Month: July 2025

The U.S. is seen as both a top ally and threat by its neighbors, a new survey has found.

The Pew Research Center polled around 32,000 adults from 25 middle- and high-income countries across every continent but Antarctica between Jan. 8 and April 26 about their geopolitical views. 

The respondents from Argentina, Australia, Brazil, Canada, France, Germany, Greece, Hungary, India, Indonesia, Israel, Italy, Japan, Kenya, Mexico, the Netherlands, Nigeria, Poland, South Africa, South Korea, Spain, Sweden, Turkey, the U.K., and the U.S. were asked to respond freely, rather than choose from a list of countries. The results were released on Tuesday.

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Many respondents named the U.S. when asked what country was their own’s most important ally. For 15 of the 24 non-U.S. surveyed countries, the U.S. was the most common response (including statistical ties).

But for eight countries, including five of the ones where the U.S. was the top response for most important ally, the U.S. was the most common response when respondents were asked about their own country’s greatest threat. That’s more than any other country but Russia, which is seen as the greatest threat to the most respondents from nine other countries (including statistical ties).

Canada and Mexico were among those where the U.S. is considered both a top ally and top threat.

The view of the U.S. as a threat to Canada and Mexico has grown significantly since researchers conducted a similar survey in 2019. The share of Canadians naming the U.S. as the country’s top threat nearly tripled from 20% to 59%, while that of Mexicans grew from 56% to 68%.

Canada and Mexico were two of the first countries to be hit by U.S. President Donald Trump’s sweeping “reciprocal” tariffs that have rocked the world. Trump has also repeatedly threatened to annex Canada and turn it into the 51st U.S. state, triggering backlash, including consumer and travel boycotts, by some Canadians.

Read More: Trump’s Trade Deals, Negotiations, and New Tariffs for Each Country

U.S., Russia, and China are most commonly named threats

While the U.S. was the most commonly mentioned threat for respondents from eight countries and the most commonly named ally for 15, China, the world’s second biggest economy that is ensnared in trade and geopolitical tensions with the U.S., was the most commonly named ally in just four countries (Indonesia, Kenya, Nigeria, and South Africa) and the most commonly named threat in three (Australia, Japan, and the U.S.).

Russia emerged as the biggest threat in Europe, as it was the most commonly named threat in nine of the 10 European countries surveyed. The share of respondents naming Russia as a key threat in Europe has grown significantly since a similar survey was conducted in 2007, according to the report. At least half of the respondents in France, Germany, the Netherlands, Poland, Sweden, and the U.K., named Russia as their countries’ top threat. And in the U.K., the share who named Russia as the top threat has grown from less than 10% in 2007 to 49% today.

Greece was the only European country where less than a quarter of respondents named Russia as the top threat. There, the majority named Turkey, reflecting a bilateral relationship that has been marked by historical territorial and cultural tensions.

The U.S. was also a commonly named threat across Europe. The U.S. was the second-most common response in six European countries. Only Hungary and Poland did not rank the U.S. among its top three threats.

China was among the most commonly named threats in all five Asia-Pacific countries surveyed. Around half of respondents in both Australia and Japan ranked China as their top threat, while around 20% of respondents in the same two countries named the U.S., making the U.S. the second-most common response.

China was also the second-most common response in India and South Korea, behind rival neighbors Pakistan and North Korea respectively.

The U.S. was also among the most commonly named threats in sub-Saharan Africa and Latin America. It’s named as the biggest threat to all three Latin American countries surveyed: Argentina, Brazil, and Mexico. Among African countries, 35% of South Africans, 23% of Kenyans, and 13% of Nigerians view the U.S. as the biggest threat. Around the same share of Nigerians named China as the country’s biggest threat.

Respondents from the U.S. mainly named China as the country’s biggest threat (42%), followed by Russia (25%). The U.S. was the only country outside the Asia-Pacific where over 20% of respondents named China as the top threat, Pew researcher Janell Fetterolf told the South China Morning Post.

Global views reflect ideological divides

Attitudes towards the U.S. and China vary across ideological lines, even within the same country.

While China was the most commonly named threat in the U.S., the share of respondents who identified as Democrats or Democrat-leaning that named China as a top threat has fallen since a similar survey in 2023. That year, the most commonly named threat by both Republicans and Democrats was China. Today, around 58% of Republican and Republican-leaning respondents named China while just 28% of Democrat and Democrat-leaning respondents did; instead, more ranked Russia as the biggest threat.

The survey also asked respondents in 19 countries, not including the U.S., to place themselves on a scale ranging from “Extreme left” to “Extreme right.” In Japan and South Korea, that scale ranged from “Extremely progressive” to “Extremely conservative.” Respondents in India, Indonesia, and Kenya were not asked about ideology.

