- Researchers projected that adult obesity rates in the U.S. will rise to 47% in the next decade.
- Women under age 35 had the largest increase in obesity prevalence from 1990 to 2022.
- Multifactorial strategies combining public policy and better access to clinical care are needed, the researchers said.
Roughly 126 million U.S. adults ages 20 and older are projected to have obesity by 2035, according to estimates from a cross-sectional analysis.
In 1990, 19.3% of U.S. adults had obesity; in 2022, this rose to 42.5%. By 2035, 46.9% of the adult population is expected to have obesity, reported Catherine O. Johnson, PhD, MPH, of the Hans Rosling Center for Population Health in Seattle, and colleagues.
"The results, with data collected over three decades, provide insight into future levels of persons living with obesity, if past trends continue. Effective policies may be identified by examining populations with consistently lower rates of obesity," Johnson and her team wrote in JAMA.
The findings vary from those seen in recent analyses of updated CDC data and the Gallup National Health and Well-Being Index, which reported early signs of declining obesity rates, possibly driven by increasing GLP-1 receptor agonist use. While the current study included data through 2022, the Gallup index identified a downward trend from 2022 to 2025.
Obesity remains a major public health threat, Johnson told MedPage Today. "We will need public health strategies as well as increased access to clinical interventions to make a difference," she said.
"Treatment needs to be multifactorial, addressing all of the many drivers of the development of obesity, along with medications or other clinical therapies that can act to reduce body weight," she recommended.
Obesity prevalence, defined as a BMI of 30 or higher, substantially varied across race/ethnicity, sex, age, and geographic region, the researchers found. From 1990 to 2022, obesity prevalence rose most for Hispanic persons of both sexes and rose least for Black males. Black females had the highest age-standardized prevalence of obesity in 2022 (56.9%), followed by Hispanic females (49.4%).
Since 1990, females under age 35 have had the largest increase in obesity prevalence. "The results indicate substantial increases in the prevalence of obesity among younger ages over the past several decades, representing earlier onset of obesity," the researchers noted. Johnson called this finding "concerning" and highlighted "the need for effective strategies to prevent weight gain and the development of obesity."
Data also showed a lower obesity prevalence among the oldest adults, likely representing premature death for those with obesity or the effects of multimorbidity in older persons, the researchers explained.
Obesity prevalence was highest in Midwestern and Southern states, though there were substantial state-level and within-state differences.
No states were expected to have a decrease in obesity prevalence over the next 10 years, but places like Mississippi, which had the highest estimated prevalence for Black females in recent years, were expected to have one of the smallest increases for this subgroup. On the other hand, larger increases were predicted for other locations like Oklahoma. This suggests that obesity prevalence may be plateauing in some locations, said Johnson's group.
Prevalence of severe obesity, defined as a body mass index (BMI) of 40 or more, was highest among females in 2022, ranging from 11.3% in white females to 20.2% among Black females. Severe obesity ranged from 5.2% to 8.5% in males.
Researchers analyzed data from 71,777 participants in the National Health and Nutrition Examination Survey (spanning 1988-2023), as well as 11,243,644 participants in the Behavioral Risk Factor Surveillance System (1988-2022) and Gallup Daily Survey (2008-2017).
"Obesity in the current analysis was defined using BMI, which does not directly measure body fat or account for body composition and may incorrectly estimate the amount and location of adipose tissue versus lean muscle mass, with some evidence that these errors may differ by demographic group," Johnson and co-authors highlighted.
Other study limitations included sparse data in some states with small populations and the use of self-reported height and weight.
Disclosures
The study was funded by the National Heart, Lung, and Blood Institute.
Johnson reported no disclosures.
Co-authors reported funding from the Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, National Cancer Institute, National Institute on Aging, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Office of Disease Prevention, and the Office of Behavioral and Social Sciences Research.
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