Obesity in the United States
This article needs to be updated.(February 2017)
Obesity in the United States has been increasingly cited as a major health issue in recent decades,[timeframe?] resulting in diseases such as coronary heart disease that lead to mortality.[needs update?] While many industrialized countries have experienced similar increases, obesity rates in the United States are the highest in the world.
Obesity has continued to grow within the United States. Two of every three American men are considered to be overweight or obese, but the rates for women are far higher. The United States contains one of the highest percentage of obese people in the world. An obese person in America incurs an average of $1,429 more in medical expenses annually. Approximately $147 billion is spent in added medical expenses per year within the United States. This number is suspected to increase approximately $1.24 billion per year until the year 2030.
The United States had the highest rate of obesity within the OECD grouping of large trading economies. From 23% obesity in 1962, estimates have steadily increased. The following statistics comprise adults age 20 and over. The overweight percentages for the overall US population are higher reaching 39.4% in 1997, 44.5% in 2004, 56.6% in 2007, and 63.8% (adults) and 17% (children) in 2008. In 2010, the Centers for Disease Control and Prevention (CDC) reported higher numbers once more, counting 65.7% of American adults as overweight, and 17% of American children, and according to the CDC, 63% of teenage girls become overweight by age 11. In 2013 the Organisation for Economic Co-operation and Development (OECD) found that 57.6% of American citizens were obese. The organization estimates that 3/4 of the American population will likely be overweight or obese by 2020. The latest figures from the CDC as of 2014 show that more than one-third (36.5%) of U.S. adults age 20 and older and 17% of children and adolescents aged 2–19 years were obese. A second study from the National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).
Obesity has been cited as a contributing factor to approximately 100–400 000 deaths in the United States per year and has increased health care use and expenditures, 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. This exceeds health care costs associated with smoking and accounts for 6% to 12% of national health care expenditures in the United States.
- 1 Prevalence
- 1.1 Race
- 1.2 Male Female Fat Ratio
- 1.3 Age group
- 1.4 In the military
- 1.5 Prevalence by state and territory
- 2 Epidemiology
- 3 Contributing factors to obesity epidemic
- 4 Total costs to the US
- 5 Effects on life expectancy
- 6 Anti-obesity efforts
- 7 Accommodations
- 8 See also
- 9 References
- 10 External links
Obesity rates have increased for all population groups in the United States over the last several decades. 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.
Obesity is distributed unevenly across racial groups in the United States.
The obesity rate for Caucasian adults (over 30 BMI) in the US in 2015 was 29.7%. For adult Caucasian men, the rate of obesity was 31.1% in 2015. For adult Caucasian women, the rate of obesity was 27.5% in 2015.
Black or African American
The obesity rate for Black adults (over 30 BMI) in the US in 2015 was 39.8%. For adult Black men, the rate of obesity was 34.4% in 2015. For adult Black women, the rate of obesity was 44.7% in 2015. BMI is not a good indicator in determining all-cause and coronary heart disease mortality in black women compared to white women.
American Indian or Alaska Native
The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2015 was 42.9%. No breakdown by sex was given for American Indian or Alaska Native adults in the CDC figures.
Hispanic or Latino
The obesity rate for the Hispanic or Latino adults category (over 30 BMI) in the US in 2015 was 31.8%. For the overall Hispanic or Latino men category, the rate of obesity was 31.8% in 2015. For the overall Hispanic or Latino women category, the rate of obesity was 31.8% in 2015.
Mexican or Mexican Americans
Within the Hispanic or Latino category, obesity statistics for Mexican or Mexican Americans were provided, with no breakdown by sex. The obesity rate for Mexican or Mexican Americans adults (over 30 BMI) in the US in 2015 was 35.2%.
Native Hawaiian or Other Pacific Islander
The obesity rate for Native Hawaiian or Other Pacific Islander adults (over 30 BMI) in the US in 2015 was 33.4%. No breakdown by sex was given for Native Hawaiian or Other Pacific Islander adults in the CDC figures.
Male Female Fat Ratio
Over 70 million adults in U.S. are obese (35 million men and 35 million women). 99 million are overweight (45 million men and 54 million women).
Historically, obesity primarily affected adults. From the mid-1980s to 2003, obesity roughly doubled among U.S. children ages 2 to 5 and roughly tripled among young people over the age of 6, but statistics show that obesity in 2-6 year olds has dropped, from 14.6% to 8.2%
Some newborns are oversized. This is more often a problem associated with a medical disorder. Unlike adults, neonates do not develop obesity. The number one cause of big babies is diabetes in their mother. The baby is not considered obese. Newborns who are born to mothers who are considered obese have a 49% decrease[clarification needed] in likelihood of mortality.
