Abstract
Consider your most recent meal. Was it satisfying? Were you focused on the food in front of you, or were you looking at something else, like your phone or television? Did you make one of your go-to recipes, or did you order takeout because someone posted a particularly appetizing photo on social media? In today’s digital era, countless factors influence what and how we eat, from socioeconomic status to targeted advertisements. But these same factors may also be negatively impacting our health.
In the past three decades, the global prevalence of obesity has nearly doubled, to the point that the number of obese and overweight individuals outnumbers those who are underweight. 1 Obesity is one of the world’s most serious public health crises, increasing the risks of developing diabetes, stroke, and some cancers. In 2019, obesity led to around 5 million deaths—20 times as many as malnutrition did. 2 The issue has reached such heights that a group of 56 doctors, called the Lancet Commission, recently classified obesity as a disease rather than just a risk factor. 3
While the conversation on metabolic health is shifting, recognizing there is a problem and developing practical solutions are two separate challenges. Supporting a person’s overall health requires not only thinking about measures of physical wellness, such as weight and cardiovascular markers, but also their mental health, behaviors, genetics, and lifestyle. It is becoming increasingly clear that tackling the global obesity crisis requires a multidisciplinary approach that meets patients where they are, as opposed to assigning a one-size-fits-all treatment plan. Telling people to simply cut calories or jog more isn’t a long-term solution.
The Growing Global Crisis of Metabolic Disorders
The term “metabolic disorder” describes any condition that disrupts the metabolic process or causes it to malfunction in any way, such as obesity, diabetes, and metabolic syndrome. 4 While some conditions are hereditary, many metabolic disorders today are preventable byproducts of lifestyle choices. For example, sleep quality and sedentary behavior have been shown to contribute to the development of metabolic diseases. 5
Each of these contributors is complex. Sleep quality may be impacted by poor sleep hygiene, such as looking at screens before bed or consuming caffeine too close to bedtime, or it may be impacted by external factors such as living in a noisy neighborhood or night shift work. Sedentary behavior is on the rise worldwide; 31% of adults (approximately 1.8 billion people) did not meet the recommended levels of physical activity in 2022, and physical inactivity among adults has increased by about five percentage points between 2010 and 2022. 6 Sedentary lifestyles are spreading worldwide because of a lack of available areas for sports or pedestrian walkways, increased occupational sedentary behaviors such as office work, and the increased penetration of digital devices such as smartphones and video games. 7 Telling an obese person to sleep better or walk more fails to consider just how complicated these contributing factors are—it’s like telling an anxious person to calm down instead of equipping them with tools to self-soothe in healthful ways.
In addition, newer research suggests that metabolic diseases are not just a product of diet and exercise but also involve genetic, psychological, and behavioral components. Environmental factors, such as diet and exposure to toxins, may even contribute to epigenetic modifications that negatively affect inflammation, the gut microbiome, and energy metabolism. 8 Regarding psychological health, chronic stress has been linked to increased cortisol levels, which can lead to insulin resistance and impaired glucose metabolism. Studies have also shown a strong association between obesity and poor mental health: patients who are obese are 18%–55% more likely to develop depression, while about 45% of adults with depression are obese. 9 Behavioral factors contributing to metabolic disease may be related to psychological health, as seen with patients who use food as a form of experiential avoidance—using food and eating to avoid uncomfortable experiences, thoughts, or memories. 10
We Are What We Eat: How Food and Behavior Are Interconnected
A discussion about the rise of metabolic disorders would be remiss without considering the impact of ultra-processed foods (UPFs), such as carbonated drinks, sugary cereals, and frozen convenience foods. UPFs are heavily processed food items made with ingredients not typically found in home kitchens, such as hydrogenated oils, high-fructose corn syrup, and emulsifiers.
Although humans have processed food for thousands of years to make it more palatable and nutritionally available, research suggests that industrial-scale food processing has accelerated metabolic issues. UPFs, which now make up more than 50% of the diet in some Western nations, increase calorie intake and alter metabolic processes independent of nutrient content.11,12 People who consume diets high in UPFs tend to have more health problems, including obesity, diabetes, and various mental health concerns. 11
And yet, in many regions, these foods are the most accessible and affordable options, as opposed to fresh ingredients and minimally processed foods. For example, Texas’ Department of Agriculture estimates that one in five people live in poor areas with limited access to nutritious foods. 2 In areas such as these, processed foods are more convenient, take less time to prepare, and may even be more affordable.