In several of the surveyed countries, respondents who identified as being on the left were more likely to name the U.S. as the country’s biggest threat, while respondents on the right were more likely to name China as their country’s biggest threat.

In Europe, Pew says supporters of right-wing populist parties were more likely to see the U.S. as an ally. Supporters of Fidesz in Hungary, Law and Justice in Poland, Reform U.K., AfD in Germany, Lega in Italy, Vox in Spain, Party for Freedom in the Netherlands, and National Rally in France all polled higher in naming the U.S. as an ally compared to supporters of other parties.

U.S. mainly seen as an economic threat

The poll also showed that the U.S. is largely seen as an economic threat, rather than a national security threat, while Russia is mostly seen as a security threat and opinions on China were mixed.

In Canada, more than three-quarters of respondents who named the U.S. as a top threat said it poses an economic risk to Canada, as did a majority of respondents in Argentina, Australia, France, Germany, Italy, Kenya, Mexico, Nigeria, South Korea, and Turkey. Still, more than half of Canadians and Mexicans also said the U.S. poses a significant national security threat.

The survey took place as Trump has levied harsh tariffs on much of the world, including some of its longtime trading partners and allies like Japan and South Korea. It’s also come after Trump shuttered USAID, risking the lives of millions around the world in dozens of low- and middle-income countries.

Russia, on the other hand, is mainly viewed as a security risk, particularly in Europe where its yearslong war with Ukraine has raised concerns about respect for territorial integrity and sovereignty. Among Americans, too, who ranked Russia as their top threat, nearly three-quarters said it poses a national security threat while a third said it poses an economic threat.

China, meanwhile, is seen as both an economic and national security risk by roughly the same share of respondents in the U.S., Canada, the U.K., South Korea, Australia, India, and South Africa. Overall, China is seen as more of an economic threat, except by Japan, which sees China as more of a security threat. In the U.S., 64% of respondents that ranked China as a top threat see it as an economic threat, while 61% see it as a security threat. 

China has in recent months ramped up its efforts to position itself as a key economic and diplomatic partner, in contrast with Trump’s more volatile leadership. But Pew’s survey—and an earlier survey of Southeast Asian nations—suggests that many countries may not be ready to fully embrace China as a global leader, especially those in its vicinity amid continuing concerns around Chinese aggression in the disputed South China Sea or towards Taiwan.

“What a lot of countries value the most is stability, a trusted, reliable, authentic partner,” Mark Cogan, associate professor of peace and conflict studies at Japan’s Kansai Gaidai University, tells TIME. The U.S. under Trump isn’t exactly prioritizing trust-building with other nations around the world, he adds, leaving it an open question should allegiances ever have to be drawn outside of a survey: “Who are they going to pick in the end?”

Modern medicine now offers safe, effective tools to treat obesity—from life-saving bariatric surgery to powerful new medications. Yet most people with obesity can’t access these treatments because obesity isn’t widely recognized as a disease. In many countries, including the U.S. and U.K., access to treatment is granted only when another related condition, like hypertension or type 2 diabetes, is already present, even though there is ample evidence that obesity alone can cause serious harm.

To improve access to care, many professional organizations have advocated for classifying obesity as a disease. However, the idea remains controversial, fueling one of the most polarizing debates in medicine and society at large. 

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Reflecting on this in 2019, I wondered why such a basic medical question provokes divided opinions across medicine and society. Determining whether a condition is a disease should be a matter of science—not opinion. Obesity has been known to humanity for thousands of years and both ancient and modern physicians have recognized its health risks. So why wasn’t this question already settled?

As I explored this issue further, it became clear that obesity had never been coherently described as an illness with its own specific signs and symptoms. Instead, it was historically measured by surrogate markers of body size and health risk, like BMI. Without a clear clinical identity, and thus no true diagnosis, it’s no surprise that the idea of obesity as a disease has remained so contentious.

The result has been ineffective prevention, fragmented care, widespread stigma, and confusion around the nature of obesity. 

With more than 1 billion people now living with obesity, effective therapies available but out of reach for many, and no coherent or ethical way to prioritize care and limited resources, an objective clinical diagnosis of obesity was more urgent than ever. 

A conversation about the issue with Dr. Marta Koch, editor-in-chief of The Lancet Diabetes & Endocrinology, led to the formation of the Commission on Clinical Obesity, which I had the privilege of chairing. We convened 56 global experts and spent over three years pursuing a challenging goal: aligning obesity diagnosis with established medical principles. 

