Rise of Obesity in America: Should We Be Alarmed?

A new snapshot of obesity in America paints an alarming picture.

In 2018, for the first time, more than 35% of adults in 9 mostly southern states -- Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, and West Virginia -- were obese.

In 2017, the prevalence of obesity was more than 35% in only 7 states.

"These latest data shout that our national obesity crisis is getting worse," said John Auerbach, MBA, president and CEO of Trust for America's Health, the nonprofit organization that published the report, The State of Obesity: Better Policies for a Healthier America 2019, on September 12.

The data in the 16th annual report "tell us that almost 50 years into the upward curve of obesity rates we haven't yet found the right mix of programs to stop the epidemic," according to Mr Auerbach.

As recently as 2012, no state had an adult obesity rate above 35%, but in the 5 years from 2013 to 2018, 33 states had statistically significant increases in adult obesity.

The current report, Mr Auerbach noted in a press release from his institution, "highlights the fundamental changes that are needed... for people to eat healthy foods and get sufficient exercise," and it provides recommendations for government policies to tackle this "obesity crisis."

Almost 40% of US Adults and Nearly 20% of Kids Are Obese

The report is based on data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (CDC) and the most recent 2015-2016 National Health and Nutrition Examination Survey (NHANES).

The nationally representative NHANES data reveal "unprecedented levels of obesity," the report states. In 2015-2016, 39.6% of adults and 18.5% of children in America were obese (body mass index [BMI]>30 kg/m² for adults), with the increased risks for numerous poor health outcomes that go along with obesity.

"Strikingly, the incidence of obesity in the United States has increased by 70% over the last 30 years for adults and by 85% over the same time... for children," the authors noted.

The data also reveal that obesity is much more of a problem among minority and disadvantaged populations.

Blacks and Latinos are often targeted in advertising for unhealthy food and tend to live in neighborhoods with fewer healthy food options or opportunities for physical activity, which may partly explain their higher obesity rates.

Among adults, nearly half of Latinos (47%) and blacks (46.8%) were obese compared with 37.9% of whites and 12.7% of Asians. Similarly, among children, about a quarter of Latinos (25.8%) and blacks (22%) were obese, but only 14.1% of white and 11% of Asian kids were obese.

Some Light at the End of the Tunnel?

There have been some successes in bucking the trend, however (eg, obesity rates among children enrolled in the Women, Infants, and Children [WIC] Special Supplemental Nutrition Program declined from 15.9% in 2010 to 13.9% in 2016, and a study published this year reported that 4-year-old children in Los Angeles County, Los Angeles, California, who had received the WIC food package since birth were less likely to become obese).

Taxes on sugar-sweetened beverages passed in several US cities and the Navajo Nation also show promise as a means to change consumers' beverage habits. For example, a 1¢/fl oz tax on sugar-sweetened beverages in Berkeley, California, and a 1.5¢/fl oz tax in Philadelphia, Pennsylvania, were associated with decreased consumption.

Clinical Context

The annual report The State of Obesity: Better Policies for a Healthier America by Trust for America's Health describes the most recent obesity trends and suggests strategies, policies, programs, and practices to address this major public health burden. State of Obesity also shows the level of commitment needed to combat obesity effectively on a large scale and includes key recommendations for specific action.

As in the past, this year’s obesity rates are alarmingly high, with persistent racial, ethnic, and geographic disparities; many populations continue to have steady increases in obesity; and meaningful reductions have not yet been achieved nationally except possibly among the youngest children in low-income families. To ensure this nation’s health, it is essential to stem and even reverse the obesity epidemic.