately,” says the executive director of the Obesity Health Alliance, Katharine Jenner. And yet, this is a challenge that is not so simple to meet. Chris Rojek is a professor of sociology at City St. George’s University of London. He explains:

“We live in a society that prizes freedom of choice and expression, values material wealth and tolerates vast inequality. In such a system, casualties are inevitable. It would be naïve – or even pious – to claim we can simply solve this. The answer is complex and touches the very fabric of our society.”

Click here for the excellent reporting of Nick Triggle. For the narrative review of pollution contributing to this burden, click here.

Case Wealthy Apple, Cross-Sectioned, photograph from the UK National Fruit Collection / Wikimedia Commons

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September 30, 2025