US Obesity Epidemic Continues to Skyrocket, With No End in Sight

Two new studies are highlighting a dark picture of the obesity epidemic in the United States: one shows the number of obesity-related deaths is on the rise and the other projects a continued increase in the number of Americans who have overweight or obesity.

In the Lancet, the Global Burden of Disease (GBD) study collaboration found that more than 170 million adults 25 years and older, as well as 15 million children and young adolescents (aged 5 to 14 years) and 21 million older adolescents (15 to 24 years), have overweight or obesity, defined as a body mass index (BMI) greater than 25 kg/m².

“The current prevalence of overweight and obesity in the US are extraordinarily high and rising, presenting a significant public health concern,” GBD study investigator Xiaochen Dai, PhD (Institute for Health Metrics and Evaluation, Seattle, WA), told TCTMD in an email. “Forecasts to 2050 highlight an even more concerning trend.”

In 25 years, it’s estimated that nearly 213 million adults and 43 million children and adolescents will have overweight or obesity. Put another way, one out of every three children and adolescents, as well as two out of every three adults, will have had a BMI exceeding 25.

“These projections emphasize an urgent need for intervention across all age groups and states, as the expected trajectory could further strain public health systems, exacerbate chronic disease burdens, and drive-up healthcare costs,” said Dai. “Without significant action, the US obesity epidemic will likely continue to escalate with broad, systemic health impacts.”

In the second study, which is scheduled for presentation this weekend at the American Heart Association 2024 Scientific Sessions in Chicago, IL, Aleenah Mohsin, MD (Brown University, Providence, RI), and colleagues showed that the number of heart disease deaths related to obesity also is increasing. Between 1999 and 2020, the age-adjusted obesity-related death rate increased from 2.1 to 7.2 deaths per 100,000, an increase of more than 240%.

Two in Three Overweight/Obese by 2050

To TCTMD, Dai said the GBD collaboration addresses a critical public issue, noting that the US has one of the highest rates of overweight and obesity, which leads to worse health outcomes over time. Despite its high-income status, the US lags behind other countries in life and healthy life expectancy, partly due to the obesity epidemic. There is also a massive economic cost to the crisis, with direct healthcare costs related to obesity estimated to be as high as $480 billion dollars in 2016, he said.

The study was an attempt to provide “comprehensive, state-specific evidence” for the US government to respond to the epidemic by showing the trajectory of disease across multiple demographics. Data were derived from numerous sources, including the major US Centers for Disease Control and Prevention (CDC) surveys, namely the National Health and Nutrition Examination Survey, the Behavioral Risk Factor Surveillance System, and National Health Interview Survey, among others.  

The age-standardized prevalence of overweight/obesity in 2021 among children/young adolescents was 36.2% in males and 37.2% in females. Among older adolescents, the prevalence in males and females was 46.7% and 50.8%, respectively. In adults, the prevalence was 75.9% in men and 72.6% in women. With respect to obesity alone, the prevalence was higher in adult females (45.6%) than in males (41.5%). The prevalence of overweight/obesity in both sexes exceeded 40% in all 50 states and Washington, DC.

Without significant action, the US obesity epidemic will likely continue to escalate with broad, systemic health impacts. Xiaochen Dai

In adolescent females, the prevalence of overweight/obesity was 63.0% in Mississippi, 59.4% in Alabama, and 59.0% in Oklahoma. Among male adolescents, the highest prevalence of overweight/obesity was seen in Texas (52.4%), West Virginia (52.2%), and Oklahoma (51.1%).

In adult males, the prevalence of overweight/obesity was more than 80% in North Dakota, with Washington, DC, having the lowest prevalence, at 65.3%. In adult women, the prevalence ranged from 63.7% in Hawaii to 79.9% in Mississippi. In males, the prevalence of obesity alone exceeded 40% in 39 states and over 45% in 14 states. 

“Among adults in 2021, West Virginia stands out as having the highest obesity prevalence in both sexes, with 50.5% in males and significant rates among females as well,” said Dai. “Mississippi, Louisiana, and Alabama also have notably high obesity prevalence rates among adult females, with Mississippi reaching 55.9%.”

While Washington, DC, Colorado, and Hawaii reported some of the lowest prevalence rates of overweight and obesity and are projected to maintain relatively lower prevalence rates by 2050, the trends are still problematic.  

“While these relatively lower rates in places like Colorado and Hawaii could be seen as ‘okay’ within the national context, the reality is that even these states face rising trends and significant public health challenges related to obesity,” said Dai. “The forecasted increases underscore that no state is truly unaffected by the obesity epidemic.” 

With respect to changes over time, there were large increases in the number of people with overweight and obesity, a trend observed across all age groups and men and women. Concerningly, the prevalence of obesity grew at a steeper rate than the number of people deemed overweight. For males, the largest increases in obesity were seen in New Mexico, Oklahoma, and Georgia. For females, the largest increases were seen in New Mexico, Kansas, and Georgia. 

Social Determinants of Health

In the analysis led by Mohsin, investigators used data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database to assess the trends in obesity-related ischemic heart disease mortality in the US between 1999 to 2020. Over the 21-year study period, there was a 5% annual increase in the rate of ischemic heart disease mortality related to obesity, an increase that was more pronounced in males, particularly those aged 55 to 64 years.

Overall, Black individuals had the highest obesity-related age-adjusted mortality rate at 3.93 deaths per 100,000 people. There were also extensive regional differences, with the highest death rates seen in Midwestern states (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin). Northeastern states, excluding Vermont, had the lowest mortality rates. 

Investigators also found that those living in nonmetropolitan areas had higher age-adjusted death rates than those living in urban areas (4.0 vs 2.9 deaths per 100,000 people). 

Sadiya Khan, MD (Northwestern Feinberg School of Medicine, Chicago, IL), who commented on the CDC WONDER analysis on behalf of the AHA, said there are disparities in social determinants of health contributing to the higher risk of obesity-related mortality among some populations, such as those who identify as Black and those living outside urban centers.

A new advisory from the AHA’s council on cardiovascular-kidney-metabolic health focuses “on these upstream social drivers of health and how we can better address and mitigate inequities related to them,” said Khan.

Pessimistic Future Trends

Speaking with TCTMD, Dai said their projections suggest that 80% of US adults will have overweight/obesity by 2050, “emphasizing the urgent need for intervention, as this crisis shows no signs of naturally leveling off.” Among adolescents, (< 24 years), it’s estimated that 43 million will be overweight or obese, with roughly 24 million meeting criteria for obesity. In adults, 146 million will be considered obese by 2050.

Their study highlights the “national and intergenerational spread of obesity,” an epidemic that requires immediate public health action. The introduction of new weight-loss medications will not be enough to fix the problem, he stressed.

“While newer anti-obesity drugs, such as GLP-1 receptor agonists, have shown effectiveness in managing weight, their national impact could be limited by high costs, inequitable access, and variable long-term effectiveness,” he said. “For these drugs to make a dent in these obesity trends, policymakers would need to address the barriers to accessibility and affordability. However, given the scale of the projections, medical treatments alone won’t suffice.”

In a Lancet editorial, Sylvain Sebert, PhD (University of Oulu, Finland), emphasizes that the introduction of weight-loss medications should not be seen as a reason to abandon obesity-prevention efforts.

“Healthcare 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,” he writes.

Dai noted that there’s been a shift on social perceptions of obesity, and while acceptance fosters inclusivity, “it may also inadvertently reduce the sense of urgency around preventive health measures” to influence community health trends. “Addressing the obesity epidemic will therefore require both systemic interventions and a supportive cultural framework that encourages healthy lifestyles,” he said.