Over the past three decades, obesity rates across the United States have surged dramatically, with prevalence among adults (25+ years) and older adolescents (15–24 years) more than doubling since 1990. By 2021, over 208 million Americans were living with overweight or obesity—a figure projected to escalate without significant reforms, according to a comprehensive analysis by the Global Burden of Disease Study Collaborator Network, published in The Lancet.
Nearly 75% of adults were affected in 2021, with obesity rates doubling since 1990 for both men (from 18.6% to 41.5%) and women (from 22.8% to 45.6%). Obesity rates among adolescents have more than doubled since 1990, with a higher prevalence among females (28.8%) than males (22.7%) by 2021.
Some states reported strikingly high levels of overweight and obesity. Over half of males in Texas (52%) and nearly two-thirds of females in Mississippi (63%) were affected. Around 80% of men in North Dakota and women in Mississippi lived with overweight or obesity.
The study also revealed generational shifts, with obesity onset occurring earlier in successive cohorts. For instance, 40% of women born in the 1980s developed obesity by age 30, compared to age 45 for those born in the 1960s.
The study projects a sharp rise in these numbers, estimating that by 2050, over 43 million children and adolescents will be living with overweight or obesity, an increase of 6.7 million from 2021. Among adults, the number will grow by 41.4 million, reaching 213 million, with 146 million classified as having obesity.
These trends highlight stark geographical and sex disparities, with southern states such as Mississippi, West Virginia, and Arkansas predicted to remain hotspots for obesity in both adults and adolescents.
These rising numbers warn of severe health and economic consequences. The surge in obesity is already evident in rising cases of childhood hypertension and type 2 diabetes. Without urgent intervention, over 260 million Americans—including more than half of all children and adolescents—will live with overweight or obesity by 2050. Obesity is linked to life-threatening conditions such as heart disease, diabetes, stroke, and even early mortality. The associated healthcare and societal costs will rise.
Obesity results from complex structural factors, including socioeconomic disparities, urbanisation, and systemic racism. Factors such as unhealthy food marketing to children, sedentary online activities, and food deserts disproportionately affect minority communities and drive obesity trends.
Existing interventions focused on individual behaviour have proven insufficient. Structural changes targeting food systems, urban planning, and economic inequalities are critical to reversing these trends.
While medications like GLP-1 receptor agonists offer promise, the authors caution against over-reliance. Instead, prevention should be central to obesity management, starting with early-life interventions such as maternal nutrition and healthy school meals.
Federal and state governments must prioritise long-term, multifaceted strategies to address obesity’s root causes. They should invest in safe, walkable neighbourhoods to promote physical activity, ensure universal access to nutritious food in schools and communities, regulate junk food marketing and support environmentally sustainable food systems.
Source: The Lancet
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