Obesity In The United States
Obesity in the United States is a major health issue resulting in numerous diseases, specifically increased risk of certain types of cancer, coronary artery disease, type 2 diabetes, stroke, as well as significant increases in early mortality and economic costs.
The CDC defines an adult (a person aged 20 years or greater) with a body mass index (BMI) of 30 or greater as obese and an adult with a BMI of 25.0 to 29.9 as overweight. Obesity in adults is divided into three categories. Adults with a BMI of 30 to 34.9 have class 1 obesity; adults with a BMI of 35 to 39.9 have class 2 obesity; adults with a BMI of 40 or greater have class 3 obesity, which is also known as extreme or severe obesity. Children (persons aged 2 to 19 years) with a BMI at or above the 95th percentile of children of the same age and sex are defined as obese, and children with a BMI at or above the 85th percentile but less than the 95th percentile are defined as overweight.
Compared to non-obese Americans, obese Americans incur an average of $1,429 more in medical expenses annually, and the obese American population spends approximately $147 billion per year in added medical expenses.
The obesity rate has steadily increased since the initial 1962 recording of 23%. By 2014, figures from the CDC found that more than one-third (crude estimate 36.5%) of U.S. adults and 17% of children were obese. The National Center for Health Statistics at the CDC showed in their most up to date statistics that 42.4% of U.S. adults were obese as of 2017-2018 (43% for men and 41.9% for women).
For the following statistics, adults is defined as age 20 and over. The overweight + obese percentages for the overall US population are higher reaching 39.4% in 1997, 44.5% in 2004, 56.6% in 2007, 63.8% (adults) and 17% (children) in 2008, in 2010 65.7% of American adults and 17% of American children are overweight or obese, and 63% of teenage girls become overweight by age 11. In 2013 the Organization for Economic Co-operation and Development (OECD) found that 57.6% of all American citizens were overweight or obese. The organization estimates that 3/4 of the American population will likely be overweight or obese by 2020. According to research done by the Harvard T.H. Chan School of Public Health, it is estimated that around 40% of Americans are considered obese, and 18% are considered severely obese as of 2019. Severe obesity is defined as a BMI over 35 in the study. Their projections say that about half of the US population (48.9%) will be considered obese and nearly 1 in 4 (24.2%) will be considered severely obese by the year 2030.
Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year and has increased health care use and expenditures, costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs. This exceeds health care costs associated with smoking and accounts for 6% to 12% of national health care expenditures in the United States.
Epidemiology
Obesity is a chronic health problem. It is one of the biggest factors for type II diabetes and cardiovascular disease. It is also associated with cancer (e.g. colorectal cancer), osteoarthritis, liver disease, sleep apnea, depression, and other medical conditions that affect mortality and morbidity.
According to NHANES data, African American and Mexican American adolescents between 12 and 19 years old are more likely to be overweight than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14% respectively. Also, in a national survey of American Indian children 5–18 years old, 39 percent were found to be overweight or at risk for being overweight. As per national survey data, these trends indicate that by 2030, 86.3% of adults will be overweight or obese and 51.1% obese.
A 2007 study found that receiving food stamps long term (24 months) was associated with a 50% increased obesity rate among female adults.
Looking at the long-term consequences, overweight adolescents have a 70 percent chance of becoming overweight or obese adults, which increases to 80 percent if one or more parent is overweight or obese. In 2000, the total cost of obesity for children and adults in the United States was estimated to be US$117 billion (US$61 billion in direct medical costs). Given existing trends, this amount is projected to range from US$860.7-956.9 billion in healthcare costs by 2030.
Food consumption has increased over time. Annual per capita consumption of cheese was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in 2000; the average person consumed 389 grams (13.7 oz) of carbohydrates daily in 1970; 490 grams (17 oz) in 2000; 41 pounds (19 kg) of fats and oils in 1909; 79 pounds (36 kg) in 2000. In 1977, 18% of an average person's food was consumed outside the home; in 1996, this had risen to 32%.
Contributing factors
Numerous studies have attempted to identify contributing factors for obesity in the United States. Common factors include an overconsumption of food and an insufficient amount of physical exercise. Dieting properly can lower a person's body weight, but the public often fails to correctly determine what to eat and what not to eat as well as how much or how little they should. For example, while dieting, people tend to consume more low-fat or fat-free products, even though those items can be just as damaging to the body as the items containing fat. For the contributing factor of too little exercise, only a small amount (20%) of jobs require physical activity.
