It affects people unevenly, places a strain on healthcare systems and costs Italy billions of euros a year. Between prevention, medication and public funds, the line between obesity and the economy is more delicate than one might imagine.

For years, obesity has been portrayed as an individual issue, a fault to be attributed to a lack of willpower: the figures tell a different story. A body mass index (BMI) of 30 or above is the statistical threshold defining obesity, and in 2025 this applied to 16.3 per cent of adults in the European Union – roughly one in six. The problem has been growing for decades: in the WHO European Region, the prevalence among adults rose by 138% between 1975 and 2016. The pandemic has accelerated this trend, reducing physical activity and increasing sedentary behaviour, particularly amongst younger people.

Weight also correlates with economic and social inequalities: the lower the socio-economic status, the higher the average obesity rate. Health economics explains this link using the Grossman model, according to which health is a form of capital that each individual accumulates and consumes according to the resources and knowledge at their disposal. Education also plays a role: WHO/Europe reports a higher prevalence amongst less educated adults, and this disadvantage is passed on to their children.

The impact on the National Health Service

From an economic perspective, the problem extends beyond the individual. Some of the consequences fall on the National Health Service, on productivity and on society as a whole: this is the definition of a negative externality, and it is here that a private matter becomes a matter of public finance. In Italy, in 2020, obesity cost around 13.3 billion euros: nearly 8 billion in direct healthcare expenditure and over 5 billion in indirect costs. This is a huge figure, especially when one considers that, according to ISTAT, Italy has one of the lowest rates of obese adults in the EU. But ‘fewer’ does not mean ‘few’: by 2025, 11.6 per cent of adults will be obese – almost 6 million people.

The new frontier: treating people today to save money tomorrow?

The debate has shifted to anti-obesity drugs, particularly GLP-1 receptor agonists. Semaglutide is the most emblematic case study. In the STEP 1 trial, involving adults who were overweight or obese and did not have diabetes, a dose of 2.4 mg per week, combined with lifestyle interventions, reduced body weight by an average of 14.9 per cent over 68 weeks, compared with 2.4 per cent for the placebo. In the SELECT study, involving over 17,000 adults who were overweight or obese, had established cardiovascular disease and did not have diabetes, the relative risk of major cardiovascular events (cardiovascular death, non-fatal heart attack or stroke) fell by 20 per cent.
The value of these treatments is not merely clinical. If they reduce weight and the risk of certain complications, they can alter the future cost profile for the healthcare system. However, the treatment is very expensive, and its impact on public finances depends on four factors: the price of the drug, the duration of treatment, patient adherence and the selection of high-risk individuals. The drug is a trump card, but it is not enough.

The real investment is in prevention (how?)

WHO Europe identifies as priorities policies that influence the environment in which food choices are made: from a sugar tax to restrictions on the marketing of unhealthy foods to children, right through to cheaper and easier access to healthy food.
What can a political actor such as the EU do in an area that remains predominantly the responsibility of Member States? And what can national governments do in an area that concerns individual behaviour? A great deal.

The Cardiovascular Health Plan (Safe Hearts Plan, December 2025) aims to establish common standards for early diagnosis, supports epidemiological research and encourages Member States to adopt national plans by 2027. Looking further ahead, the European institutions could also take action on standardised nutritional labelling and transparency in the food supply chain through the single market; at present, however, these are merely possibilities, not measures that have already been planned.

The challenge facing the healthcare system is not just about ‘how much’ is spent, but about ‘how’ limited resources – which are difficult to maximise – are utilised. The trade-off is clear and is not confined to the economic sphere, let alone the aesthetic one. A population that tends to eat poorly and follow unhealthy dietary habits is heading for certain decline – in terms of values, health and, above all, the economy. And this decline is paid for dearly.

The only option for Italy and for Europe is to decide how much to invest today so as not to face an exorbitant bill tomorrow.