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Projected Prevalence of Obesity and Severe Obesity in 2030 by State
Study Questions:
What are the estimated rates of obesity at the state level in the United States?
Methods:
The investigators adjusted reported body mass index (BMI) data from the Behavioral Risk Factor Surveillance System (BRFSS) Survey (1993–1994 and 1999–2016) to align with objective measures of body mass index (BMI) from the National Health and Nutrition Examination Survey (NHANES) to estimate prevalence trends in BMI categories in each state. Projections for BMI categories were estimated through the year 2030. BMI categories included underweight or normal weight (BMI <25 kg/m2), overweight (25 to <30 kg/m2), moderate obesity (30 to <35 kg/m2), and severe obesity (≥35 kg/m2). Self-reported BRFSS survey data were corrected for self-reporting bias. Multinomial regression models were created for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030. The accuracy of the approach was evaluated using data from 1990 through 2010 to predict 2016 outcomes.
Results:
A total of 6,264,226 adults (≥18 years of age) from the BRFSS survey (1993–1994 and 1999–2016) provided data on BMI, which was corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in NHANES. An estimated 48.9% (95% confidence interval [CI], 47.7-50.1) of adults will be obese by the year 2030 using this method of estimation. An estimated 29 states will have over 50% of adults in the obese range for BMI. No states would have obesity rates below 35%. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9-25.5), and the prevalence will be higher than 25% in 25 states. Severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1-29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9-33.4), and low-income adults (31.7%; 95% CI, 30.2-33.2).
Conclusions:
This analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups.
Perspective:
These results suggest an alarming increase in obesity and, in particular, severe obesity over the next decade. In particular, low-income adults, women, and non-Hispanic blacks are at the highest risk. As the authors suggest, the prevention of weight gain is of critical importance. It must include a multilevel approach with involvement of communities and public health and policy expertise, in addition to health care providers. Such rates of obesity will carry significant costs to be incurred by everyone; efforts to prevent weight gain and effectively manage weight loss are urgently needed.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention
Keywords: Body Mass Index, Metabolic Syndrome, Obesity, Obesity, Morbid, Overweight, Prevalence, Primary Prevention, Thinness, Weight Gain, Weight Loss
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