Other factors not directly related to caloric intake and activity levels that are believed to contribute to obesity include air conditioning, the ability to delay gratification, and the thickness of the prefrontal cortex of the brain. Genetics are also believed to be a factor, with a 2018 study stating that the presence of the human gene APOA2 could result in a higher BMI in individuals. Also, the probability of obesity can even start before birth due to things that the mother does such as smoking and gaining a lot of weight. Recently there has also been a "fat is beautiful" movement in the US, in which people who consider thin as more attractive than fat are accused of "fat-shaming".
Effects on life expectancy
The United States' high obesity rate is a major contributor to its relatively low life expectancy relative to other high-income countries. It has been suggested that obesity may lead to a halt in the rise in life expectancy observed in the United States during the 19th and 20th centuries. In the event that obesity continues to grow in newer generations, a decrease in well being and life span in the future generations may continue to degenerate. According to Olshansky, obesity diminishes "the length of life of people who are severely obese by an estimated 5 to 20 years." History shows that the number of years lost will continue to grow because the likelihood of obesity in new generations is higher. Children and teens are now experiencing obesity at younger ages. They are eating less healthy and are becoming less active, possibly resulting in less time lived compared to their parents' . The life expectancy for newer generations can expect to be lower due to obesity and the health risks they can experience at a later age.
Prevalence
The National Center for Health Statistics estimates that, for 2015–2016 in the U.S., 39.8% of adults aged 20 and over were obese (including 7.6% with severe obesity) and that another 31.8% were overweight. In the NCHS update for 2018, statistics on severe obesity among U.S adults had already climbed to 9.2% while the total obesity prevalence had reached 42.4%. This also marked the first time in American history that the obesity rates had reached or exceeded 2/5 people in every adult age groups.
Obesity rates have increased for all population groups in the United States over the last several decades. Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased by a factor of five, from one in two thousand to one in four hundred.
There have been similar increases seen in children and adolescents, with the prevalence of overweight in pediatric age groups nearly tripling over the same period. Approximately nine million children over six years of age are considered obese. Several recent studies have shown that the rise in obesity in the US is slowing, possibly explained by saturation of health-oriented media.
Race
Obesity is distributed unevenly across racial groups in the United States. Overall, the prevalence of obesity and severe obesity was highest among non-Hispanic black adults and lowest among non-Hispanic Asian adults. The prevalence of obesity among men was not significantly different between non-Hispanic white, non-Hispanic black, and Hispanic men. Some of these races tend to populate low socio-economic status neighborhoods and therefore can lack the resources such as safe play areas, as well as grocery stores with affordable fruits and vegetables. Furthermore, minority households can be more prone to obesity because of cultural food preferences and family norms.
Caucasian
The obesity rate for Caucasian adults 18 years and older (over 30 BMI) in the US in 2015 was 29.7%. For adult Caucasian men, the rate of obesity was 31.1% in 2015. For adult Caucasian women, the rate of obesity was 27.5% in 2015. The most recent statistics from the NHANES of age adjusted obesity rates for Caucasian adults 20 years and older in the U.S. in 2016 was 37.9%. The obesity rates of Caucasian males and Caucasian females from the NHANES 2016 data were relatively equivalent, obesity rates were 37.9% and 38.0%, respectively.
Black or African American
The obesity rate for Black adults 18 years and older (over 30 BMI) in the US in 2015 was 39.8%. For adult Black men, the rate of obesity was 34.4% in 2015. For adult Black women, the rate of obesity was 44.7% in 2015. The most recent statistics from the NHANES of age adjusted obesity rates for Black adults 20 years and older in the U.S. in 2016 was 46.8%. According to the obesity rates from the NHANES 2016 data, black males had significantly lower than black females, their rates were 36.9% and 54.8%, respectively.
American Indian or Alaska Native
The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2015 was 42.9%. No breakdown by sex was given for American Indian or Alaska Native adults in the CDC figures.
