Obesity prevalence in US has more than doubled over 30 years, projected to rise even more
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Key takeaways:
- The prevalence of obesity more than doubled in the U.S. from 1990 to 2021.
- If trends continue, in most U.S. states, two-thirds of adults will have obesity by 2050.
The prevalence of obesity in the U.S. more than doubled from 1990 to 2021, and the number of Americans with obesity could reach 260 million by 2050 if trends do not change, researchers reported in The Lancet.
“Our analysis lays bare the decades-long failure to tackle the growing overweight and obesity epidemic in the USA. The catastrophic consequences of the surge in overweight and obesity among children are already evident in the rising prevalence of childhood hypertension and type 2 diabetes,” Emmanuela Gakidou, MSc, PhD, professor of health metrics sciences and senior director of organizational development and training at the Institute for Health Metrics and Evaluation, University of Washington, said in a press release.
The researchers conducted the analysis based on self-reported and measured anthropometric data from 134 sources. For adults, overweight was defined as BMI 25 kg/m2 to less than 30 kg/m2 and obesity was defined as BMI 30 kg/m2 or more. For individuals younger than 18 years, the definitions were based on International Obesity Task Force criteria.
The researchers estimated that in 2021, there were 15.1 million (95% uncertainty interval [UI], 13.5 million-16.8 million) children (defined as aged 5 to 14 years), 21.4 million (95% UI, 20.2 million-22.6 million) adolescents (defined as aged 15 to 24 years) and 172 million (95% UI, 169 million-174 million) adults (defined as aged 25 years or older) with obesity in the U.S.
In an analysis by state, the researchers found that for male adolescents, the highest prevalence of age-standardized overweight or obesity was in Texas (52.4%; 95% UI, 47.4-57.6), for female adolescents, the highest prevalence of age-standardized overweight or obesity was in Mississippi (63%; 95% UI, 57-68.5), for adult men, the highest prevalence of overweight or obesity was in North Dakota (80.6%; 95% UI, 78-6-82.5) and for adult women, the highest prevalence of overweight or obesity was in Mississippi (79.9%; 95% UI, 77.8-81.8).
‘Complex, interrelated factors’
“The sharp rise in overweight and obesity among younger people in the U.S. between 1990 and 2021 can be attributed to several complex, interrelated factors,” Xiaochen Dai, PhD, MPH, lead research scientist at the Institute for Health Metrics and Evaluation and co-first author of the paper, told Healio. “These include the following:
“Dietary shifts: Increased consumption of calorie-dense, processed foods, driven by aggressive marketing and affordability, has significantly raised calorie intake among young people.
“Reduced physical activity: Sedentary lifestyles, influenced by more screen time and less physical activity in schools, have lowered energy expenditure.
“Environmental and structural factors: Many neighborhoods lack access to safe recreational spaces, and car-dependent communities discourage physical activity, contributing to more sedentary behavior.
“Socioeconomic and policy gaps: Socioeconomic disparities limit access to healthy food and exercise options, especially in lower-income communities, while existing policies haven’t effectively countered these trends.
“Intergenerational influence: Many young people are raised in environments where unhealthy eating and sedentary habits are normalized, often passed down from previous generations.
“And increasing social acceptance: The normalization of obesity ... can sometimes lead to a reduced urgency to address the obesity epidemic.”
From 1990 to 2021, the percentage change in the age-standardized obesity prevalence increased by 158.4% (95% UI, 123.9-197.4) in male adolescents and 185.9% (95% UI, 139.4-237.1) in female adolescents, whereas the percentage change in obesity prevalence was 123.6% (95% UI, 112.4-136.4) in adult men and 99.9% (95% UI, 88.8-111.1) in adult women, Dai, Gakidou and colleagues wrote.
If the trends and patterns do not change, by 2050, there will be 43.1 million (95% UI, 37.2 million-47.4 million) American children and adolescents and 213 million (95% UI, 202 million-221 million) American adults with overweight and obesity, and in most states, one-third of children and adolescents and two-thirds of adults will have obesity, the researchers wrote.
“If not enough is done to counter the rise in overweight and obesity, the consequences could be severe for individuals, public health systems, and society as a whole,” Dai told Healio, noting these include increased burden of chronic diseases, more early-onset health issues, mental health consequences, substantial economic burden on health care systems, long-term health implications for future generations and added strain on the health infrastructure.
Secondary prevention not enough
In the U.S., “the overweight and obesity crisis ... has now surpassed every known level of epidemic progression,” Sylvain Sebert, PhD, professor of life-course epidemiology at the University of Oulu in Finland, wrote in a related editorial. “There is great hope in new therapeutic approaches, such as GLP-1 analogs, for more effective and well-tolerated treatments for overweight and obesity; however, these treatments should not be seen as a reason to abandon prevention efforts. Health care systems cannot manage the epidemic solely through lifelong secondary prevention policies. There is no vaccine for noncommunicable diseases like obesity. Yet, similar to infectious diseases, obesity is preventable in most cases, and its early signs are recognizable. The genomic, environmental and commercial determinants of obesity have been well established. Also, strong evidence exists that obesity develops throughout the life course, beginning in the earliest stages of life. Hopefully this excellent new report will find its way onto the global policy agenda to aid in prevention efforts for all causes identified and all potential consequences of the obesity crisis.”
References:
- Sebert S. Lancet. 2024;doi:10.1016/S0140-6736(24)02467-X.
- Without immediate action nearly 260 million people in the USA predicted to have overweight or obesity by 2050. https://www.eurekalert.org/news-releases/1064500. Published Nov. 14, 2024. Accessed Nov. 15, 2024.
For more information:
Xiaochen Dai, PhD, MPH, can be reached at xdai88@uw.edu.
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GBD 2021 US Obesity Forecasting Collaborators. Lancet. 2024;doi:10.1016/S0140-6736(24)01548-4.
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