The Trump administration has made MAHA – Make America Healthy Again one of its defining domestic initiatives. The movement promises to tackle chronic disease, improve diets and reverse the decline in Americans’ health. Some of its proposals have attracted widespread criticism and may well make matters worse. Central to the MAHA world view is the belief that the medical industry intentionally harms individuals and relies too heavily on prescription drugs rather than alternative therapies. It is obsessed by anti-vax and 5G conspiracy theories.
But in one important respect MAHA appears to be winning.
After decades of relentless increases, the United States has become the first major advanced economy to show convincing signs that its obesity epidemic may have reached a turning point.
The change is still modest. The latest CDC data suggest adult obesity has fallen from 42.8% in 2017–18 to 40.3% in 2021–23, while other large studies indicate that average BMI peaked around 2021 before levelling off and beginning a slight decline. After forty years of almost uninterrupted increases, even a small reversal is significant.
The obvious question is why.
Although MAHA has embraced the issue, it is difficult to argue that the movement deserves much credit. The trend began before Donald Trump returned to office. The far more likely explanation is the rapid adoption of a new generation of anti-obesity medicines such as Wegovy, Ozempic and Mounjaro. For the first time, pharmaceutical innovation appears capable of reversing what many regarded as an inevitable consequence of modern life.
A breakthrough that not everyone can access
If these drugs are changing America’s health, they are doing so unevenly.
Access depends heavily on health insurance, employer benefits, state Medicaid rules and the ability to pay hundreds of dollars a month out of pocket. Millions of Americans remain excluded despite being clinically eligible.
This creates a striking irony.
The people who would benefit most from GLP-1 drugs are often those on lower incomes, who also have the highest rates of obesity, diabetes and cardiovascular disease. Many of these communities form the electoral heartland of both the MAGA and MAHA movements.
Yet they are also among those least likely to receive treatment. Wealthier Americans can often obtain GLP-1 drugs through private insurance or direct payment. Lower-income households are much more likely to face restricted coverage or find the medicines unaffordable.
America may therefore be becoming healthier while simultaneously becoming more unequal.
If GLP-1 drugs are responsible for reversing obesity, the first beneficiaries are affluent Americans, while many of those who enthusiastically supported the promise to “Make America Healthy Again” remain at the back of the queue. MAHA is making wealthy, well educated Democrat voters healthier, while their own voters suffer.
This is not simply a health story. It is an economic one. Poor health already contributes to lower labour market participation, higher sickness absence and reduced productivity. If access to effective treatment becomes concentrated among higher-income households, existing inequalities in health and economic opportunity could widen further.
Is Britain taking a better approach?
Britain has chosen a very different model.
Rather than relying on insurance or ability to pay, access is determined nationally through NICE guidance and provided by the NHS. In principle, this should produce a much fairer system than America’s fragmented insurance market.
The problem is capacity.
Although around 3.4 million people could eventually qualify for treatment under NICE guidance, the NHS intends to roll the programme out gradually over more than a decade, initially concentrating on patients at greatest medical risk.
The result is a different form of rationing. In America, access is often determined by income. In Britain, it is determined by waiting lists and clinical prioritisation.
The wealthy already have another option: paying privately. While the NHS expands treatment gradually, those who can afford it are increasingly bypassing the public system altogether.
Britain may therefore avoid America’s insurance lottery, but it still risks creating a two-tier system in which wealth buys faster access to life-changing medicines.
How do other advanced economies compare?
| Country | Adult obesity | Access to GLP-1 drugs | Current trend |
|---|---|---|---|
| United States | ~40% | Mainly insurance/private | Plateau or slight decline |
| United Kingdom | ~27% | NHS, phased rollout | Still rising slowly or plateauing |
| Australia | ~30% | Limited public subsidy | No clear decline |
| Germany | ~23–25% | Mostly private for obesity | Plateau |
| France | ~17–18% | Public reimbursement for severe obesity | Expanding access |
| Japan | ~5% | Publicly funded but tightly restricted | Remains very low |
Several different policy models are beginning to emerge.
America has embraced rapid pharmaceutical innovation but has left access largely to the market.
Britain and France are pursuing universal access through public healthcare, but introducing treatment cautiously because of cost and capacity constraints.
Germany still relies largely on private payment for obesity treatment.
Japan remains an outlier altogether. Its obesity rate has never approached Western levels, reflecting decades of different diets, transport habits, urban design and cultural attitudes towards food.
From a health policy to an economic policy
For years, governments have treated obesity primarily as a public health issue.
They may soon have to start thinking about it as an economic one.
If GLP-1 drugs continue to reduce obesity, diabetes, cardiovascular disease and long-term illness, they could increase labour market participation, reduce sickness absence and improve productivity across entire economies. America doesn’t just have a health divide, it has an economic divide. Prosperous Democrat voting cities, better educated, more productive richer and healthier vs MAGA voting rural and small town America, less well educated, poorer, sicker, less productive. The priority should be interventions to improve the health status and productivity of poor, rural, and small town America. Instead America is doing the opposite. Trump wants to grow the economy while reducing immigration, which restricts the growth of the labour force. If he can reduce obesity and increase labour market participation his chances of success are a lot better.
The question is no longer simply whether governments can afford these medicines. It is whether they can afford not to make them widely available. The UK Government has bet the ranch on improving UK productivity. Here we have a way of doing that, but we are rationing it.
The United States may have demonstrated that obesity is not an irreversible feature of modern life. The next challenge—for America, Britain and every other advanced economy—is ensuring that one of the most important medical breakthroughs of recent decades benefits society as a whole, rather than simply those who can afford to be first.
https://deaton.scholar.princeton.edu/deaths-of-despair