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. In less than one generation, the average weight of a child has risen by 5 kg in the United States. As of 2014, about one-third of children and teens in the US are overweight or obese. The prevalence of child obesity in today's society concerns health professionals because a number of these children develop health issues that weren't usually seen until adulthood.
Some of the consequences in childhood and adolescent obesity are psychosocial. Overweight children and Overweight adolescents are targeted for social discrimination, and thus, they begin to stress-eat. The psychological stress that a child or adolescent can endure from social stigma can cause low self-esteem which can hinder a child's after school social and athletic capability, especially in plump teenage girls, and could continue into adulthood. Teenage females are often overweight or obese by age 12, as, after puberty, teenage girls gain about 15 pounds, specifically in the arms, legs, and chest/midsection.
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 19.6%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.
In 2000, approximately 39% 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.
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.
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.
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.
"More than 80 percent of affected children become overweight adults, often with lifelong health problems." Children are not only highly at risk of diabetes, high cholesterol and high blood pressure but obesity also takes a toll on the child's psychological development. Social problems can arise and have a snowball effect, causing low self-esteem which can later develop into eating disorders.
There are more obese US adults than those who are just overweight. According to a study in The Journal of the American Medical Association (JAMA), in 2008, the obesity rate among adult Americans was estimated at 32.2% for men and 35.5% for women; these rates were roughly confirmed by the CDC again for 2009–2010. Using different criteria, a Gallup survey found the rate was 26.1% for U.S. adults in 2011, up from 25.5% in 2008. Though the rate for women has held steady over the previous decade, the obesity rate for men continued to increase between 1999 and 2008, according to the JAMA study notes. Moreover, "The prevalence of obesity for adults aged 20 to 74 years increased by 7.9 percentage points for men and by 8.9 percentage points for women between 1976–1980 and 1988–1994, and subsequently by 7.1 percentage points for men and by 8.1 percentage points for women between 1988–1994 and 1999–2000." According to the CDC, "obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults."
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. Obesity in the elderly increases healthcare costs.[clarification needed] Nursing homes are not equipped with the proper equipment needed to maintain a safe environment for the obese residents. If a heavy bedridden patient is not turned, the chances of a bed sore increases. If the sore is untreated, the patient will need to be hospitalized and have a wound vac placed.
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 US$15 million in 2002. Obesity is currently the largest single cause for the discharge of uniformed personnel.
In 2005, 9 million adults of ages 17 to 24, or 27%, were too overweight to be considered for service in the military.
Research in 2012 on young servicemen's autopsies revealed a high incidence of conditions consistent with coronary artery disease.
Prevalence by state and territory
The following figures were averaged from 2005–2007 adult data compiled by the CDC BRFSS program and 2003–2004 child data[A] from the National Survey of Children's Health. There is also data from a more recent 2016 CDC study of the 50 states plus the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.
Care should be taken in interpreting these numbers, because they are based on self-report surveys which asked individuals (or, in case of children and 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.
The long-running REGARDS study, published in the journal of Obesity in 2014, brought in individuals from the nine census regions and measured their height and weight. The data collected disagreed with the data in the CDC's phone survey used to create the following chart. REGARDS found that the West North Central region (North Dakota, South Dakota, Minnesota, Missouri, Nebraska, and Iowa), and East North Central region (Illinois, Ohio, Wisconsin, Michigan, and Indiana) were the worst in obesity numbers, not the East South Central region (Tennessee, Mississippi, Alabama, Kentucky) as had been previously thought. Dr. P.H., professor in the Department of Biostatistics in the UAB School of Public Health George Howard explains that "Asking someone how much they weigh is probably the second worst question behind how much money they make," "From past research, we know that women tend to under-report their weight, and men tend to over-report their height." Howard said as far as equivalency between the self-reported and measured data sets, the East South Central region showed the least misreporting. "This suggests that people from the South come closer to telling the truth than people from other regions, perhaps because there's not the social stigma of being obese in the South as there is in other regions."
|Obese adults (mid-2000s)||Obese adults (2016)||Overweight (incl. obese) adults
|Obese children and adolescents
|District of Columbia||22.1%||22.6%||55.0%||14.8%||43|
|Northern Mariana Islands||—||—||—||16%||—|
|Virgin Islands (U.S.)||—||32.5%||—||—||—|
Obesity is a chronic health problem. It is one of the biggest factors for a type II diabetes, and cardiovascular disease. It is also associated with cancer (e.g. colorectal cancer), osteoarthritis, liver disease, sleep apnea, depression and other medical conditions that affect mortality and morbidity.
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. As per national survey data, these trends indicate that by 2030, 86.3% of adults will be overweight or obese and 51.1% obese.
A 2007 study found that receiving Food Stamps long term (24 months) was associated with a 50% increased obesity rate among female adults.
