Issue Category: Obesity/Chronic Disease

New Report: Rates of Adult Obesity Continue to Climb, Particularly in Communities Experiencing Barriers to Healthy Eating and Few Opportunities for Physical Activity

20th Annual Report Finds 22 States Have Adult Obesity Levels Above 35 Percent

(Washington, DC – September 21, 2023) – The number of adults in the United States with obesity continues to climb according to a new report, State of Obesity 2023: Better Policies for a Healthier America, released today. The report, the 20th annual edition produced by Trust for America’s Health (TFAH), examines the root causes of the nation’s rising obesity rates, and makes policy recommendations to address them.

According to TFAH’s analysis of the latest data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System, in 2022, 22 states had an adult obesity rate at or above 35 percent, up from 19 states the prior year. A decade ago, no state had an adult obesity rate at or above the 35 percent level.

West Virginia (41%), Louisiana (40.1%), Oklahoma (40.0%), and Mississippi (39.5%) have the highest rates of adult obesity. The District of Columbia (24.3%), Colorado (25.0%), and Hawaii (25.9%) have the lowest adult obesity rates.

Over the past two decades obesity rates have climbed for all population groups with certain populations of color experiencing the highest rates, often due to structural barriers to healthy eating and a lack of opportunities and places to be physically active.

Data summarized in the report from the 2017 – 2020 National Health and Nutrition Examination Survey (NHANES) tracks obesity trends nationally and within populations groups. Nationally, 41.9 percent of adults have obesity. Black and Latino adults and people living in rural communities tend to have the highest rates of obesity.

  • Black adults have the highest level of adult obesity at 49.9 percent.
  • Hispanic adults have an obesity rate of 45.6 percent.
  • White adults have an obesity rate of 41.4 percent.
  • Rural areas of the country have higher rates of obesity than urban and suburban areas.

Obesity rates are also increasing among children and adolescents with nearly 20 percent of U.S. children ages 2 to 19 having obesity according to 2017–2020 NHANES data. These rates have more than tripled since the mid-1970s, and Black and Latino youth have substantially higher rates of obesity than do their white peers.

An Evolving Understanding of Obesity

Since TFAH’s initial report, published in 2004, the national adult obesity rate has increased by 37 percent and the national youth obesity rate increased by 42 percent. The widespread increases show that obesity is a society-wide, population-level issue, i.e., one rooted in societal and environmental factors that are often beyond individual choice. TFAH concludes that solving the nation’s obesity crisis will require addressing the economic and structural factors that impact where people live and their access to employment, transportation, healthcare, affordable and healthy food, and places to be physically active.

Over the past 20 years, important strides have been made in understanding that obesity is a disease and how to prevent it, including the role that social determinants of health and health inequities play in driving obesity rates. Furthermore, many obesity-related policies and programs that have been implemented, such as increased access to and benefits within nutrition support programs, have a proven record of success but need increased investment to reach more people and communities.

“It’s critical to recognize that obesity is a multifactored disease involving much more than individual behavior,” says J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.  “In order to stem the decades long trend of increasing obesity rates we have to acknowledge that the obesity crisis is rooted in economic, health, and environmental inequities.  Ensuring all people and communities have equitable opportunity and access to healthy food and physical activity is fundamental to addressing this crisis.”

Addressing obesity is critical because it is associated with a range of diseases, including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and some cancers. Obesity is estimated to increase U.S. healthcare spending by $170 billion annually (including billions by Medicare and Medicaid).

Recommended Policy Steps to Address the Obesity Crisis

The report includes recommendations for policy actions that should be taken by federal, state, and local officials and other stakeholders within five issue areas:

  • Advance health equity by strategically dedicating federal resources to efforts that reduce obesity-related disparities and related conditions, including by increasing funding for CDC’s chronic disease and obesity prevention programs.
  • Decrease nutrition insecurity while improving nutritional quality of available food. Actions steps include guaranteeing healthy school meals for every student, increasing access to the Supplemental Nutrition Assistance Program (SNAP) and other nutrition support programs, and implementing a mandatory front-of-package labeling system on food packaging to help consumers make informed choices.
  • Change the marketing and pricing strategies that lead to health disparities, including closing tax loopholes and eliminating business-cost deductions for advertising unhealthy food to children.
  • Make physical activity and the built environment safer and more accessible for everyone. Action steps include increasing federal education funding to support health and physical education in schools and investing in active transportation projects like pedestrian and bike paths.
  • Work within the healthcare system to reduce disparities and close gaps in clinical-to-social service referrals by increasing access to health insurance through expanding Medicaid, making marketplace insurance more affordable, and expanding healthcare screenings for social needs.

