Obesity in the United States
This article needs to be updated.February 2017)(
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 economic costs. While many industrialized countries have experienced similar increases, obesity rates in the United States are the highest in the world.
Obesity has continued to grow within the United States. Two of every three American men are considered to be overweight or obese, but the rates for women are far higher. The United States contains one of the highest percentage of obese people in the world. An obese person in America incurs an average of $1,429 more in medical expenses annually. Approximately $147 billion is spent in added medical expenses per year within the United States. This number is suspected to increase approximately $1.24 billion per year until the year 2030.
The United States had the highest rate of obesity within the OECD grouping of large trading economies. From 23% obesity in 1962, estimates have steadily increased. The following statistics comprise adults age 20 and over. The overweight percentages for the overall US population are higher reaching 39.4% in 1997, 44.5% in 2004, 56.6% in 2007, and 63.8% (adults) and 17% (children) in 2008. In 2010, the Centers for Disease Control and Prevention (CDC) reported higher numbers once more, counting 65.7% of American adults as overweight, and 17% of American children, and according to the CDC, 63% of teenage girls become overweight by age 11. In 2013 the Organisation for Economic Co-operation and Development (OECD) found that 57.6% of American citizens were overweight or obese. The organization estimates that 3/4 of the American population will likely be overweight or obese by 2020. The latest figures from the CDC as of 2014 show that more than one-third (36.5%) of U.S. adults age 20 and older and 17% of children and adolescents aged 2–19 years were obese. A second study from the National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).
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.
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.
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 or a biological limit on obesity.
Obesity is distributed unevenly across racial groups in the United States.
The obesity rate for Caucasian adults (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.
Black or African AmericanEdit
The obesity rate for Black adults (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. BMI is not a good indicator in determining all-cause and coronary heart disease mortality in black women compared to white women.
American Indian or Alaska NativeEdit
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.
Hispanic or LatinoEdit
The obesity rate for the Hispanic or Latino adults 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 31.8% in 2015. For the overall Hispanic or Latino women category, the rate of obesity was 31.8% in 2015.
Mexican or Mexican AmericansEdit
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 IslanderEdit
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.
Over 70 million adults in U.S. are obese (35 million men and 35 million women). 99 million are overweight (45 million men and 54 million women).
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%
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 neurodevelopmental 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.[non-primary source needed]
Children and teensEdit
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. As of 2014, about one-third of children and teens in the US are overweight or 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.
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 is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults."
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.[clarification needed] 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.
In the militaryEdit
An estimated 16% percent of active duty U.S. military personnel were obese in 2004, with the cost of remedial bariatric surgery for the military reaching US$15 million in 2002. Obesity is currently the largest single cause for the discharge of uniformed personnel.
In 2005, 9 million adults aged 17 to 24, or 27%, were too overweight to be considered for service in the military.
Prevalence by state and territoryEdit
The following figures were averaged from 2005–2007 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."
|Obese adults (mid-2000s)||Obese adults (2016)||Overweight (incl. obese) adults
|Obese children and adolescents
|District of Columbia||22.1%||22.6%||55.0%||14.8%||43|
|Northern Mariana Islands||—||—||—||16%||—|
|Virgin Islands (U.S.)||—||32.5%||—||—||—|
Obesity is a chronic health problem. It is one of the biggest factors for a 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 the 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 with time. For example, 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%.
Obesity in the US is generally caused by long term patterns of behavior that including sitting still and not exercising enough, eating too much, and consuming too much high calorie food and drinks.
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.[better source needed] 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.
Total costs to the USEdit
There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability. In particular, diabetes has become the seventh leading cause of death in the United States, with the U.S. Department of Health and Human Services estimating in 2008 that fifty-seven million adults aged twenty and older were pre-diabetic, 23.6 million diabetic, with 90–95% of the latter being type 2-diabetic.
Obesity has also been shown to increase the prevalence of complications during pregnancy and childbirth. Babies born to obese women are almost three times as likely to die within one month of birth and almost twice as likely to be stillborn than babies born to women of normal weight.
Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year (including increased morbidity in car accidents) 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 or problem drinking and, by one estimate, accounts for 6% to 12% of national health care expenditures in the United States (although another estimate states the figure is between 5% and 10%).
The Medicare and Medicaid programs bear about half of this cost. Annual hospital costs for treating obesity-related diseases in children rose threefold, from US$35 million to US$127 million, in the period from 1979 to 1999, and the inpatient and ambulatory healthcare costs increased drastically by US$395 per person per year.
