Dr Leonardo Trasande
Paediatrician, NYU Professor and author of Sicker Fatter Poorer on the true cost of endocrine disrupting chemicals to human health.
Dr Leonardo Trasande is Professor of Paediatrics, Environmental Medicine and Population Health at NYU Langone Health and Director of the Division of Environmental Paediatrics. He is internationally recognised for his research into the economic and health costs of endocrine disrupting chemical exposure, leading studies that documented $340 billion in annual disease costs in the US and €163 billion in Europe attributable to chemical exposure. His 2019 book Sicker Fatter Poorer brought this research to a mainstream audience for the first time. He represents the Endocrine Society at the Global Plastics Treaty negotiations and has contributed to the World Health Organization and UNEP reports on endocrine disrupting chemicals. He trained at Harvard and completed a legislative fellowship in the office of Senator Hillary Rodham Clinton. He has said that endocrine disrupting chemicals are one of the biggest global health threats of our time and that 2% of the population know about it while 99% are affected by it.
Watch the Talk
In this TEDx talk delivered at the Great Pacific Garbage Patch in December 2025, Dr Trasande covers how plastics and the chemicals they contain cause harm from before birth through to old age, and what the economic and health costs of inaction look like. One of the most recent and comprehensive public talks he has given on this subject.
Key Points from His Research
Trasande's research has quantified what most policy makers ignore. His studies found that endocrine disrupting chemical exposure costs the US $340 billion annually and Europe €163 billion in disease burden. More recently his team documented $249 billion per year in US disease costs attributable specifically to chemicals in plastics. These figures come from calculating the economic cost of conditions directly linked to chemical exposure including infertility, obesity, diabetes, learning disabilities and certain cancers.
Trasande identifies five categories of endocrine disrupting chemicals that carry the strongest evidence for human health harm: bisphenols (BPA and its replacements), phthalates, pesticides, flame retardants and PFAS. These are not obscure industrial chemicals. They are present in food packaging, non-stick cookware, children's products, cleaning products, clothing and personal care products used in virtually every household every single day.
As a paediatrician Trasande focuses particularly on the effects of chemical exposure during development. He notes that children have higher surface-area-to-body-weight ratios than adults, breathe more air per kilogram of body weight, eat more food per kilogram and have developing organ systems that are more sensitive to chemical interference. The window of fetal development and early childhood is the period of greatest vulnerability and the period in which chemical damage is most likely to have lasting consequences.
Trasande has researched what he calls obesogens, endocrine disrupting chemicals that interfere with the body's metabolism and fat storage mechanisms. His research suggests that chemical exposure is a contributing factor to the global obesity epidemic that cannot be explained by diet and exercise alone. BPA exposure in particular has been associated with disrupted metabolic signalling in multiple studies.
Unlike some researchers in this field, Trasande is explicitly empowering in his approach. He argues that while systemic regulatory change is essential, individual choices about what we eat, what we cook with and what we put on our bodies make a measurable and meaningful difference to our personal chemical body burden. Eating organic reduces pesticide exposure. Switching to glass storage reduces bisphenol exposure. Choosing PFAS-free cookware reduces PFAS intake from food. Small changes, consistently applied, add up.
Full Transcript
Transcript of The Plastic Health Paradox, TEDx Great Pacific Garbage Patch, December 2025. Lightly edited for readability.
So, I have a confession to make. I have long been part of the plastic pollution problem. In some ways, I still am. And for a long time, I have been an unwitting contributor.
We have been taught in medical school that much of the plastic equipment we use was essential. And indeed, much of it probably is still. We intubate babies with breathing tubes made of plastic. We feed adults who are malnourished or having difficulties after a surgical procedure with gastric tubing made of plastic. We filter out blood when patients are critically ill and their kidneys are failing. We provide critical treatments with inhalation medication delivery through plastic. But so much of plastic in healthcare is actually non-essential and we waste a lot of plastic. 14,000 tons of waste are produced by US hospitals. 20% of that is plastic. So we are part of the problem.
And we may have been lulled to sleep as healthcare professionals about the plastic pollution problem. The average medical student gets between one and four hours still to this day of environmental health training. That is less than one open heart procedure.
We have also, when training, been taught for many years based upon a Swiss philosopher about toxicology, Theophrastus Bombastus von Hohenheim. Paracelsus. He taught us something to the effect of only the dose makes the thing a poison. So the assumption was that lower levels of chemical exposures were not a problem. High dose exposures, bigger problem. But a theme of my journey in plastics and human health is that knowledge evolves, and things change.
Even as a paediatric resident, I probably saw the alarms coming when I saw children with type 2 diabetes coming through time and time again, more every year. And then there were scientific statements starting to emerge. The Endocrine Society came out with a first scientific statement on what we call hormone disrupting chemicals. A second statement followed with 1,331 scientific references just six years later. So things evolve very quickly in our knowledge and understanding of what plastic does to our health.
