'Survey-weighted obesity prevalence 75.2%' in US?

Body Mass Index and Anthropometric Criteria to Assess Obesity
Nora M. Al-Roub, MD1; Devesh Malik, BS2; Mohammed Essa, MD, MPH3,4
et al
Author Affiliations
Article Information

JAMA Netw Open
Published Online: December 29, 2025
2025;8;(12):e2549124. doi:10.1001/jamanetworkopen.2025.49124

Introduction

Obesity has historically been defined using body mass index (BMI). However, BMI does not account for adipose tissue, limiting its accuracy. The Lancet Diabetes & Endocrinology Commission created a revised obesity definition including anthropometric measures (waist circumference [WC], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]),1 encompassing and subcategorizing preclinical obesity (excess adiposity without organ dysfunction or physical impairment) and clinical obesity (a disease). Though more than 70 organizations have endorsed this definition,1 its use in practice has not been evaluated. Since obesity prevalence has implications for screening, risk assessment, and public health efforts, we estimated US obesity prevalence using these criteria.


Methods

We analyzed adults with BMI (calculated as weight in kilograms divided by height in meters squared) measured in the 2017-2023 National Health and Nutrition Examination Survey (NHANES) (eFigure in Supplement 1).2 Obesity was defined using BMI, WC, WHR, and WHtR (eTables 1 and 2 in Supplement 1).1 We examined survey-weighted obesity prevalence and anthropometric criteria and compared subgroups using prevalence ratios (eMethods in Supplement 1). This study followed the STROBE guideline and was exempted from review and informed consent by the Yale institutional review board since NHANES data are deidentified.
Results

The study included 14 414 participants representing 237 700 000 US adults. Survey-weighted obesity prevalence was 75.2% (95% CI, 73.8%-76.5%) overall, including 100% (95% CI, 99.9%-100%) among adults with BMI of 30 or greater, 80.4% (95% CI, 78.6%-82.1%) with BMI 25 to less than 30, and 38.5% (95% CI, 36.4%-40.6%) with BMI less than 25 (Figure). Prevalence was similar for men and women and higher for Hispanic adults and increased substantially with age (Table). Prevalence did not change from 2017-2020 to 2021-2023. The most common abnormal anthropometric criterion was WHtR above 0.50 (80.0% [95% CI, 78.6%-81.3%] of adults), followed by elevated WHR (73.1% [95% CI, 71.6%-74.6%]) and elevated WC (58.3% [95% CI, 56.8%-59.7%]), and 39.9% (95% CI, 38.0%-41.0%) of all adults had BMI of 30 or greater. Obesity prevalence using an alternative cutoff of WHtR above 0.60 was 58.4% (95% CI, 56.7%-60.2%) (Figure).
Figure. US Prevalence of Obesity Across Body Mass Index (BMI) Categories With Incorporation of Anthropometric Criteria
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https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843225

Obesity definition and elevated anthropometric measures (waist circumference, waist-to-hip ratio, and waist-to-height ratio) were based on criteria cited by the 2025 Lancet Diabetes & Endocrinology Commission. Alternative obesity definitions were used for Asian adults (eTable 2 in Supplement 1). A waist-to-height ratio >0.5 was considered a criterion for obesity in the primary analysis and an alternative waist-to-height ratio >0.6 was also evaluated. All prevalence estimates were survey weighted and age standardized using data for US adults from the National Health and Nutrition Examination Survey. BMI was calculated as weight in kilograms divided by height in meters squared.
Table. US Prevalence of Obesity and Excess Adiposity Based on BMI and Anthropometric Criteriaa
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