Obesity in the United States
Historical U.S. Obesity Rate, 1960-2004.[1]

Obesity in the United States has been increasingly cited as a major health issue in recent decades. While many industrialized countries have experienced similar increases, obesity rates in the United States are among the highest in the world with 74.6% of Americans being overweight or obese.[2] Estimates have steadily increased, from 19.4% in 1997, 24.5% in 2004[3] to 26.6% in 2007,[4] to 33.8% (adults) and 17% (children) in 2008.[5]

The direct medical cost of obesity and indirect economic loss to obesity has been estimated to be as high as $51.64 billion and $99.2 billion in 1995, respectively;[6] this rose to $61 billion and $117 billion in 2000.[7] Researchers for the Centers for Disease Control and Prevention and RTI International estimate that in 2003, obesity-attributable medical expenditures reached $75 billion.[8]

Contents

Prevalence

Obesity prevalence by state, 1985–2006.[9]

Obesity rates have increased for all population groups in the United States over the last several decades.[10] Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased by a factor of five, from one in two thousand to one in four hundred. There have been similar increases seen in children and adolescents, with the prevalence of overweight in pediatric age groups nearly tripling over the same period. Approximately nine million children over six years of age are considered obese. Several recent studies have shown that the rise in obesity in the US is slowing, possibly explained by saturation of health-oriented media or a biological limit on obesity.[11]

By age group

Historically, obesity primarily afflicted adults, but this has changed in the last 2 decades. 15-25 percent of American children and adolescents are now obese. Children and adolescents who are obese are likely to be obese in adulthood and to develop obesity-related health problems.[12]

Newborns

Some newborns may be born big but this is more often a problem associated with a medical disorder. Unlike adults, newborns do not develop obesity. The number one cause of big babies is diabetes but this is not considered to be an obese baby.

Children and teens

From 1980 to 2008, the prevalence of obesity in children aged 6 to 11 years tripled from 6.5% to 19.6%. The prevalence of obesity in teenagers more than tripled from 5% to 18.1% in the same time frame.[13]

Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 17.0%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.[14]

In 2000, approximately 19% of children (ages 6–11) and 17% of adolescents (ages 12–19) were overweight and an additional 15% of children and adolescents were at risk to becoming overweight, based on their BMI.[15]

Analyses of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999–2000, 2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall, in 2003-2006, 11.3% of children and adolescents aged 2 through 19 years were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile [16]

Trend analyses indicate no significant trend between 1999–2000 and 2007-2008 except at the highest BMI cut point (BMI for age 97th percentile) among all 6- through 19-year-old boys. In 2007-2008, 9.5% of infants and toddlers were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% were at or above the 95th percentile; and 31.7% were at or above the 85th percentile of BMI for age.[17]

In summary, between 2003 and 2006, 11.3% of children and adolescents were obese and 16.3% were overweight. A slight increase was observed in 2007 and 2008 when the recorded data shows that 11.9% of the children between 6 and 19 years old were obese and 16.9% were overweight. The data recorded in the first survey was obtained by measuring 8,165 children over four years and the second was obtained by measuring 3,281 children.

Elderly

Although obesity is reported in the elderly, the numbers are still significantly lower than the levels seen in the young adult population. It is speculated that socioeconomic factors may play a role in this age group when it comes to developing obesity.[18]

In the military

An estimated sixteen percent of active duty U.S. military personnel were obese in 2004, with the cost of remedial bariatric surgery for the military reaching $15 million in 2002. Obesity is currently the largest single cause for the discharge of uniformed personnel.[19]

In 2005, 9 million adults of ages 17 to 24, or 27%, were too overweight to be considered for service in the military.[20]

Prevalence by state

The following figures were averaged from 2005–2007 adult data compiled by the CDC BRFSS program[21] and 2003–2004 child data from the National Survey of Children's Health.[22][23]

Care should be taken in interpreting these numbers, because they are based on self-report surveys which asked individuals (or, in case of children & adolescents, their parents) to report their height and weight. Height is commonly overreported and weight underreported, sometimes resulting in significantly lower estimates. One study estimated the difference between actual and self-reported obesity as 7% among males and 13% among females as of 2002, with the tendency to increase.[24]