Asian
The obesity rate for Asian adults 18 years and older (over 30 BMI) in the US in 2015 was 10.7%. No breakdown by sex was given for Asian adults in the CDC figures. In more recent statistics from the NHANES in 2016 of a breakdown by sex was provided. Asian adults 20 years and older had a total obesity rate of 12.7%. The rate among Asian males was 10.1% and among Asian females it was 14.8%. Asian Americans have substantially lower rates of obesity than any other racial or ethnic group.
Hispanic or Latino
The obesity rate for the Hispanic or Latino adults 18 years and older category (over 30 BMI) in the US in 2015 was 31.8%. For the overall Hispanic or Latino men category, the rate of obesity was 31.6% in 2015. For the overall Hispanic or Latino women category, the rate of obesity was 31.9% in 2015. According to the most recent statistics from the NHANES in 2016 Latino adults had the highest overall obesity rates. Latino Adults age 20 and older had reached an obesity rate of 47.0%. Adult Latino men's rate was 43.1%, the highest of all males. For adult Latina women the rate was 50.6%, making them second to African-American women.
Mexican or Mexican Americans
Within the Hispanic or Latino category, obesity statistics for Mexican or Mexican Americans were provided, with no breakdown by sex. The obesity rate for Mexican or Mexican Americans adults (over 30 BMI) in the US in 2015 was 35.2%.
Native Hawaiian or other Pacific Islander
The obesity rate for Native Hawaiian or other Pacific Islander adults (over 30 BMI) in the US in 2015 was 33.4%. No breakdown by sex was given for Native Hawaiian or other Pacific Islander adults in the CDC figures.
Sex
Over 70 million adults in U.S. are obese (35 million men and 35 million women). 99 million are overweight (45 million women and 54 million men). NHANES 2016 statistics showed that about 39.6% of American adults were obese. Men had an age-adjusted rate of 37.9% and Women had an age-adjusted rate of 41.1%.
The CDC provided a data update in May 2017 stating that for adults 20 years and older, the crude obesity rate was 39.8% and the age adjusted rate was measured to be 39.7%. Including the obese, 71.6% of all American adults age 20 and above were overweight.
Age
Historically, obesity primarily affected adults. From the mid-1980s to 2003, obesity roughly doubled among U.S. children ages 2 to 5 and roughly tripled among young people over the age of 6, but statistics show that obesity in 2-6-year-olds has dropped, from 14.6% to 8.2%. In recent years from 2015 to 2016, U.S. adults was 39.8% (crude). Overall, the prevalence among adults aged 40–59 (42.8%) was higher than among adults aged 20–39 (35.7%). No significant difference in prevalence was seen between adults aged 60 and over (41.0%) and younger age groups.
Newborns
Mothers who are obese and become pregnant have a higher risk of complications during pregnancy and during birth, and their newborns are at greater risk for preterm birth, birth defects, and perinatal death. There are more possible risks to children born to obese mothers than pregnant women who are not obese. Newborns are also at risk for neurodevelopmental issues. Obese women are in the position to possibly put their child at risk for compromised neurodevelopmental outcomes. It is not known the whole effect that obesity can have on the neurodevelopment of the child. Reports concluded that "children born to mothers with gestational diabetes, which is linked with maternal obesity, are at a higher risk for lower cognitive test scores and behavioral problems." Obese women are less likely to breastfeed their newborns, and those who start doing so are likely to stop sooner. Children who were breastfed every extra week by age 2 had a lower chance of being obese if the hospitals were informative about breastfeeding with mothers or if mothers chose to breastfeed that played a role in the child's weight.
Children and teens
From 1980 to 2008, the prevalence of obesity in children aged 6 to 11 years tripled from 6.5% to 19.6%. The prevalence of obesity in teenagers more than tripled from 5% to 18.1% in the same time frame. In less than one generation, the average weight of a child has risen by 5 kg in the United States. In 2014 it was reported 17.2% of youth aged 2–19 were considered obese and another 16.2% were overweight. Meaning, over one-third of children and teens in the US were overweight or obese. Statistics from a 2016-2017 page on the CDC's official website that 13.9% of toddlers and children age 2–5, 18.4% of children 6-11, and 20.6% of adolescents 12-19 are obese. The prevalence of child obesity in today's society concerns health professionals because a number of these children develop health issues that weren't usually seen until adulthood.