 

Read the full report

Improving Americans’ Nutrition Security Requires Legislative Action

Q&A with Dr. Hilary Seligman:

Hilary Seligman, M.D., MAS, is a professor at the University of California, San Francisco, with appointments in the Departments of Medicine, Epidemiology, and Biostatistics. Her research and advocacy work focuses on food insecurity, its health implications, and the needed policy responses.

 

TFAH: Food insecurity is obviously a serious problem in the United States. Can you also talk about the issue of nutrition insecurity and the relationship between the two?

Dr. Seligman: First, it’s important to recognize that the food-security construct always considered access to nutrition, not just calories. But, the sector’s new focus on nutrition security has helped emphasize the importance of providing not just food but food that meets people’s health and nutrition needs. The construct of nutrition security is also strongly related to issues of equity and the massive burden of early mortality in our country that is related to poor diets.


TFAH: Can food banks and charitable food networks address hunger and improve nutrition?

Dr. Seligman: Yes, of course they can, and they must. The charitable food system as a whole has made massive investment and progress in this area over the last decade. What I do want to call attention to though is that the same forces that make it difficult for individuals to afford and prepare healthy food make it difficult for the charitable food system to distribute healthy food. Healthy alternatives almost always cost more, they are often perishable, and they often require more preparation time which can be costly to provide. So, although there has been strong investment and tremendous progress at the system level, there is still a lot to be done. It will always be cheaper to distribute a box of mac and cheese than it will be to distribute a peach.


TFAH: You’ve been a leader in grassroots anti-hunger programs in the San Francisco area, programs like EatSF, a healthy food voucher program. Are these programs making a difference in food insecurity for San Francisco families and children?

Dr. Seligman: EatSF is one of a rapidly growing ecosystem of state and local food voucher programs and produce prescription programs in the U.S. These programs have functioned as a way for local leaders and health systems to say: We see we have this critical problem of nutrition insecurity in our community, this is not acceptable in the richest county in the U.S., and we are going to do something about it. I think that is amazing, and I am privileged to be a part of that movement. But, let’s be honest, the nutrition security problem in the U.S. is not going to be solved by small local programs. We need a systems-based approach. We need better policies to address nutrition security, and we need to rectify the way in which our current policies work better for white people than they do for people who are not white.


TFAH: Can you say more about that? How does current policy work better for white people than for people of color?

Dr. Seligman: SNAP program policies are a good example. In order for able bodied adults to receive SNAP benefits they have to be working. For a myriad of reasons, Black people are less likely to be able to secure employment. They are therefore less likely to be able to meet the work requirements that would allow them to enroll in SNAP, even if they are food insecure.


TFAH: You direct the National Clinician Scholars Program at the UCSF School of Medicine. The goal of the program is to train clinicians to be change-agents in order to improve their patients’ health. Are clinicians and the healthcare system doing enough to address the social determinants of health? Are they well-prepared to treat their patients who have obesity?

Dr. Seligman: Traditionally, healthcare in the U.S. has focused on treating, not preventing, disease in individuals. The evidence is very clear that this is the worst way to approach obesity: first to do it at the treatment stage (when obesity has already developed, rather than to prevent the onset of obesity) and second to do it by attempting to change people’s behaviors, rather than changing the environments that resulted in the onset of obesity to begin with. So, although I hate that we need to be having this discussion at all, we do. We do because the U.S. has completely failed at prevention efforts and at policy and environmental approaches to obesity prevention for decades. So now, what needs to be done? Obesity and poor diets are the biggest drivers of healthcare costs in the country— so the healthcare system has to get involved (whether it is traditionally in their wheelhouse or not), and the best way to do this is by addressing social determinants of health and food environments. It is not a comfortable fit for the healthcare system, but there really is no other choice. And because it is not a comfortable fit and requires a new way of thinking about healthcare and new kinds of engagement and policy change, we have to nurture the next generation of healthcare leaders to be able to tackle these really complicated problems.


