The increasing rates of obesity are contributing to a decrease in life expectancy in the USA. Although innovative obesity therapies are being developed, they alone will not suffice to combat the widespread obesity epidemic. Patients with overweight and obesity face incredible headwinds in an increasingly obesogenic food environment derived from previous and current food, agricultural, and governmental policies. Regional policies contribute to the development of food swamps, which exert an even more substantial influence on weight gain than food deserts. Grocery store layouts and marketing practices perpetuate unhealthy food purchases among low-income individuals. Furthermore, national agricultural policies have contributed to increased portion sizes and a supply of ultra-processed foods. To effectively treat and advocate for patients, general internists must understand how these policies drive the obesity epidemic. In this review, we dissect the marketing practices and regional and national food policies that contribute to the obesogenic food environment. We also highlight policies that provide evidence for improving the food environment and reversing the obesity epidemic.