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 US$117 billion (US$61 billion in direct medical costs). Given existing trends, this amount is projected to range from US$860.7-956.9 billion in healthcare costs by 2030.
Food consumption has increased with time. For example, annual per capita consumption of cheese was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in 2000; the average person consumed 389 grams (13.7 oz) of carbohydrates daily in 1970; 490 grams (17 oz) 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%.
Contributing factors to obesity epidemic
This section may need to be rewritten entirely to comply with Wikipedia's quality standards. (June 2012)
According to Cleveland Clinic, cultural, social, and environmental factors, among others, all affect eating behaviors.
Meat consumption, from fast food restaurants or at home, have been positively associated with weight gain in men and women. The 2010 EPIC-PANACEA study in the American Journal of Clinical Nutrition tracked 373,803 people over a period of 8 years to determine factors leading to obesity. Poultry, red meat, and processed meat were all attributed to this increased weight gain. A follow-up response across a sample of 91,214 people found that even controlling for calories and lifestyle factors, meat consumption is positively linked with obesity. Further reviews and meta-analysis have also implicated increased meat consumption with obesity.
Fast food has been cited as a contributing factor to obesity in the United States by various sources over the years. Around one third of children aged 4 to 19 eat fast food every day in the U.S.
Many popular American foods, including hamburgers, french fries, bacon, and doughnuts, are high in fat and carbohydrate content. These food items are also relatively inexpensive and available at fast food chains across the country (for ex. value menu). These convenience foods are frequently fried and are high in calories. Consumption of foods exceedingly high in fat calories can lead to obesity. Many menu items at fast food establishments do not fulfill basic nutritional requirements of a healthy meal. In a 2010 report by the Rudd Center for Food Policy it was noted that less than 1% of children's meals combinations met nutrition standards recommended by experts. Meals provided in public schools are a primary example of developing poor nutritional choices as the foods offered are not as healthy as they are claimed to be. Some school system provide children with these popular foods that are very high in fats and calories.
Fast food chains and restaurants have experienced improved sales with larger portion sizes. Research cited by the Center for Disease Control estimates restaurant meal sizes to be four times larger than they were in the 1950s.
Three studies published in the United States shows a correlation between sweet soda and fruit drinks to obesity. The consumption of sweet soda and fruit drinks has more than doubled since the 1970s. The first study showed that "drinking sugary drinks was affecting genes that regulate weight and increased the genetic predisposition of a person to gain weight." The other two studies showed that "giving to children and adolescents calorie-free drinks like mineral water or soft drinks sweetened with artificial sweeteners resulted in weight loss."
One of the other two studies was conducted by Boston Children's Hospital who examined two groups of adolescents. The group which was encouraged to consume water or light sodas for a year gained 0.68 kilograms (1.5 lb). The other group, which consumed sugary drinks, gained 1.5 kilograms (3.3 lb). The third study was conducted by Vrije Universiteit in Amsterdam, Netherlands. They studied 641 children ages four to eleven over 18 months. They were split into two groups. One group drank sweet and fruity drinks and the other group drank the same drink with sugarless sweeteners. The group that drank the drink that had sugarless sweeteners gained 6.39 kilograms (14.1 lb) on average compared to 7.36 kilograms (16.2 lb) on average by the other group.
A sedentary lifestyle is another possible contributing factor to obesity. A sedentary lifestyle is a type of lifestyle with no or irregular physical activity. Sedentary activities include sitting, reading, watching television, playing video games, and computer use for much of the day with little or no vigorous physical exercise. Transportation in the United States relies heavily on cars and encourages a sedentary lifestyle which may reduce the overall activity of individuals, plus a sedentary lifestyle could also cause a person to eat more making them gain more weight and becoming obese or overweight. A sedentary lifestyle can contribute to many preventable causes of death. Screen time is the amount of time a person spends watching a screen such as a television, computer monitor, or mobile device. Excessive screen time is linked to negative health consequences. Much of the workforce gets insufficient exercise. Most employees work sitting down for hours at a time. As Americans have become more sedentary in their lifestyles, obesity rates have risen. More than 60% of adults do not exercise as recommended, and approximately 25% of adults are not active at all. Exercise prevents excess weight and helps maintain weight loss. Despite the well-known benefits of physical activity, many adults and many children lead a relatively sedentary lifestyle and are not active enough to achieve these health benefits. Being active boosts high-density lipoprotein (HDL), and decreases unhealthy triglycerides.
In adolescents, obesity has been associated with the household availability and level of intake of sugar-sweetened beverages. Research has shown that families who frequently spend significant time eating dinner as a family tend to have lower rates of obesity among children.
People are generally social which carries over into their eating habits. As Sidney Mintz, professor of anthropology at Johns Hopkins University said, "Interaction over food is the single most important feature of socializing." The business world typically transacts business deals over food.
