State of Obesity 2021: Better Policies for a Healthier America

Trust for America’s Health’s (TFAH) 18th annual report on the nation’s obesity crisis found that sixteen states have adult obesity rates at 35 percent or higher, up from 12 states in 2019 and that social and economic factors linked to obesity were exacerbated by the COVID-19 pandemic.

(Washington, DC – September 15, 2021) – State of Obesity 2021: Better Policies for a Healthier America, is based in part on newly released 2020 data from the CDC’s Behavioral Risk Factors Surveillance System and analysis by TFAH. It provides an annual snapshot of rates of overweight and obesity by age, race/ethnicity and state of residence for U.S. adults.

In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that the COVID-19 pandemic changed eating habits, worsened levels of food insecurity, created obstacles to physical activity, and heightened stress, all exacerbating the decades long pattern of obesity in America.

In the report, TFAH calls for addressing the social determinants of obesity, for example, by ensuring access to no cost healthy school meals for all students, a program started during the pandemic.

Sixteen states have adult obesity rates at or above 35 percent

Obesity rates vary considerably between states and regions of the country. In 2020, Mississippi had the highest adult obesity rate at 39.7 percent, followed by West Virginia at 39.1 percent and Alabama at 39 percent. Colorado had the lowest adult obesity rate nationally at 24.2 percent.

Nationally, 16 states now have adult obesity rates at or above 35 percent.  Reaching the 35 percent or higher level this year were Delaware, Iowa, Ohio, and Texas. The twelve states that continue to have adult rates above 35 percent are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia.  (See rates chart for data on all 50 states and the District of Columbia).

As recently as 2012, no state had an adult obesity rate above 35 percent.

The social conditions in people's lives contribute to obesity

Systemic inequities and socioeconomic factors contribute to higher rates of obesity among certain racial and ethnic populations. According to the latest available national data – from the 2017 – 2018 National Health and Nutrition Examination Survey (NHANES), Black adults had the highest level of adult obesity nationally at 49.6 percent; driven in large part by an adult obesity rate among Black women of 56.9 percent.  Hispanic adults have an obesity rate of 44.8 percent. White adults have an obesity rate of 42.2 percent. Asian adults have an obesity rate of 17.4 percent.

“The epidemic of obesity is an urgent problem in the U.S. and has worsened during the COVID-19 pandemic. What is needed are transformational policies and bold investment in programs that reduce health inequities and address the social and economic conditions that are barriers to access to affordable, healthy food and physical activity,” said J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health.

Rising obesity rates are also a problem among children and adolescents.  According to the 2017 – 2018 NHANES data nearly 20 percent (19.3 percent) of U.S. children ages 2 to 19 have obesity. These data more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers.

Obesity is associated with a range of diseases, including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and many types of cancers. Obesity is estimated to increase healthcare spending by $149 billion annually (about half of which is paid for by Medicare and Medicaid). Furthermore, obesity is one of the underlying health conditions associated with the most serious consequences of COVID-19 infection, including higher risk of hospitalization and death.

Policies to Address the Obesity Crisis

Solving the nation’s obesity crisis will require increased investment and bold policy action. Recommendations within this report focus on two principles: 1) the need for multi-sector, multi-disciplinary approaches, and 2) an intentional focus on those population groups that experience a disproportionate risk for obesity.  Policymakers will not be able to reverse obesity trends without addressing the social, economic and environmental conditions at the root of the crisis.

The report includes policy recommendations – actions to be undertaken by federal, local and state government, the education sector, the healthcare sector and the food industry – including:

  • Increase funding for CDC’s National Center for Chronic Disease Prevention and Health Promotion. This investment should include at least $125 million in FY2022 for CDC’s Division of Nutrition, Physical Activity and Obesity and $102.5 million in FY2022 for CDC’s Racial and Ethnic Approaches to Community Health to ensure sufficient and equitable funding for obesity prevention programs in all 50 states.
  • Make healthy school meals free for all students as a step to end child hunger and ensure access to healthy foods. Protect the recent expansion of the Supplemental Nutrition Assistance Program (SNAP) benefits and enhance access to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
  • Close tax loopholes and eliminate business-cost deductions related to the advertising of unhealthy food and beverages to children.
  • Increase the price of sugary drinks through an excise tax, with tax revenue allocated to local efforts to reduce health and socioeconomic disparities and obesity prevention programs.
  • Ensure that every resident has safe and convenient access to walking and biking trails, and that all students have safe routes to walk or bike to school. State and local education agencies should prioritize physical activity during the school day.
  • Expand access to health insurance including through the extension of Medicaid and by making marketplace coverage more affordable. Insurance plans should cover all U.S. Preventive Services Task Force “A” or “B” recommendations for obesity prevention programs with no cost-sharing to the patient.

Read the full report