The river was swift and unrelenting, its currents carrying victim after victim downstream. Local villagers responded by stringing nets across the water to prevent further drownings. Yet, despite their efforts, the death toll continued to rise.
Eventually, a newcomer to the village asked a simple yet critical question: “Why are people falling into the river in the first place?” Following the water upstream, the villagers discovered the source of the problem: a crumbling bridge sending person after person into the rapids.
This “ upstream parable ” illustrates the folly of America’s response to obesity.
Like the villagers, Americans have relied on reactive, downstream solutions to combat the problem. Most recently, political and public health officials have touted weight loss drugs like Ozempic and Wegovy as the solution. While these medications help people lose significant weight, they don’t address the reason people become obese in the first place.
Enter Robert F. Kennedy Jr., the controversial nominee for secretary of health and human services. While his nomination raises serious questions, it also offers a rare opportunity to confront the drivers of the obesity epidemic.
Obesity: Why the root of the problem matters
Obesity rates in the U.S. have surged over the past 30 years. According to The Lancet, the percentage of adults classified as overweight or obese has more than doubled to nearly half the population. Among adolescents, obesity rates tripled in the same period.
But the health consequences extend beyond weight gain. Obesity is a major driver of both diabetes and cardiovascular disease, and contributes to 50 percent of cancer deaths, according to the American Cancer Society.
While medical organizations acknowledge that many factors contribute to obesity, public health leaders increasingly describe it as a genetic and biological disease. But these factors could not possibly double obesity in just 30 years — human DNA evolves over millennia, not decades. This focus on biology — and on medical treatments like drugs and surgery — obscures the epidemic’s root cause.
The primary culprit is the food industry, which deliberately manufactures and markets ultra-processed, calorie-dense products packed with refined sugars and unhealthy fats.
Of course, genetics do play a role. The FTO gene, which increases susceptibility to overeating, helped early humans survive food shortages by encouraging calorie storage during times of abundance. In our modern era, the food industry has exploited this evolutionary holdover by engineering foods that trigger dopamine in the brain, driving addiction-like behaviors and overconsumption.
The result is a population increasingly dependent on nutrient-poor, high-calorie foods. Today, 42 percent of U.S. adults are obese, costing the health care system $173 billion annually.
While GLP-1 weight-loss drugs offer effective treatment for those already struggling with obesity, they require lifelong use to maintain results. More than eight in 10 patients discontinue these medications within two years, and the drug’s annual cost — exceeding $10,000 per person — places immense strain on patients and payors, and may soon hit Medicare’s budget, too.
Without changes to food manufacturing and marketing, the chronic disease crisis — which is responsible for 30 percent to 50 percent of preventable heart attacks, strokes, kidney failures and cancers — will only worsen.
Robert F. Kennedy Jr.: A controversial hope
Kennedy., awaiting Senate approval as President-elect Donald Trump’s pick for HHS secretary, is a polarizing figure. His promotion of debunked theories — like vaccines causing autism or Covid-19 targeting specific racial groups —raises serious concerns. Still, if confirmed, Kennedy could push for aggressive reforms that target the root causes of obesity, a step none of his predecessors have taken.
Kennedy has been outspoken in his criticism of the Food and Drug Administration, accusing the agency of suppressing access to products that “advance[s] human health but can’t be patented by” pharmaceutical companies. He has also voiced opposition to the widespread use of GLP-1 weight-loss drugs, describing them as a shortsighted approach to combating obesity.
Looking to the past for cures
Kennedy has promised to confront the food industry and revive America’s health, but the question remains: How might he achieve these ambitious goals? History offers a two-part blueprint: prohibition and taxation.
In the 1970s, research linked lead in gasoline to severe neurological damage in children. In response, the Environmental Protection Agency phased out leaded gasoline, reducing lead levels in children by over 90 percent. Similarly, eliminating lead in paint and pipes demonstrated how regulatory prohibitions can drive significant public health improvements.
More recently, local governments in cities like Berkeley, California, and Philadelphia implemented soda taxes to curb sugary beverage consumption, cutting sales by as much as 38 percent. Despite resistance and heavy lobbying from the beverage industry, these measures highlight how financial disincentives can effectively encourage healthier choices.
The sensible path forward
As long as high-calorie, processed foods dominate grocery stores, school cafeterias and restaurant menus, the nation’s health will remain in crisis.
Taxation offers a logical solution. If sugar- and fat-laden products contribute to hundreds of billions in health care costs, those expenses should be reflected in their prices. Revenue from these taxes, coupled with future savings from reduced obesity-related health care spending, could subsidize healthier food options for low-income families.
This dual approach — discouraging harmful choices while promoting affordable, nutritious alternatives — has the potential to reshape America’s food landscape and improve public health for generations to come.
If RFK Jr.’s nomination is confirmed and he chooses to target the food industry, he may garner bipartisan support. Democrats have long championed nutritional improvements for disadvantaged families, while Republicans seek reforms that reduce health care spending.
The time has come to move upstream — to repair the crumbling bridge of American health rather than relying on the safety nets of surgery and drugs. The next HHS secretary will face significant resistance from the food industry in pursuing this course, but courageous leadership can turn the tide of the obesity epidemic and deliver a stronger, healthier future for our nation.
Pearl, the author of “ ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.