State & District of Columbia Obese Adults Overweight Adults Obese Children & Adolescents Obesity Rank
Alabama 30.1% 65.4% 16.7% 3
Alaska 27.3% 64.5% 11.1% 14
Arizona 23.3% 59.5% 12.2% 40
Arkansas 28.1% 64.7% 16.4% 9
California 23.1% 59.4% 13.2% 41
Colorado 21.0% 55.0% 9.9% 51
Connecticut 20.8% 58.7% 12.3% 49
D.C. 22.1% 55.0% 14.8% 43
Delaware 25.9% 63.9% 22.8% 22
Florida 23.3% 60.8% 14.4% 39
Georgia 27.5% 63.3% 16.4% 12
Hawaii 20.7% 55.3% 13.3% 50
Idaho 24.6% 61.4% 10.1% 31
Illinois 25.3% 61.8% 15.8% 26
Indiana 27.5% 62.8% 15.6% 11
Iowa 26.3% 63.4% 12.5% 19
Kansas 25.8% 62.3% 14.0% 23
Kentucky 28.4% 66.8% 20.6% 7
Louisiana 29.5% 64.2% 17.2% 4
Maine 23.7% 60.8% 12.7% 34
Maryland 25.2% 61.5% 13.3% 28
Massachusetts 20.9% 56.8% 13.6% 48
Michigan 27.7% 63.9% 14.5% 10
Minnesota 24.8% 61.9% 10.1% 30
Mississippi 34.4% 67.4% 17.8% 1
Missouri 27.4% 63.3% 15.6% 13
Montana 21.7% 59.6% 11.1% 45
Nebraska 26.5% 63.9% 11.9% 18
Nevada 23.6% 61.8% 12.4% 36
New Hampshire 23.6% 60.8% 12.9% 35
New Jersey 22.9% 60.5% 13.7% 42
New Mexico 23.3% 60.3% 16.8% 38
New York 23.5% 60.0% 15.3% 37
North Carolina 27.1% 63.4% 19.3% 16
North Dakota 25.9% 64.5% 12.1% 21
Ohio 26.9% 63.3% 14.2% 17
Oklahoma 28.1% 64.2% 15.4% 8
Oregon 25.0% 60.8% 14.1% 29
Pennsylvania 25.7% 61.9% 13.3% 24
Rhode Island 21.4% 60.4% 11.9% 46
South Carolina 29.2% 65.1% 18.9% 5
South Dakota 26.1% 64.2% 12.1% 20
Tennessee 29.0% 65.0% 20.0% 6
Texas 27.2% 64.1% 19.1% 15
Utah 21.8% 56.4% 8.5% 44
Vermont 21.1% 56.9% 11.3% 47
Virginia 25.2% 61.6% 13.8% 27
Washington 24.5% 60.7% 10.8% 32
West Virginia 30.6% 66.8% 20.9% 2
Wisconsin 25.5% 62.4% 13.5% 25
Wyoming 24.0% 61.7% 8.7% 33

Epidemiology

According to the NHANES data, African American and Mexican American adolescents between 12 and 19 years old are more likely to be overweight than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14% respectively. Also, in a national survey of American Indian children 5–18 years old, 39 percent were found to be overweight or at risk for being overweight.[25]

Looking at the long-term consequences, overweight adolescents have a 70 percent chance of becoming overweight or obese adults, which increases to 80 percent if one or more parent is overweight or obese. In 2000, the total cost of obesity for children and adults in the United States was estimated to be $117 billion ($61 billion in direct medical costs).

Food consumption has increased with time. For example, annual per capita consumption of cheese per capita was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in 2000; the average person consumed 389 grams of carbohydrates daily in 1970; 490 in 2000; 41 pounds (19 kg) of fats and oils in 1909; 79 pounds (36 kg) in 2000. In 1977, 18% of an average person's food was consumed outside the home; in 1996, this had risen to 32%.[26]

Medical costs

An obese Hawaiian woman.

There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability.[27] In particular, diabetes has become the seventh leading cause of death in the United States,[28] with the U.S. Department of Health and Human Services estimating in 2008 that fifty-seven million adults aged twenty and older were pre-diabetic, 23.6 million diabetic, with 90–95% of the latter being type 2-diabetic.[29] Obesity has also been shown to increase the prevalence of complications during pregnancy and childbirth. Babies born to obese women are almost three times as likely to die within one month of birth and almost twice as likely to be stillborn than babies born to women of normal weight.[30]

Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year[10] and has increased health care use and expenditures,[27][31][32][33] costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs.[34] This exceeds health-care costs associated with smoking or problem drinking[33] and accounts for 6% to 12% of national health care expenditures in the United States.[35]

The Medicare and Medicaid programs bear about half of this cost.[33] Annual hospital costs for treating obesity-related diseases in children rose threefold, from $35 million to $127 million, in the period from 1979 to 1999,[36] and the inpatient and ambulatory healthcare costs increased drastically by $395 per person per year.[32] These trends in healthcare costs associated with pediatric obesity and its comorbidities are staggering, urging the surgeon general to predict that preventable morbidity and mortality associated with obesity may surpass those associated with cigarette smoking.[31][37] Furthermore, the probability of childhood obesity persisting into adulthood is estimated to increase from approximately twenty percent at four years of age to approximately eighty percent by adolescence,[38] and it is likely that these obesity comorbidities will persist into adulthood.[39]

Anti-obesity efforts

Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias.[40] State legislators in California, for example, passed laws banning the sale of machine-dispensed snacks and drinks in elementary schools in 2003, despite objections by the California-Nevada Soft Drink Association. The state followed more recently with legislation to prohibit their soda sales in high schools starting July 1, 2009, with the shortfall in school revenue to be compensated by an increase in funding for school lunch programs.[41] A similar law passed by the Connecticut General Assembly in June 2005 was vetoed by governor Jodi Rell, who stated the legislation "undermines the control and responsibility of parents with school-aged children."[42]

In mid-2006, the American Beverage Association (including Cadbury Schweppes, Coca Cola and PepsiCo) agreed to a voluntary ban on the sale of all high-calorie drinks and all beverages in containers larger than 8, 10 and 12 ounces in elementary, middle and high schools, respectively.[43][44]

Non-profit organizations such as HealthCorps work to educate people on healthy eating and advocate for healthy food choices in an effort to combat obesity.[45]

The American First Lady Michelle Obama is leading an initiative to combat childhood obesity entitled "Let's Move". Mrs. Obama says she aims to wipe out obesity "in a generation". Let's Move! has partnered with other programs.[46]

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