Rising Obesity Rates in America: A Public Health Crisis

If you practice medicine in the 21st century, you’re aware that obesity is common in the United States. Some have labeled it a public health crisis, partly due to its overlap and causal relationship with many other health issues. The issue is not limited to the U.S. The WHO has even identified what it calls “an escalating global epidemic of overweight and obesity.”

While we agree we want to turn the tide on this trend, it’s helpful to understand the scale of the problem.

First, there is no exact definition of a public health crisis. The Chicago Department of Public Health defines a public health emergency as, “any adverse event (natural or man-made) that compromises the health of the population and has the potential to cause widespread illness.” However, an emergency suggests immediate action is required, as in the case of a viral outbreak or a hurricane.

Though no less important, a crisis may be considered more chronic. The term has been applied to non-epidemiological issues ranging from pornography to gun violence to racism.

Obesity is not included in The Health and Human Services’ (HHS) list of public health emergencies. What we do know about obesity, however, is that rates are increasing—rapidly. As a medical professional, it may feel as urgent as anything else you treat.

Alarming Statistics of Obesity in America

As of a 2023 report, obesity affects one in three adults and one in six children in America. Consider these statistics, which the CDC collected as part of their National Health and Nutrition Examination Survey (NHANES):

• The prevalence of obesity in the U.S. was 41.9% for the period from 2017 to March 2020.
• For comparison over time, the prevalence was just 30.5% twenty years earlier, in 1999-2000.
• The estimated medical cost of obesity in the U.S. is nearly $173 billion annually.
• A 2023 report from the World Obesity Atlas (WOA) predicts that more than half of the global population will have obesity by 2035, and the U.S. ranks near the top for highest prevalence.
  
  Perhaps most concerning is the relationship between obesity and decreasing life expectancy. A 2014 NIH study showed that severe or class III obesity may shorten life expectancy by as much as 14 years compared with a healthy-weight adult. That is just on par with the impact on life expectancy due to cigarette smoking.

Obesity Rates for Children and Adolescents

Experiencing obesity in childhood can make it hard to overcome it later in life. Unfortunately, children are not immune to the trend of rising obesity rates in America. The CDC reports that for 2017-2020:

• The prevalence of obesity among children and adolescents was 19.7%.
• Prevalence among 2- to 5-year-olds was 12.7%.
• Among 6- to 11-year-olds, 20.7%.
• Among 12- to 19-year-olds, 22.2%.
  
  

This means that more than 14 million U.S. children are living with obesity. They may also experience related conditions like high blood pressure, high cholesterol, type 2 diabetes, asthma, and joint problems. Childhood obesity is more common among certain populations, which we will discuss briefly.

Obesity Rates by Geography

Rates of obesity vary considerably among regions of the country. Adults living in rural areas are more prone to obesity than adults in urban areas, and there is a significant difference in the prevalence of obesity between the Northeast and Southern regions of the U.S.

As of 2023, three states—Louisiana, West Virginia, and Oklahoma—had obesity rates of 40% or greater. Only Washington, D.C. has a rate below 25%.

Obesity Rates by Race and Ethnicity

Obesity affects some ethnic and racial groups disproportionately. Returning to the CDC’s NHANES report:

• Non-Hispanic Black adults had the highest age-adjusted prevalence of obesity at 49.9%.
• The prevalence is even higher among non-Hispanic Black women, at 54.8%.
• Prevalence among Hispanic adults is 45.6%.
• Among non-Hispanic White adults, it is 41.4%.
• Among non-Hispanic Asian adults, it is 16.1%.

Rates are also disproportionately higher in children of some ethnicities.

• Obesity prevalence was 26.2% among Hispanic children.
• 24.8% among non-Hispanic Black children.
• 16.6% among non-Hispanic White children.
• 9.0% among non-Hispanic Asian children.
  
  It should be noted that all the obesity rates reported here are based on BMI, the current standard. However, it is recommended that BMI charts be tailored to race and ethnicity, along with other factors, as they don’t always provide an accurate picture of health for all people.

Obesity and Socioeconomic Status

Another factor in rising obesity rates is socioeconomic status, which considers education and household income. The CDC reported findings collected from 2011-2014:

• Adults with college degrees had lower obesity prevalence compared with those with less education.
• In women, the prevalence of obesity decreased with increasing income from 45.2% to 29.7%.
• However, among men, there was no difference in obesity prevalence between the lowest (31.5%) and highest (32.6%) income groups.
  
  There is further complexity among different age groups and ethnicities. The report linked above goes into more detail on these differences.
  

Health Issues Associated with Obesity

One of the most concerning aspects of obesity is that it predisposes someone to develop several chronic diseases. such as cardiovascular disease, cancers, type 2 diabetes, elevated cholesterol, high blood pressure, stroke, osteoarthritis, steatotic liver disease, sleep apnea, infertility, depression, and social isolation. Moreover, interrelated conditions can exacerbate one another, as seen in sarcopenic obesity, a condition characterized by the coexistence of high BMI and significant muscle loss.

