In many ways, it’s been a banner year for chronic disease. America’s enduring ailments became a central theme of the Trump administration, with health secretary Robert F. Kennedy Jr. wielding his influence over the president.
Trump created a commission focused on childhood chronic illnesses, which issued two reports on the matter. Statehouses across the country passed Make America Healthy Again-inspired legislation. Private companies and public bodies began emphasizing their commitments to combatting disease. Supplemental Nutritional Assistance Programs cut soda from their menus.
And yet, the factors that drive tens of millions of people to sickness remain largely intact, if not stronger. The administration began its term by decimating scientific research and public health expertise. Congress slashed benefits that support the health of low-income Americans, including millions of children. The MAHA commission’s much-awaited reports landed, in many quarters, with a disappointing thud. Kennedy made a panoply of promises but, so far, has watered down or failed to achieved most of them.
His most enduring legacy as we close out 2025 is dramatically overhauling federal vaccine policy to suit his beliefs, injecting skepticism into the highest ranks of government. (There was also the remarkable press conference about an alleged link between Tylenol and autism.)
Here are three issues we’re keeping an eye on in 2026, which could further cement Kennedy’s legacy, and even have a positive impact on chronic disease.
What effects will GLP-1 price drops have?
The benefits of blockbuster GLP-1 drugs like Ozempic, Wegovy, and Zepbound have become so convincing, they’ve swayed even a spending-averse president and pharma-vilifying health secretary. The Trump administration’s lower negotiated prices on obesity medications could have meaningful effects on public health, experts say — and perhaps the biggest disease-fighting impact of all the ideas Kennedy has pursued so far.
Obesity, type 2 diabetes, and other weight-related conditions are leading drivers of disability and death in the U.S., and cost the U.S. tremendously. So while GLP-1s are expensive — evidenced by exploding prescription drug spending in 2025 — they have proven effective at inducing weight loss and reducing cardiovascular risk, among other things.
Giving more Americans access to the medications is likely to drive down rates of prevalent and problematic chronic conditions. (Early signs point to a slight decrease in obesity rates this year, potentially because of the medications.)
A growing body of evidence also suggests GLP-1s might be useful for treating some substance use disorders. If that research proves out, the drugs’ addiction-curbing effects could be another boon to public health. Heavy alcohol use in particular is an underappreciated and common driver of chronic conditions, including liver disease and certain forms of cancer.
All of the big GLP-1 buzz comes with a medium-sized asterisk. While studies up to this point have shown a mostly mild side effect profile, more long-term studies are needed to establish the drugs’ safety when used over the course of many years. Rare but serious problems, such as pancreatitis, kidney stones, arthritis, suicidal thinking, and eye disease, have to be investigated further. Some experts also worry about GLP-1-induced reductions in lean mass, and how that might contribute to other chronic issues, such as sarcopenia. Companies are actively devising strategies to counteract muscle loss in people taking the drugs.
At the same time, many in the field are racing to figure out new formulations and versions of GLP-1s, including oral pills. Those in the world of pediatrics are still debating when the drugs are appropriate for children and teens, or if lifelong adherence is actually needed for all patients to maintain the medications’ benefits. These important questions could determine the scale of long-term public health gains, since many people fall off medication regimens over time.
In 2026, we could start to see the first wave of effects from widespread GLP-1 use.
How radical will the new dietary guidelines be?
The debut of the new dietary guidelines is now slated for January after several delays so far this year. Suspense is high among food and nutrition experts about what guidelines might look like under MAHA, particularly when it comes to two big potential changes on saturated fat and ultra-processed foods.
Kennedy and other MAHA leaders have said they intend to overturn the current recommendations to limit saturated fat, going against the recommendations of the dietary guidelines advisory committee and a wealth of evidence showing that eating too much saturated fat raises LDL cholesterol, the “bad” kind linked with a higher risk of heart disease.
Jerold Mande, CEO of the nutrition nonprofit Nourish Science and a former senior policymaker on food issues at the Food and Drug Administration and United States Department of Agriculture, said that a change to saturated fat recommendations would be a boon for the meat and dairy industries — but that the food industry at large would likely prefer maintaining the status quo. “They don’t see a strong future for animal products. They just keep getting more and more expensive,” he explained. For packaged food companies trying to decide on the sources of fats in their products, “meat’s just not an option in the long run” — vegetable oils that contain polyunsaturated fats are a cheaper and more sustainable bet.
