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Study Finds Nearly 75% of Adults 25 and Older Have Overweight or Obesity
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Key Takeaways
- Nearly 75% of US adults are overweight or obese, with significant increases in prevalence since 1990, especially among adolescents.
- The study used a generalized ensemble model to project future trends, predicting substantial increases in obesity by 2050.
If patterns and trends were to continue, the authors predict that nationwide overweight and obesity prevalence in adults will surpass 80% by 2050.
According to findings of a recent study published in The Lancet, nearly 75% of US adults are overweight or obese. The authors are concerned that existing policies have not effectively address overweight and obesity, and without major reform, trends will continue to escalate and negatively impact both the individual and population level.1,2
For this study, both self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Because of potential self-reported biases, the authors made adjustments to mitigate them from possibly influencing results.2
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For individuals older than 18 years of age, overweight was defined as having a body mass index (BMI) of 25 kg/m2 to less than 30 kg/m2, and obesity was defined as a BMI of 30 kg/m2 of higher. For those younger than 18 years, definitions were based on International Obesity Task Force criteria, according to the authors. Additionally, historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated, and based on the assumption that past trends and patterns will continue, a generalized ensemble model was then used to derive the projected estimates up to 2050. All estimates were calculated by both age and sex at the national level, with estimates for older adolescents (individuals aged 15 to 24 years) and adults (individuals ≥25 years) calculated for 50 states and Washington, DC.2
According to the study findings, an estimated 15.1 million (95% UI 13.5–16.8) children and young adolescents, 21.4 million (95% UI 20.2–22.6) older adolescents, and 172 million (95% UI 169–174) adults had overweight or obesity in 2021. Between 1990 and 2021, the change in the age-standardized prevalence of obesity increased by approximately 158.4% (95% UI 123.9–197.4) and 185.9% (95% UI 139.4–237.1) among male and female adolescents, respectively. The change in prevalence among adults was lower, with increases being 123.6% (95% UI 112.4–136.4) in men and 99.9% (95% UI 88.8–111.1) in women.2
The data also showed that Texas had the highest age-standardized prevalence of overweight or obesity for male adolescents (52.4%; 95% UI 47.4–57.6), whereas Mississippi had the highest for female adolescents (63.0%; 95% UI 57.0–68.5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for men (80.6%; 95% UI 78.5–82.6) and in Mississippi for women (79.9%; 95% UI 77.8–81.8).2
Using a model that depended on the continuation of past trends and patterns, the authors predict that an additional 3.33 million children and young adolescents, 3.41 million older adolescents, and 41.4 million adults will have overweight or obesity by 2050. Additionally, most states in 2050 will have a projected 1 in 3 adolescents and 2 in 3 adults will have obesity. The authors note that although southern states—such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia, and Kentucky—are predicted to continue having high prevalences of obesity, the highest percentage changes from 2021 are projected in Utah for adolescents and Colorado for adults.2
The authors observed that obesity’s prevalence has outpaced the increase in overweight over time, particularly among adolescents.2 Additionally, they acknowledge that BMI is an imperfect measure and lacks the ability to capture variations in body structures across populations; however, they explain that BMI, from a scientific perspective, can be correlated with other measures of body fat (eg, waist-stature ratios, waist circumference, and dual x-ray absorptiometry), making it a practical tool to study population levels.1,2
Further, there are many factors that can contribute to the increased rates of overweight and obesity, such as the wide availability of ultra-processed foods, difficulties accessing fresh food, an overall increase in sedentary activity, and social drivers of health outcomes (eg, food insecurity, transportation access, employment and education) for minority and low-income communities.1 The authors note that further research is needed to better understand and evaluate how environmental factors, such as exposure to microplastics which may be disrupting individuals’ microbiomes, are influencing these trends.1,2
“It’s going to require a lot more attention and a lot more investment than we are currently giving the problem,” Sarah C. Armstrong, MD, professor of pediatrics and population health sciences at Duke University, said in a New York Times article. “Obesity comes from genetic, physiological, and environmental interactions. It’s not the fault of any 1 individual who has the disease.”1
Other potential factors may influence, such as high maternal BMI prior to conception, excessive weight gain during pregnancy, and high infant birth weight, can also be influences. Although at the individual level, interventions that involve a combination of lifestyle modifications, medication, and surgery may be beneficial, not every individual will need or benefit from these. The authors urge that innovations should be leveraged to both treat and manage existing obesity equitably at the individual level.1,2
Structural changes are necessary to have a larger influence reversing population-wide trends. The authors suggest that regulation of nutritional content in food, the overall marketing of unhealthy foods, and subsidies for health food and taxes on sugar-sweetened beverages may have effects; however, such measures will require coordination at the federal level.1