Mental health issues are very common in individuals with obesity. The pervasive stigma around obesity can negatively affect self-esteem. Repeated unsuccessful attempts to lose weight and keep it off can also harm a person’s mental health.

It is important to address a patient’s overall health and to help them understand the wider health implications of their weight.

What Has Caused Increasing Obesity Rates?

Obesity is a “complex neurobehavioral disease” resulting from increased caloric intake and reduced physical activity. Many factors influence the occurrence of obesity, including body-weight genes, type and quantity of food consumed, physical activity, lack of sleep, stress, and socioeconomic factors.

So why have these rates increased in recent decades? Much of the trend can be attributed to pure caloric intake. The average American consumes 23% more daily calories than in 1970.

Nearly half of the average daily calories (all 2,481 of them) come from flour and grains.

In 2016, the USDA enumerated American eating habits in its Food Availability (Per Capita) Data System (FADS) report. In addition to the above, they found that Americans eat more corn-derived sweeteners than 20 years ago, as well as more cheese, but less beef, and less milk. It’s difficult to tie obesity rates to any one food trend.

Americans are cooking at home less and eating more than they used to, which can make portion control and nutritional choices a challenge. Furthermore, limited income can put healthier foods out of reach for some. Other proposed culprits include more time in sedentary work and less walking.

In the 2020s, rates of depression and anxiety are reaching new highs. Mental health shares a complicated relationship with weight. These conditions can lead to emotional eating patterns and reduced motivation for adopting healthy lifestyle changes.

Perhaps some combination of the above causes has led to the increase in obesity rates. Remember that each patient is unique, and presents with their own experiences, lifestyle, and health history.

Applying the Four Pillars of Obesity Treatment to This Crisis

The OMA endorses a comprehensive care model for treating obesity that we call the four pillars: nutrition therapy, physical activity, behavioral modification, and medical interventions.

Applying this model equips medical professionals to treat the whole person, not just the symptoms of obesity. As we face this public health crisis together, here are some of the ways we can hope to reverse these alarming trends.

Nutrition Therapy

A healthy and balanced diet is effective at preventing and treating obesity. A patient can focus on consuming whole grains, fruits and vegetables, fat-free or low-fat milk, along with a variety of proteins derived from animal or plant sources.

Recommend that a patient cut back on processed foods and keep sugar intake under six teaspoons a day. They can also focus on drinking more water daily. You can help by connecting your patients with resources where they can learn more about healthful eating.

Physical Activity

Increased physical activity and an adequate amount of sleep are widely accepted as healthy practices when it comes to maintaining a healthy weight.

The American Heart Association recommends 150-300 minutes of moderate-intensity aerobic activity weekly. Walking 10,000 steps daily is another way to target a reasonable physical activity goal. Focus on helping the patient set realistic goals for themselves with continued encouragement along the way. It may be very difficult for a person to go from no activity to 10,000 steps overnight. Celebrate increased activity wins, regardless of how small they may be to start.

If patients can find ways to wean themselves away from screens and mobile devices, they may find it easier to fit activity and movement into their routines. A wearable device can track their steps and may help motivate them. Encourage your patients to be active with something they enjoy, and perhaps they can invite family or friends to participate as well.

Behavior Modification

Making lifestyle changes can be very difficult and complex for a patient with obesity. It is not as easy as eating better and moving more; this is where behavior modification can help.

Behavioral techniques can help to address barriers to maintaining a healthy lifestyle such as eating out, food cravings, snacking, emotional eating, and sedentary habits.

Some patients may need a personalized approach that helps them sort through their predispositions toward food and eating. Some may benefit from cognitive behavioral therapy.

One technique you might employ with patients is motivational interviewing. This collaborative communication style has gained prominence as an effective tool to enable sustainable lifestyle modifications.

It incorporates listening, interpersonal skills, and support to break a patient out of ambivalence and act toward setting goals and making positive changes. Learn more about motivational interviewing here.

Medical Interventions

Medical and surgical options are also used to control obesity. A growing list of medications is approved to treat obesity. Most work by suppressing the appetite or delaying the time of passage of food from the stomach to the intestine, causing a sensation of fullness.

However, these medications may not be the right choice for everyone.

Many factors go into determining if a medication is needed and appropriate for a patient such as health history, current medications, allergies, side effects, and contraindications.

Surgical approaches to reducing weight are also popular. The surgical approach is usually reserved for individuals with severe obesity and involves reducing the size of the stomach or altering the digestive tract resulting in weight loss.

As a medical practitioner, even if you don’t specialize in obesity medicine, you can play a role in reversing the trend of rising obesity rates in America. The OMA is here for you with numerous resources, conferences, podcasts, and other learning opportunities. Explore our website and consider becoming a member today.