The consequences are particularly severe for children. Young people growing up in these food deserts are more likely to be obese than those from richer ones, where stores that sell fresh, nutrient-dense food are more accessible. But childhood obesity rates aren’t limited to specific geographic areas—global rates have quadrupled since 1990, with developing nations experiencing the fastest increase. 2 Some interventions, such as sugar taxes and “black box” warnings on UPFs, have had minimal impact, but no country has successfully reduced childhood obesity rates.
Social media and smartphones are a serious contributor that previous generations did not contend with at the same scale. Children in the United States who have more screen time at ages 9–11 are more likely to develop a binge-eating disorder 1 year later, and each hour on social media corresponds to a 62% higher risk. 13 The mechanisms that may explain the association are complex; children may be more prone to overeating and ignoring hunger cues while distracted by screens, and adolescents who hold negative feelings toward their own body image are more likely to binge eat. Children are also exposed to a steady stream of marketing in the form of targeted advertisements and influencers peddling sponsored content, all of which are changing the way we engage with food. One study estimated that young people see marketing for food between 30 and 189 times per week on social media apps, with fast food and sugary drinks being the most common. 14 When faced with so much content, it’s unsurprising that children would develop a disordered relationship with eating.
The Future of Metabolic Health Interventions
Too frequently, clinicians prescribe obesity medications or lifestyle interventions without considering potential underlying psychological issues. It’s clear that the factors underlying metabolic diseases are as nuanced as they are multifaceted, and as such, interventions should be tailored to the patient’s unique needs. Before prescribing anti-obesity medication like Ozempic and Wegovy, clinicians can integrate mental health support into obesity treatment plans by screening for depression, anxiety, and eating disorders. This is particularly relevant now that weight-loss drugs are FDA-approved for weight management in adolescents ages 12 and older with obesity. Not only are the long-term side effects of such medications unclear for kids, but putting children on weight loss medication overlooks the mental and behavioral factors underlying their food choices, which may stay with them through adulthood. 15
Interventions aimed at improving psychological well-being and helping patients practice healthful dietary patterns can help prevent or manage metabolic disease. Technology is a powerful way to make this happen. Telemedicine and remote monitoring can provide patients with access to digital health coaching, mental health counseling, and even remote monitoring of glucose levels and heart rate variability. Cognitive behavioral therapy (CBT) can help patients change behaviors gradually and modify attitudes toward food and eating 4 —and for patients who don’t have easy access to mental health providers, telemedicine helps improve access as long as the patient has a digital device.
Virtual reality (VR) and artificial intelligence (AI) will also play a key role in meaningful interventions. VR can be used alongside CBT to modify behaviors in an immersive, yet private setting.4,16 VR interventions can help identify what cues contribute to a patient’s habits and how to overcome triggers and negative emotions associated with them. In addition, AI is currently being studied for its efficacy in developing personalized nutrition plans that align with the patient’s dietary needs and health goals. 17 In the future, it would not be outside the realm of possibility for patients to interact with AI-generated avatars that provide meal plans, guide them through behavioral interventions, and share data with their healthcare provider. The question is not whether these technologies will play a role in future health care—it is how they will be implemented responsibly to ensure long-term metabolic health improvements rather than just short-term weight loss.
The global metabolic crisis cannot be solved with simplistic solutions like “eat less, move more.” While diet, exercise, and medication are important, they fail to address the complex interplay of behavioral, psychological, and environmental factors that drive metabolic disorders.
A holistic approach that incorporates mental health support, personalized nutrition, and innovative technologies can empower individuals to make meaningful lifestyle changes. The challenge ahead is not merely treating obesity but transforming the way we approach metabolic health—through education, prevention, and systemic change.
We cannot reverse the metabolic crisis overnight, but we can begin by acknowledging that health is more than a number on the scale. Our future interventions must reflect that reality.
Brenda K. Wiederhold
Editor-in-Chief