Plastic hacks our hormones, our signalling molecules that underlie basic biological functions, from temperature, metabolism, salt, sugar, and even sex. These are chemicals that run around in extremely low levels in our body. They are the concert masters of human function. And what chemicals in plastics do is hack those normal signalling molecules.
Going back to Paracelsus, these are chemicals operating at the same levels as grains of sand in a desert or salt in an Olympic-size swimming pool. Operating at really low dose levels, but at the same levels that hormones normally operate.
We have evidence at this point for so many chemicals in plastics and their effects on human health. We are talking about flame retardants used to make sure that plastic devices do not burn. We are talking about phthalates used to soften polyvinyl chloride plastic used in food packaging and cosmetics. We are talking about bisphenols used in aluminium can linings and thermal paper receipts. We are talking about per and polyfluoroalkyl substances, forever chemicals, used in non-stick cooking and oil and water resistant clothing.
And the impacts run from cradle to grave and womb to tomb. They make babies shrink compared to their normal birth weight so that they are programmed to take an adverse metabolic profile for the rest of their lives, obesity, diabetes, and heart disease. We are talking about effects on thyroid hormone, the master conductor of brain development. And in the clinically normal range, this is not something an obstetrician can detect. You have literally shrinkage of the baby's brain compared to the optimal amount. So they have a permanent burden of cognitive deficits, autism, and even attention deficit hyperactivity disorder.
As a paediatrician, I will tell you kids are uniquely susceptible for all sorts of reasons. Pound for pound, they eat more food, breathe in more air, drink more water. Developing organs are vulnerable. But we are all vulnerable to the effects of these chemicals. 50,000 Americans between the ages of 55 and 64 die of early heart disease due to phthalates alone. Increasingly, we are understanding that flame retardants, bisphenols and phthalates contribute to hormone sensitive cancers, thyroid, ovary, breast, and testicular cancer.
The costs of diseases due to chemicals in plastic are $249 billion a year in the US alone. That is already 1.2% of gross domestic product. And that is just the plastic specific part, covering one category of the 16,000 chemicals used in plastic materials. We know nothing about 10,000 of those 16,000.
Take that out to a global level and just phthalates alone, one category of those 16,000 chemicals, we are talking about 350,000 people dying globally. The social costs of those deaths are between $510 billion and $3.74 trillion. The global revenue of the plastics industry is around $500 to $700 billion a year. So this is already a losing industry based on one disease endpoint due to one set of chemicals.
I have not said a thing, by the way, about micro and nano plastics. What I can tell you is they are probably the toxic drug delivery systems that bring chemicals to tissues, and they may have wrecking ball effects on our bodies as a result. We have so much more to do.
The National Academy of Sciences now suggests routine testing for per and polyfluoroalkyl substances, those forever chemicals, in roughly 150 million Americans that have enough water contamination to spike up the levels. And they are specifically suggesting additional medical monitoring and clinical follow-up based upon the testing. That PFAS report was a watershed first clinical test for environmental hazards since lead exposure in children. If we do not measure, we do not know what is going on. We cannot tell that there is a problem in the first place.
Would I tell you that what I learned in medical school was wrong? No, it was what we knew at the time. But what I was told at the beginning of medical school is that half of what we learned would roughly be wrong by the time we ended medical school or even 20 years later. That means we have to put plastics and environmental hazards firmly into all aspects of what we do.
If there is one thing I can leave you with today, it is to be as curious about the invisible as the visible. The evidence is already telling us we have to act.
Dr Leonardo Trasande, TEDx Great Pacific Garbage Patch, December 2025
We in healthcare have led the way in preventing environmental hazards. We got mercury out of medical waste incinerators. We have led the way in preventing lead exposure in children. We can be part of the change that consumers are demanding right now. And be part of the solution in our own house.
His Book
Sicker Fatter Poorer
Dr Leonardo Trasande. Published 2019.
Trasande builds the case that the epidemic increases in chronic disease seen over the past half century, obesity, diabetes, infertility, learning disabilities and certain cancers, cannot be explained by genetics or lifestyle alone. He documents the role of endocrine disrupting chemicals in driving these conditions, quantifies the economic cost of regulatory failure, and provides practical guidance on how individuals can meaningfully reduce their exposure. Written for a general audience, it is one of the most comprehensive and readable books on this subject available.
Connects directly to: our Start Here page on endocrine disruptors, the Research and Studies page, and our Food and Nutrition guide on pesticide exposure.
Endocrine-disrupting chemicals are one of the biggest global health threats of our time. And 2% of us know about it — but 99% of us are affected by it.
Dr Leonardo Trasande, NYU School of Medicine
Sources: Trasande L et al., Endocrine disrupting chemicals and disease costs (2016) | Trasande L, Sicker Fatter Poorer (2019) | WHO/UNEP State of the Science Report on Endocrine Disrupting Chemicals | TEDx Great Pacific Garbage Patch (December 2025). Some links on this page are Amazon affiliate links. Purify The World may earn a small commission on purchases made through these links at no extra cost to you.