Obesity rates in France have doubled since the late 1990s, affecting around 10 million people. Behind those numbers are lives shaped not just by health concerns, but by judgment, exclusion, and silence. Now, a growing push to recognise obesity as a disease is challenging both medical norms and deep-rooted stigma.
The situation is particularly acute in the overseas territories of New Caledonia and French Polynesia, where obesity rates for the 18-24 age group are 23 percent and 41 percent respectively, according to a recent report.
Obesity is now the fourth most common cause of mortality worldwide. It is a high risk factor for diseases including diabetes, heart disease and cancer.
In 1997 the World Health Organization (WHO) recognised it as a disease in its own right. Switzerland, Italy, Portugal and Germany have followed suit and there are now growing calls for France to do the same.
“France has done a lot to tackle obesity, but now it must go one step further and recognise obesity as a disease,” says Anne-Sophie Joly, founder of the CNAO – a collective of organisations representing patients with obesity – and the author of Je n’ai pas choisi d’être grosse ("I didn’t choose to be fat").
“People don’t imagine for an instant the suffering people living with obesity go through, not just from a physical point of view, but moral and psychological,” Joly said.
French stigma
While obesity is a global disease, living in France as an extremely overweight individual can be particularly challenging, due to the widespread stigma.
“France values thinness more than other countries, we reject and stigmatise [those who are overweight] a lot,” said sociologist Jean-François Amadieu, author of La Société du Paraitre ("Society of appearances"). “International comparisons show the French are very hard on overweight people.”
Joly has experienced fatphobia in the workplace, but says this begins much earlier in life.
“For children, in schools and in higher education, it’s terrible. They’re bullied, particularly on social networks... it’s a slaughterhouse. There are suicide attempts. It's intolerable.”
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This fatphobia is even found in the medical profession.
“Some doctors think it’s all the patients’ fault. They make them feel guilty and patients then internalise this, they blame themselves,” said Olivier Zeigler, a doctor specialising in nutrition at the University of Lorraine.
When Joly began putting on weight as a student, her doctor told her simply to eat less and exercise more.
There followed years of yo-yo dieting, then bariatric surgery which enabled her to lose 70 kilograms. But she couldn't keep the weight off. She says that tissue cells keep a memory of your former, heavier weight which means you "enter a mechanical metabolic spiral and after a while it's irreversible".
Listen to Anne-Sophie Joly’ discuss the fight to raise awareness of the reality of obesity on the Spotlight on France podcast, episode 126.
'Health inequality'
Recognising obesity as a disease would, Joly says, not only reduce stigma but allow better prevention through improved training of health professionals.
At the moment there is a lack of awareness over the particular needs of patients living with obesity. Joly points to their sometimes being refused surgery due to operating theatre staff’s lack of knowledge on anaesthetic dosing. She also says clinics are often ill-equipped, with examining tables and chairs that are too small.
The poorly adapted environment and the way patients are treated by some doctors "deters patients from seeking help," she said. “We're talking about refusal of care, it amounts to health inequality."
But the jury is still out in France on whether recognising obesity as a disease is the way forward.
"There are advantages and disadvantages," Ziegler points out. “A part of the obese population refuses to accept the description, and we can understand that."
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And indeed some of those classed as obese arguably are not. The current measure of obesity – the Body Mass Index (BMI), which uses height and weight – doesn’t distinguish between muscle and fat, so rugby players or judokas, for example, could find themselves labelled as obese.
In a bid to clarify the situation, a group of 56 international health experts recently recommended adding criteria such as waist circumference to BMI. They also proposed two definitions of obesity – pre-clinical and clinical.
"Funders are also afraid because a large proportion of the French population is now affected and the cost of drugs and treatments, if reimbursed, will be high. But it will be very positive for the prevention of complications."
Wonder drugs
The recent arrival of effective weight-loss drugs in France is forcing the debate on obesity.
GLP-1 drugs – marketed under the name Wegovy, the same drug as the much-discussed Ozempic, another brand name – arrived in France in October 2024. They can help patients lose up to 20 percent of their bodyweight – “far more than gastric bands," says Joly, who sees them as a game-changer.
Several thousand chronically obese patients are receiving the drug for free as part of a study by its Danish manufacturer. But outside of this study, the drug is not reimbursed in France and prescriptions are tightly controlled. At a cost of around €300 a month, it is out of reach for most people.
If obesity were to be recognised as a disease in France, it would most likely lead to reimbursement of Wegovy by France’s already cash-strapped public health system.
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Long-term costs
Joly's CNAO recently handed France’s health ministry a report with more than 100 recommendations. In addition to calling for obesity to be recognised as a disease, it advocates for a 10-year obesity plan, like the one effectively rolled out for cancer.
Joly is quietly confident that things are changing, with a national obesity conference held in March under the aegis of President Emmanuel Macron.
Despite resistance over the costs of recognising obesity as a disease, Joly insists the long-term costs of continuing with the status quo will be far greater.
“People with obesity are between four to eight times more likely to get cancer," she pointed out. "And it’ll get worse. It concerns society as a whole.”
The report on obesity among young people in New Caledonia and French Polynesia warned that the cost to those territories runs to €25 million.