Technology such as televisions, cellular devices, and video games add on to the epidemic by increasing time spent in the home versus the time that could be spent being outside or doing some kind of physical activity. Not only have studies proven that children who watch more TV tend to have higher body fat percentage but that what they actually view can affect their eating habits. The approximate $10 billion spent annually for commercials to advertise food instills brand recognition and loyalty with children.
But in 2011, researchers assessed the causal relationship between recent increases in female labor force participation and the increased prevalence of obesity among women and found no such causal link. However, as families have become increasingly busy, quality family time has decreased.
Although some genetic links to obesity have been made, relatively little is known about how genes or loci might influence dynamic measures of weight change over time.
Total costs to the US
There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability. In particular, diabetes has become the seventh leading cause of death in the United States, 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.
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.
Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year (including increased morbidity in car accidents) and has increased health care use and expenditures, 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. This exceeds health-care costs associated with smoking or problem drinking and, by one estimate, accounts for 6% to 12% of national health care expenditures in the United States (although another estimate states the figure is between 5% and 10%).
The Medicare and Medicaid programs bear about half of this cost. Annual hospital costs for treating obesity-related diseases in children rose threefold, from US$35 million to US$127 million, in the period from 1979 to 1999, and the inpatient and ambulatory healthcare costs increased drastically by US$395 per person per year.
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. 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, and it is likely that these obesity comorbidities will persist into adulthood.
Effects on life expectancy
The United States' high obesity rate is a major contributor to its relatively low life expectancy relative to other high-income countries. It has been suggested that obesity may lead to a halt in the rise in life expectancy observed in the United States during the 19th and 20th centuries.
The National Center for Health Statistics reported in November 2015:
Trends in obesity prevalence show no increase among youth since 2003–2004, but trends do show increases in both adults and youth from 1999–2000 through 2013–2014. No significant differences between 2011–2012 and 2013–2014 were seen in either youth or adults.
Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias. 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. 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."
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.
Former American First Lady Michelle Obama led an initiative to combat childhood obesity entitled "Let's Move". Obama said she aimed to wipe out obesity "in a generation". Let's Move! has partnered with other programs. Walking and bicycling to school helps children increase their physical activity.
In 2008, the state of Pennsylvania enacted a law, the "School Nutrition Policy Initiative," aimed at the elementary level. These "interventions included removing all sodas, sweetened drinks, and unhealthy snack foods from selected schools, 'social marketing' to encourage the consumption of nutritious foods and outreach to parents." The results were a "50 percent drop in incidence of obesity and overweight", as opposed to those individuals who were not part of the study.
In the past decade there have been school-based programs that target the prevention and management of childhood obesity. There is evidence that long term school-based programs have been effective in reducing the prevalence of childhood obesity.
For two years, Duke University psychology and global health professor Gary Bennett and eight colleagues followed 365 obese patients who had already developed hypertension. They found that regular medical feedback, self-monitoring, and a set of personalized goals can help obese patients in a primary care setting lose weight and keep it off.
Major United States manufacturers of processed food, aware of the possible contribution of their products to the obesity epidemic, met together and discussed the problem as early as April 8, 1999; however, a proactive strategy was considered and rejected. As a general rule, optimizing the amount of salt, sugar and fat in a product will improve its palatability, and profitability. Reducing salt, sugar and fat, for the purpose of public health, had the potential to decrease palatability and profitability.
Media influence may play an important role in prevention of obesity as it has the ability to boost many of the main prevention/intervention methods used nowadays including lifestyle modification. The media is also highly influential on children and teenagers as it promotes healthy body image and sets societal goals for lifestyle improvement. Examples of media influence are support for the "Let's Move!" campaign and the MyPlate program initiated by Michelle Obama, and the NFL's Play60 campaign. These campaigns promote physical activity in an effort to reduce obesity especially for children.
Ultimately, federal and local governments in the U.S. are willing to create political solutions that will reduce obesity ratings by "recommending nutrition education, encouraging exercise, and asking the food and beverage industry to promote healthy practices voluntarily." In 2008, New York City was the first city to pass a "labeling bill" that "require[d] restaurants" in several cities and states to "post the caloric content of all regular menu items, in a prominent place and using the same font and format as the price."
 Along with obesity came the accommodations made of American products. Child-safety seats in 2006 became modified for the 250,000 obese U.S. children ages six and below.  The obese incur extra costs for themselves and airlines when flying. Weight is a major component to the formula that goes into the planes take off and for it to successfully fly to the desired destination. Due to the weight limits taken in consideration for flight in 2000, airlines spent $275 million on 350 million additional gallons of fuel for compensation of additional weight to travel.
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- EPODE International Network, the world's largest obesity-prevention network
- World Fit, a program of the United States Olympic Committee
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