Some of the consequences in childhood and adolescent obesity are psychosocial. Overweight children and overweight adolescents are targeted for social discrimination, and thus, they begin to stress-eat. The psychological stress that a child or adolescent can endure from social stigma can cause low self-esteem which can hinder a child's after school social and athletic capability, especially in plump teenage girls, and could continue into adulthood. Teenage females are often overweight or obese by age 12, as, after puberty, teenage girls gain about 15 pounds, specifically in the arms, legs, and chest/midsection.
Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 19.6%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.
In 2000, approximately 39% of children (ages 6–11) and 17% of adolescents (ages 12–19) were overweight and an additional 15% of children and adolescents were at risk of becoming overweight, based on their BMI.
Analyses of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999–2000, 2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall, in 2003–2006, 11.3% of children and adolescents aged 2 through 19 years were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile.
Trend analyses indicate no significant trend between 1999–2000 and 2007–2008 except at the highest BMI cut point (BMI for age 97th percentile) among all 6- through 19-year-old boys. In 2007–2008, 9.5% of infants and toddlers were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% were at or above the 95th percentile; and 31.7% were at or above the 85th percentile of BMI for age.
In summary, between 2003 and 2006, 11.3% of children and adolescents were obese and 16.3% were overweight. A slight increase was observed in 2007 and 2008 when the recorded data shows that 11.9% of the children between 6 and 19 years old were obese and 16.9% were overweight. The data recorded in the first survey was obtained by measuring 8,165 children over four years and the second was obtained by measuring 3,281 children.
"More than 80 percent of affected children become overweight adults, often with lifelong health problems." Children are not only highly at risk of diabetes, high cholesterol and high blood pressure but obesity also takes a toll on the child's psychological development. Social problems can arise and have a snowball effect, causing low self-esteem which can later develop into eating disorders.
Adults
There are more obese US adults than those who are just overweight. According to a study in The Journal of the American Medical Association (JAMA), in 2008, the obesity rate among adult Americans was estimated at 32.2% for men and 35.5% for women; these rates were roughly confirmed by the CDC again for 2009–2010. Using different criteria, a Gallup survey found the rate was 26.1% for U.S. adults in 2011, up from 25.5% in 2008. Though the rate for women has held steady over the previous decade, the obesity rate for men continued to increase between 1999 and 2008, according to the JAMA study notes. Moreover, "The prevalence of obesity for adults aged 20 to 74 years increased by 7.9 percentage points for men and by 8.9 percentage points for women between 1976–1980 and 1988–1994, and subsequently by 7.1 percentage points for men and by 8.1 percentage points for women between 1988–1994 and 1999–2000." According to the CDC, obesity has consistently remained the highest among middle-age adults since 2011. In the most recent update, 44.8% of Americans in their forties and fifties qualified as obese; meanwhile 40% of young adults and 42.4% of older adults were obese.
Elderly
Although obesity is reported in the elderly, the numbers are still significantly lower than the levels seen in the young adult population. It is speculated that socioeconomic factors may play a role in this age group when it comes to developing obesity. Obesity in the elderly increases healthcare costs. Nursing homes are not equipped with the proper equipment needed to maintain a safe environment for the obese residents. If a heavy bedridden patient is not turned, the chances of a bed sore increases. If the sore is untreated, the patient will need to be hospitalized and have a wound vac placed.
Prevalence by state and territory
The following figures were averaged from 2005 to 2007 adult data compiled by the CDC BRFSS program and 2003–2004 child data[A] from the National Survey of Children's Health. There is also data from a more recent 2016 CDC study of the 50 states plus the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.
Care should be taken in interpreting these numbers, because they are based on self-report surveys which asked individuals (or, in case of children and adolescents, their parents) to report their height and weight. Height is commonly overreported and weight underreported, sometimes resulting in significantly lower estimates. One study estimated the difference between actual and self-reported obesity as 7% among males and 13% among females as of 2002, with the tendency to increase.