TFAH: What are the links between public policy and obesity? What policy actions or changes would you like to see enacted?

Dr. Seligman: Oh, there are so many of them—dozens if not more are being discussed as potential approaches for the next Farm Bill. At the federal level alone, there are policy levers that Congress, USDA, and the FDA have authority over that could help reverse obesity trends. Let’s start with an enormous one: SNAP. Early in my career I worked on health literacy, and I was always challenged by the lack of existing infrastructure to reach people with effective health literacy interventions. Food insecurity is not like that. SNAP works. It reaches almost 50 million people in the U.S. annually. It is available in every county nationwide. It helps families to afford more nutritious food. So, we have the tools, we have the evidence, and we have the infrastructure to solve food insecurity in the U.S. What we lack is the political will. We need to expand SNAP eligibility to all the people who aren’t receiving the food they need but who are not currently eligible for benefits, and we need to raise benefit rates to allow for the purchase of healthy food. If these changes are made, it is very clear to me that they will have a substantial impact on obesity rates and on public health.


TFAH: There  were a number of waivers in federal food programs like SNAP, WIC, and school meals, during the COVID-19 pandemic to better reach individuals and families during the public health emergency. Are there any lessons we can learn from these policy changes?

Dr. Seligman: Yes! The predominant lesson is: these programs work. Food insecurity rates did not increase nearly as much as anticipated during the pandemic, although there were certainly vast disparities in how the pandemic impacted different communities. Why didn’t rates of food insecurity rise as much as anticipated? Because we had the will to do the things we knew—based on a tremendous amount of evidence— would make a difference. When we make it easier for people to enroll in SNAP, more people have access to benefits and food insecurity falls. When we provide money on debit cards to replace the meals not being served in schools, food insecurity falls. When stimulus checks were sent to people across the U.S. in response to the pandemic, low-income households reported that food was the first or second most covered item from the stimulus money.

The really optimistic lesson is that we know how to address hunger, nutrition security, and obesity prevention through good public policy. Now we just have to keep these programs in place as interest in the pandemic wanes.

Additional Resources:

Brief: Legislative Priorities for the 118th Congress

Report:  State of Obesity 2022

Priority Issue: Obesity /Chronic Disease

This interview was originally published as a part of TFAH’s 2022 State Of Obesity: Better Policies for a Healthier America report.

State of Obesity 2022 Congressional Briefing and Webinar

This briefing explores the findings from TFAH’s recent report, which found obesity rates continue to climb nationwide and within population groups. 19 states had adult obesity rates at 35% or higher, up from 16 states the previous year. These persistent increases underscore that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are beyond personal choice. Addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

Panelists discussed the latest data on obesity and its impacts, promising approaches to ensure healthier communities, and offered policy recommendations that can help all American lead healthier lives.

Resources:

Trust for America’s Health

The White House:

 

 

Nation’s Obesity Epidemic is Growing: 19 States Have Adult Obesity Rates Above 35 Percent, Up From 16 States Last Year

Social and Economic Factors Are Key Drivers of Increasing Obesity Rates

(Washington, DC – September 27, 2022) – Four in ten American adults have obesity, and obesity rates continue to climb nationwide and within population groups, according to a report State of Obesity 2022: Better Policies for a Healthier America released today by Trust for America’s Health (TFAH). The report amplifies the importance of the White House Conference on Hunger, Nutrition and Health happening tomorrow. The Conference and the report are intended to spotlight the links between hunger, nutrition, and health, and diet-related diseases including obesity. In addition, they will drive policy action to address food insecurity and health disparities, factors often at the root of diet-related health issues.