The new guidelines may also make waves by taking a stance against ultra-processed foods, a frequent target of Kennedy criticism — and a move the advisory committee eschewed late last year, citing the need for more data. “If the dietary guidelines said something about ultra-processed foods that just got people paying attention, I think that would be great,” said Marlene Schwartz, director of the Rudd Center for Food Policy & Health at the University of Connecticut. But she said the guidelines would also need to provide a definition of what constitutes ultra-processed food, a task that the FDA and USDA have said they plan to take on.
The federally funded school lunch program, which is required to follow dietary guidelines, is one big area that could feel impact from such changes. But first the USDA would need to translate the new recommendations into specific requirements for schools, a process that can take years. New restrictions on added sugar and sodium in school meals recently went into effect; before that, the most recent overhaul was the Healthy, Hunger-Free Kids Act of 2012, which required schools to serve more fruits, vegetables, and whole grains.
Schools would also need more government support and resources to shift away from ultra-processed foods and toward fresher meals, said Juliana Cohen, a professor of nutrition and public health at Merrimack College. “It’s going to be hard for food service directors, who are already working extremely hard to meet school meal standards, to then have to analyze every nutrition label to figure out if this is in fact ultra-processed food,” she said. And many school cafeterias don’t have the infrastructure or equipment to prepare fresh food on-site.
The more immediate impact might show up in military cafeterias, Mande said. Defense Secretary Pete Hegseth “can change policy without rulemaking,” he said, noting that the military years ago implemented evidence-backed changes like a color-coded nutrition labeling system that signals which foods have more processing or higher levels of added sugar and artificial sweeteners. Kennedy specifically mentioned the implications of the new guidelines for the military in a November speech.
Rumor has it the new guidelines may also do away with the oft-overlooked MyPlate symbol and replace it with the old food pyramid, turned upside down. Mande notes that this very plot point came up in a 2014 “South Park” episode as a way to solve chronic disease, with fats and oils positioned at the top. Now, he said, “people in positions of power are saying the same thing.”
Which health-boosting experiments in rural America will get the nod?
Its name is bold and its $50 billion budget is record-setting, the single largest investment in rural health care since the Medicare Modernization Act of 2003, the Senate Finance Committee pronounced in July.
At first glance, the Rural Health Transformation Program appears to be just a conduit for funneling funds to strapped rural hospitals and clinics facing slashed Medicaid spending. (The money is likely to fall far short of filling the Medicaid gap, a University of Pennsylvania analysis says.) But there’s more to the story, one that depends on adherence to the MAHA agenda in 2026 and beyond.
Half of that $50 billion will be shared equally by states that apply. Another quarter will be awarded depending on how rural the state is. The remaining $12.5 billion will be distributed to states whose proposals most closely fit MAHA goals, as espoused by Kennedy as health secretary. That invites speculation on what qualifies as a MAHA program.
States were encouraged to seek money for “new and emerging technologies” to bolster prevention and chronic disease management” and for “data and technology driven solutions” to bring health care services as close to a patient’s home as is possible. Other recommended tech solutions include remote monitoring, robotics, and artificial intelligence.
Award proposals were due Nov. 6, with decisions to be made by Dec. 31. On Dec. 18 the Centers for Medicaid and Medicare Services created an Office of Rural Health Transformation to provide oversight. Here’s a look at what some states were betting on to gain favor.
- Delivering health care across vast distances is the top consideration for Montana. Its proposal aims to address the root causes of rural health disparities with these five solutions: expanded technology use, a stronger workforce, secure financial solvency, modernized care delivery, and prevention and community health embedded at the center of care.
- In New York, care coordination, primary care access, behavioral health care access, and the incidence of chronic conditions led the state’s list of what’s behind urban-rural health disparities.
- Indiana already has a “Make Indiana Healthy Again” program. As part of that initiative, the state wants to go further with SNAP by enlisting technology to promote healthy eating in grocery store deserts. The existing Double Up Indiana Program enables SNAP recipients to get a SNAP match for buying fruits and vegetables at farmers markets, but it has only limited retail access. Indiana wants to study integrating nutrition incentives directly onto the Hoosier Works Electronic Benefits Transfer card people now use.
- And Texas has a proposal to reduce chronic disease through prevention, wellness, and nutrition services that it calls “Rural Texas Strong,” That means deploying consumer-facing technology to help patients improve their health, upgrading hospital and clinic equipment, and bolstering the rural health care work force with training, scholarships, relocation payments, and career development.
These projects show us what states would like to try to keep rural residents from falling even farther behind in virtually every measure of chronic disease. The winning states will get a federal boost to put those plans in motion and, eventually, to see what works.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