The long-running REGARDS study, published in the journal of Obesity in 2014, brought in individuals from the nine census regions and measured their height and weight. The data collected disagreed with the data in the CDC's phone survey used to create the following chart. REGARDS found that the West North Central region (North Dakota, South Dakota, Minnesota, Missouri, Nebraska, and Iowa), and East North Central region (Illinois, Ohio, Wisconsin, Michigan, and Indiana) were the worst in obesity numbers, not the East South Central region (Tennessee, Mississippi, Alabama, Kentucky) as had been previously thought. Dr. P.H., professor in the Department of Biostatistics in the UAB School of Public Health George Howard explains that "Asking someone how much they weigh is probably the second worst question behind how much money they make," "From past research, we know that women tend to under-report their weight, and men tend to over-report their height." Howard said as far as equivalency between the self-reported and measured data sets, the East South Central region showed the least misreporting. "This suggests that people from the South come closer to telling the truth than people from other regions, perhaps because there's not the social stigma of being obese in the South as there is in other regions."
The area of the United States with the highest obesity rate is American Samoa (75% obese and 95% overweight).
| States, district, & territories |
Obesity rank | Obese adults (mid-2000s) | Obese adults (2020) | Overweight (incl. obese) adults (mid-2000s) |
Obese children and adolescents (mid-2000s) |
|---|---|---|---|---|---|
 Alabama |
5 | 30.1% | 36.3% | 65.4% | 16.7% |
 Alaska |
9 | 27.3% | 34.2% | 64.5% | 11.1% |
 American Samoa |
— | — | 75% | 95% | 35% |
 Arizona |
30 | 23.3% | 29.5% | 59.5% | 12.2% |
 Arkansas |
7 | 28.1% | 35.0% | 64.7% | 16.4% |
 California |
48 | 23.1% | 25.1% | 59.4% | 13.2% |
 Colorado |
51 | 21.0% | 22.6% | 55.0% | 9.9% |
 Connecticut |
42 | 20.8% | 26.9% | 58.7% | 12.3% |
 Delaware |
23 | 25.9% | 31.8% | 63.9% | 22.8% |
 District of Columbia |
50 | 22.1% | 23.0% | 55.0% | 14.8% |
 Florida |
35 | 23.3% | 28.4% | 60.8% | 14.4% |
 Georgia |
24 | 27.5% | 31.6% | 63.3% | 16.4% |
 Guam |
— | — | 28.3% | — | 22% |
 Hawaii |
49 | 20.7% | 23.8% | 55.3% | 13.3% |
 Idaho |
32 | 24.6% | 29.3% | 61.4% | 10.1% |
 Illinois |
27 | 25.3% | 31.1% | 61.8% | 15.8% |
 Indiana |
12 | 27.5% | 33.6% | 62.8% | 15.6% |
 Iowa |
4 | 26.3% | 36.4% | 63.4% | 12.5% |
 Kansas |
18 | 25.8% | 32.4% | 62.3% | 14.0% |
 Kentucky |
8 | 28.4% | 34.3% | 66.8% | 20.6% |
 Louisiana |
6 | 29.5% | 36.2% | 64.2% | 17.2% |
 Maine |
33 | 23.7% | 29.1% | 60.8% | 12.7% |
 Maryland |
26 | 25.2% | 31.3% | 61.5% | 13.3% |
 Massachusetts |
44 | 20.9% | 25.9% | 56.8% | 13.6% |
 Michigan |
19 | 27.7% | 32.3% | 63.9% | 14.5% |
 Minnesota |
35 | 24.8% | 28.4% | 61.9% | 10.1% |
 Mississippi |
2 | 34.4% | 37.3% | 67.4% | 17.8% |
 Missouri |
17 | 27.4% | 32.5% | 63.3% | 15.6% |
 Montana |
46 | 21.7% | 25.3% | 59.6% | 11.1% |
 Nebraska |
15 | 26.5% | 32.8% | 63.9% | 11.9% |
 Nevada |
43 | 23.6% | 26.7% | 61.8% | 12.4% |
 28/Flag_of_New_Hampshire.svg/23px-Flag_of_New_Hampshire.svg.png" decoding="async" width="23" height="15" class="thumbborder" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/Flag_of_New_Hampshire.svg/35px-Flag_of_New_Hampshire.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/28/Flag_of_New_Hampshire.svg/45px-Flag_of_New_Hampshire.svg.png 2x" data-file-width="660" data-file-height="440"> New Hampshire |
38 | 23.6% | 28.1% | 60.8% | 12.9% |
 New Jersey |
41 | 22.9% | 27.3% | 60.5% | 13.7% |
 New Mexico |
35 | 23.3% | 28.4% | 60.3% | 16.8% |
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