The report finds that persistent increases in obesity rates across population groups underscores that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are often beyond personal choice. The report’s authors conclude that addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

Based in part on newly released 2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, and analysis by TFAH, the report tracks rates of overweight and obesity by age, race/ethnicity, and state of residence. Among the most striking findings are:

Nineteen states have adult obesity rates over 35 percent.  West Virginia, Kentucky, and Alabama have the highest rate of adult obesity at 40.6 percent, 40.3 percent, and 39.9 percent, respectively. The District of Columbia, Hawaii, and Colorado had the lowest adult obesity rates at 24.7 percent, 25 percent, and 25.1 percent respectively.

A decade ago, no state had an adult obesity rate at or above 35 percent.  (See state-by-state rate chart).

National data from the 2017-2020 National Health and Nutrition Examination Survey also included in the report show the following:

  • Nationally, 41.9 percent of adults have obesity.
  • Black adults had the highest level of adult obesity at 49.9 percent.
  • Hispanic adults had an obesity rate of 45.6 percent.
  • White adults had an obesity rate of 41.4 percent.
  • Asian adults had an obesity rate of 16.1 percent.
  • Rural parts of the country had higher rates of obesity than did urban and suburban areas.

Structural and social determinants are significantly influencing the rates of obesity among adults and youth.  Factors such as structural racism, discrimination, poverty, food insecurity, housing instability, and lack of access to quality healthcare are key drivers of the differences in obesity rates across racial and ethnic groups. These systemic barriers make it inappropriate to assign blame to individuals with obesity for their weight. The purpose of this report is to analyze conditions in people’s lives which make them more likely to develop obesity and recommend policies to address those conditions.

Obesity rates are also increasing among children and adolescents with nearly 20 percent of U.S. children ages 2 to 19 having obesity. These rates more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers.

A special section of the report looks at the relationship between food insecurity and obesity. Food insecurity, defined as being uncertain of having or unable to acquire enough food because of insufficient money or resources, is driven by many of the same social and economic factors that drive obesity including poverty and living in communities with many fast-food establishments but limited or no access to healthy, affordable foods such as available in full-service supermarkets or farmers markets. Being food and nutrition insecure often means families must eat food that costs less but is also high in calories and low in nutritional value.

Obesity is multifactored and involves more than individual behavior

Social and economic factors including experiencing poverty and the impact of long-standing structural racism and health inequities are strongly associated with obesity and are at the root of higher rates of obesity in low-income communities that have fewer resources to support healthy eating and being physically active.

“The continued increase in rates of obesity across all population groups is alarming,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Policies and programs to reduce obesity need to be implemented at a systems level. We must advance policies that address the community, institutional, and structural factors that are barriers to healthy eating and physical activity and that exacerbate health inequities.”

Addressing obesity is critical because it is associated with a range of diseases including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and some cancers. Obesity is estimated to increase U.S. healthcare spending by $170 billion annually (including billions by Medicare and Medicaid).

The report includes recommendations for policy actions that federal, state, and local policymakers and other stakeholders should take including:

  • Increase funding for the CDC’s National Center for Chronic Disease Prevention and Health Programs to prevent obesity and related chronic diseases. Funding increases need to be sufficient to put proven obesity prevention programs to work in every state and should prioritize those communities where the need is greatest to address health inequities.
  • Make healthy school meals for all students a permanent policy, extend COVID-19 flexibilities that expand nutrition access for students and their families, strengthen school nutrition standards, and increase students’ opportunities for physical activity during the school day.
  • Expand the CDC’s social determinants of health program to address the upstream, structural drivers of chronic disease.
  • Decrease food insecurity and improve the nutritional quality of available food by increasing funding for and participation in nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program.
  • End unhealthy food marketing to children by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to young people.
  • Impose excise taxes on sugary drinks and devote the revenue to local obesity prevention programs and to reduce health disparities.
  • Expand support for maternal and child health, including supporting breastfeeding.
  • Fund active transportation projects like pedestrian and biking paths in all communities and make local spaces more conducive to physical activity such as opening school recreational facilities to community groups outside of school hours.
  • Expand access to healthcare and require insurance coverage with no cost sharing for U.S. Preventive Task Force recommended obesity prevention programs.

Read the full report