The task wasn’t easy. At the start, our opinions varied widely. When pressed to describe obesity as a disease, we’d fall back on portraying it as a harbinger of other diseases. We got stuck in a loop, saying obesity qualifies as a disease if two—or maybe three—other related diseases and conditions are also present. But those conditions have their own distinct causes and mechanisms beyond obesity. This arbitrary reasoning has no parallel elsewhere in medicine.

Accustomed to measuring obesity merely by BMI, which is a proxy for body size and associated health risks, rather than by objective signs of direct harm to health, we specialist care providers had, over time, become so detached from the core principles of clinical diagnosis that our idea of disease itself had become distorted.

Disease diagnosis, by definition, identifies a distinct disease entity rather than an overall state of ill health. In stark contrast, for decades we quantified the health impact of obesity using risk scoring systems and management frameworks that grade obesity’s severity based on the risk of mortality from related conditions like hypertension or diabetes, thereby reflecting a state of overall ill health, but not a distinct pathological entity. This practice has fostered a tendency to conflate diagnosis with management frameworks, confuse co-morbidities with symptoms, and ultimately blur the distinction between obesity as a risk factor and as a disease state.

To move forward, we had to return to the drawing board and recall the foundational principles of disease diagnosis we learned in medical school: diseases are pathological conditions that directly impair organ function, producing measurable signs and symptoms—regardless of other conditions.

Viewing obesity through this lens required us to reverse-engineer its traditional medical framing. Doing so, the conceptual challenges began to resolve, and we reached strong consensus that obesity can indeed be a disease—when it leads to illness by directly causing harm to the body’s organs— though this is not always the case. We proposed a two-part diagnostic framework:

1. Clinical obesity: a chronic disease where excess fat causes impairment in the function of organs (e.g., heart, lungs, joints, metabolism, the reproductive system) or the whole organism.
2. Pre-clinical obesity: a condition where excess fat increases future health risks but hasn’t yet caused detectable harm.

This framework helps identify who needs care aimed at risk reduction and who needs interventions for disease treatment. It moves beyond BMI to focus on real health impact—just as we do with diabetes, cancer, and other diseases.

Over many years as a bariatric surgeon, I’ve treated many patients with severe symptoms of clinical obesity. I’ve seen some people struggle to breathe, walk, or work, but still be denied care because their obesity wasn’t recognized as a disease. This long overdue diagnostic clarity was thus not just a medical milestone—it was a step toward correcting a longstanding injustice and improving access to care.

Although the new diagnostic framework was endorsed by 79 professional societies and praised by many for its clarity, some expert’s reactions echoed the same conceptual barriers we faced during the work of the Commission. A few critics questioned why related diseases like diabetes weren’t included in the definition of clinical obesity, revealing the entrenched habit of defining obesity through other conditions. Others were frustrated—some even outright angry—that the Commission fell short of declaring all forms of obesity a disease and instead recommended a more nuanced clinical diagnosis. Such critics are concerned that our approach might dilute the sense of urgency necessary and undermine public messaging.

But diagnoses are not meant to serve as narratives or slogans—they must reflect medical reality. Long-established medical evidence shows that obesity exists on a spectrum—a fact already recognized since Hippocrates and Galen over 2,000 years ago.

The health impact of obesity, in fact, varies widely at the individual level. Some people experience organ damage due to obesity alone, others remain healthy for years, even lifelong. In some contexts, extra body fat can even offer protection—such as during recovery from surgery or critical illness, a phenomenon called the “obesity paradox.”

Recognizing the evidence of obesity’s spectrum isn’t a weakness of the new diagnosis—it’s a strength. The categories of clinical and pre-clinical obesity reflect real differences in health status and allow for personalised care.

Some worry that people with pre-clinical obesity will not be considered a priority and could lose access to care. But doctors already intervene in other pre-clinical conditions when there is a high health risk—prescribing statins for high cholesterol, metformin for pre-diabetes, even performing surgery for pre-cancerous polyps. The same logic should apply to pre-clinical obesity. No health system can afford to offer surgery or costly medications to every person with obesity—nor should it, if some don’t need them. Tailoring care based on need—not size—is far more coherent and sustainable than applying the same treatment to everyone.

Obesity is not just a clinical spectrum—it’s also a biological one. Excess fat can result from other medical conditions, side effects of medication, genetic disorders, or adaptation to modern environments, and likely other causes that are still unknown. Yet society still frames obesity as a failure of willpower—a harmful misconception that fuels stigma and misleads approaches to care and policy.

An objective clinical diagnosis of obesity finally allows us to separate risk from disease and biology from blame. 

But adopting this diagnosis will require a fundamental shift in mindset, within medicine and across society. It’s time for healthcare professionals, policymakers, and the public to recognize that obesity can be a disease for some, though not for all. And that we must not diagnose illness—nor judge character—based on body size alone.