September 16, 2019
A new snapshot of obesity in America paints an alarming picture.
In 2018, for the first time, more than 35% of adults in nine mostly southern states — Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, and West Virginia — were obese.
In 2017, the prevalence of obesity was more than 35% in only seven states.
"These latest data shout that our national obesity crisis is getting worse," said John Auerbach, MBA, president and CEO of Trust for America's Health, the nonprofit organization that published the report, State of Obesity: Better Policies for a Healthier America 2018, on September 12.
The data in the 16th annual report "tell us that almost 50 years into the upward curve of obesity rates we haven't yet found the right mix of programs to stop the epidemic," according to Auerbach.
As recently as 2012, no state had an adult obesity rate above 35%. But in the 5 years from 2013 to 2018, 33 states had statistically significant increases in adult obesity.
The current report, Auerbach noted in a press release from his institution, "highlights the fundamental changes that are needed ... for people to eat healthy foods and get sufficient exercise," and it provides recommendations for government policies to tackle this "obesity crisis."
Almost 40% of US Adults and Nearly 20% of Kids Are Obese
The report is based on data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and prevention (CDC) and the most recent 2015-2016 National Health and Nutrition Examination Survey (NHANES).
The nationally representative NHANES data reveal "unprecedented levels of obesity," the report states. In 2015-2016, 39.6% of adults and 18.5% of children in America were obese (body mass index > 30 kg/m2 for adults), with the increased risks of numerous poor health outcomes that go along with obesity.
"Strikingly, the incidence of obesity in the United States has increased by 70% over the last 30 years for adults and by 85% over the same time ... for children," the authors note.
The data also reveal that obesity is much more of a problem among minority and disadvantaged populations.
Blacks and Latinos are often targeted in advertising for unhealthy food and tend to live in neighborhoods with fewer healthy food options or opportunities for physical activity, which may partly explain their higher obesity rates.
Among adults, nearly half of Latinos (47%) and blacks (46.8%) were obese, compared with 37.9% of whites and 12.7% of Asians.
Similarly, among children, about a quarter of Latinos (25.8%) and blacks (22%) were obese, but only 14% of white and 11% of Asian kids were obese.
Some Light at the End of the Tunnel?
There have been some successes in bucking the trend, however.
For example, obesity rates among children enrolled in the Women, Infants and Children (WIC) Special Supplemental Nutrition Program declined from 15.9% in 2010 to 13.9% in 2016.
And a study published this year reported that 4-year-old children in Los Angeles County who had received the WIC food package since birth were less likely to become obese.
Taxes on sugar-sweetened beverages passed in several US cities and the Navajo Nation also show promise as a means to change consumers' beverage habits. For example, a 1-cent per ounce tax on sugar-sweetened beverages in Berkeley, California, and a 1.5-cent per ounce tax in Philadelphia, Pennsylvania, were associated with decreased consumption.
What's Needed to Move the Needle?
The report makes 31 recommendations for federal, state, and local governments to introduce policies to help improve access to nutritious foods, provide safe opportunities for physical activity, and minimize harmful advertising.
Some key recommendations are:
- Extend the WIC Special Supplemental Nutrition Program for 2 years postpartum for mothers and to age 6 for children.
- Tax sugary drinks and use the money to fix health and social disparities.
- Ensure that the CDC can fund obesity prevention strategies in every state (up from the 16 in which they are currently funded).
- Make it harder to advertise unhealthy food to children by ending federal tax loopholes.
- Fully fund federal programs for student physical education.
- Fund Safe Routes to Schools (SRTS), Complete Streets, Vision Zero, and other pedestrian safety initiatives.
- Ensure programs such as the Supplemental Nutrition Assistance Program (SNAP) follow the Dietary Guidelines for Americans.
- Strengthen and expand school nutrition programs and eliminate all unhealthy food marketing to students.
- Enforce laws for health insurers to cover all obesity-related preventive services.
- Cover evidence-based comprehensive pediatric weight management programs and services in Medicaid.
The percentage of obese adults in each state in 2018 is as follows (listed in descending order in each percentage category):
- 35.0% to 39.5%: Mississippi, West Virginia, Arkansas, Louisiana, Kentucky, Alabama, Iowa, North Dakota, Missouri.
- 34.0% to 34.9%: Oklahoma, Texas, Kansas, Tennessee, South Carolina, Indiana, Nebraska, Ohio.
- 30.0% to 33.9%: Delaware, Michigan, North Carolina, Georgia, New Mexico, Wisconsin, Illinois, Maryland, Pennsylvania, Florida, Maine, Virginia, Minnesota, South Dakota.
- 26.0% to 29.9%: Oregon, New Hampshire, Alaska, Arizona, Nevada, Wyoming, Washington, Idaho, Utah, Rhode Island, New York, Vermont, Connecticut, Montana.
- 23.0% to 25.9%: California, Massachusetts, New Jersey, Hawaii, District of Columbia, Colorado.
The report was funded by the Robert Wood Johnson Foundation.