These trends in healthcare costs associated with pediatric obesity and its comorbidities are staggering, urging the Surgeon General to predict that preventable morbidity and mortality associated with obesity may surpass those associated with cigarette smoking. Furthermore, the probability of childhood obesity persisting into adulthood is estimated to increase from approximately twenty percent at four years of age to approximately eighty percent by adolescence, and it is likely that these obesity comorbidities will persist into adulthood.
Effects on life expectancyEdit
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 healthier 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.
The National Center for Health Statistics reported in November 2015:
Trends in obesity prevalence show no increase among youth since 2003–2004, but trends do show increases in both adults and youth from 1999–2000 through 2013–2014. No significant differences between 2011–2012 and 2013–2014 were seen in either youth or adults.
Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias. State legislators in California, for example, passed laws banning the sale of machine-dispensed snacks and drinks in elementary schools in 2003, despite objections by the California-Nevada Soft Drink Association. The state followed more recently with legislation to prohibit their soda sales in high schools starting July 1, 2009, with the shortfall in school revenue to be compensated by an increase in funding for school lunch programs. A similar law passed by the Connecticut General Assembly in June 2005 was vetoed by governor Jodi Rell, who stated the legislation "undermines the control and responsibility of parents with school-aged children."
In mid-2006, the American Beverage Association (including Cadbury Schweppes, Coca-Cola, and PepsiCo) agreed to a voluntary ban on the sale of all high-calorie drinks and all beverages in containers larger than 8, 10 and 12 ounces in elementary, middle and high schools, respectively.
Former American First Lady Michelle Obama led an initiative to combat childhood obesity entitled "Let's Move". Obama said she aimed to wipe out obesity "in a generation". Let's Move! has partnered with other programs. Walking and bicycling to school helps children increase their physical activity.
In 2008, the state of Pennsylvania enacted a law, the "School Nutrition Policy Initiative," aimed at the elementary level. These "interventions included removing all sodas, sweetened drinks, and unhealthy snack foods from selected schools, 'social marketing' to encourage the consumption of nutritious foods and outreach to parents." The results were a "50 percent drop in incidence of obesity and overweight", as opposed to those individuals who were not part of the study.
In the past decade there have been school-based programs that target the prevention and management of childhood obesity. There is evidence that long term school-based programs have been effective in reducing the prevalence of childhood obesity.
For two years, Duke University psychology and global health professor Gary Bennett and eight colleagues followed 365 obese patients who had already developed hypertension. They found that regular medical feedback, self-monitoring, and a set of personalized goals can help obese patients in a primary care setting lose weight and keep it off.
Major United States manufacturers of processed food, aware of the possible contribution of their products to the obesity epidemic, met together and discussed the problem as early as April 8, 1999; however, a proactive strategy was considered and rejected. As a general rule, optimizing the amount of salt, sugar and fat in a product will improve its palatability, and profitability. Reducing salt, sugar and fat, for the purpose of public health, had the potential to decrease palatability and profitability.
Media influence may play an important role in prevention of obesity as it has the ability to boost many of the main prevention/intervention methods used nowadays including lifestyle modification. The media is also highly influential on children and teenagers as it promotes healthy body image and sets societal goals for lifestyle improvement. Examples of media influence are support for the "Let's Move!" campaign and the MyPlate program initiated by Michelle Obama, and the NFL's Play60 campaign. These campaigns promote physical activity in an effort to reduce obesity especially for children.
In 2011 The Obama Administration introduced a $400 million Healthy Food Financing Initiative, the goal of the program is to "create jobs and economic development, and establish market opportunities for farmers and ranchers," as described by the secretary of agriculture, Tom Vilsack.
Ultimately, federal and local governments in the U.S. are willing to create political solutions that will reduce obesity ratings by "recommending nutrition education, encouraging exercise, and asking the food and beverage industry to promote healthy practices voluntarily." In 2008, New York City was the first city to pass a "labeling bill" that "require[d] restaurants" in several cities and states to "post the caloric content of all regular menu items, in a prominent place and using the same font and format as the price."
 Along with obesity came the accommodations made of American products. Child-safety seats in 2006 became modified for the 250,000 obese U.S. children ages six and below.  The obese incur extra costs for themselves and airlines when flying. Weight is a major component to the formula that goes into the planes take off and for it to successfully fly to the desired destination. Due to the weight limits taken in consideration for flight in 2000, airlines spent $275 million on 350 million additional gallons of fuel for compensation of additional weight to travel.
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