• Overview
  • Obesity prevalence
  • Trends over time
  • Population breakdowns
  • Drivers
  • Comorbidities
  • Health systems
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Obesity prevalence

Adults, 2017-2018

Survey type:Measured
Age:18+
Sample size:5429
Area covered:National
References:Reanalysis of NHANES 2017/18 by Rachel Jackson Leach, Jaynaide Powis World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2015-2016

Survey type:Measured
Age:20+
Sample size:5406
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2013-2014

Survey type:Measured
Age:20+
Sample size:5455
Area covered:National
References:Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. doi:10.1001/jama.2016.6458.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2012

Survey type:Measured
Age:20+
Sample size:5181
Area covered:National
References:Ruopeng An, “Prevalence and Trends of Adult Obesity in the US, 1999–2012”, ISRN Obesity, vol. 2014, Article ID 185132, 6 pages, 2014. doi:10.1155/2014/185132
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2009-2010

Survey type:Measured
Age:20+
Sample size:5926
Area covered:National
References:NHANES Survey - Published in Flegal KM, Carrolll MD, Kit BK, Ogden CL. Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010. JAMA Published online January 17, 2012. doi: 10.1001/jama.2012.39
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2007-2008

Survey type:Measured
Age:20+
Sample size:5555
Area covered:National
References:Flegal KM, Carroll MD, Ogden CL and Curtin LR. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303 (3): 235 - 241.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2003-2004

Survey type:Measured
Age:20+
Sample size:4431
Area covered:National
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA,Tabak CJ, & Flegal KM. (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. The Journal of the American Medical Association, Vol 295(13):1549 - 1555.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2003

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2001-2002

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2000

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1999-2000

Survey type:Measured
Age:20-74
Sample size:3601
References:Centres for Disease Control and Prevention. http://www.cdc.gov/
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1999

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1991

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1988-1994

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1976

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1973

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1971-1974

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1960-1962

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1960

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2017-2018

Survey type:Measured
Age:5-17
Sample size:2086
Area covered:National
References:Reanalysis of NHANES 2017/18 by Rachel Jackson Leach, Jaynaide Powis World Obesity Federation
Cutoffs:IOTF

Children, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2398
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:IOTF

Children, 2013-2014

Survey type:Measured
Sample size:1927
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Sample size based on 5-9yrs, 13-17yrs IOTF International Cut off
Cutoffs:IOTF

Children, 2011-2012

Survey type:Measured
Age:6-11
Sample size:1268
Area covered:National
References:Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA (2014)26;311(8):806-14.
Notes:85th & 95th Centile CDC cut off
Cutoffs:CDC

Children, 2009-2010

Survey type:Measured
Age:5-17
Sample size:2435
Area covered:National
References:NHANES IASO analysis
Notes:IOTF cut off (monthly)
Cutoffs:IOTF

Children, 2003-2004

Survey type:Measured
Age:6-17
Sample size:2613
Area covered:National
References:Lobstein T, Jackson - Leach R. Child overweight and obesity in the USA: prevalence rates according to IOTF definitions. Int J Pediatr Obes. 2007;2(1):62-4.
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Children, 2001-2002

Survey type:Measured
Age:6-11
Sample size:4258
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:Child Cut-Off: 85/95 Centile (see paper for further details)
Cutoffs:Other

Children, 1999-2000

Survey type:Measured
Age:6-11
Sample size:4018
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:Cut-off point: 85/95 Centile (see paper for further details)
Cutoffs:Other

Children, 1988-1994

Survey type:Measured
Age:6-17
Sample size:6108
References:Wang Y, Monteiro C, Popkin B. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. American Journal of Clinical Nutrition 2002;75:971-7
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3
Cutoffs:IOTF

Children, 1971-1974

Survey type:Measured
Age:6-17
Sample size:4471
References:Wang Y, Monteiro C, Popkin B. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. American Journal of Clinical Nutrition 2002;75:971-7
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3
Cutoffs:IOTF

Overweight/obesity by education

Men, 2017-2018

Survey type:Measured
Age:18+
Sample size:5350 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2017-2018

Survey type:Measured
Age:18+
Sample size:5350 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2015-2016

Survey type:Measured
Age:20+
Sample size:5202
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2015-2016

Survey type:Measured
Age:20+
Sample size:5202
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2013-2014

Survey type:Measured
Age:20+
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2013-2014

Survey type:Measured
Age:20+
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2007-2010

Survey type:Measured
Age:25+
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Age-adjusted estimates are adjusted using three age groups: 25-44 years, 45-64 years, and 65 years and over. GED is General Educational Development high school equivalency diploma.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2007-2010

Survey type:Measured
Age:25+
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Age-adjusted estimates are adjusted using three age groups: 25-44 years, 45-64 years, and 65 years and over. GED is General Educational Development high school equivalency diploma.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2315
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:Other

Girls, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2315
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:Other

Boys, 2013-2014

Survey type:Measured
Age:5-9
Sample size:1883
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 13-17yrs also available
Cutoffs:IOTF

Girls, 2013-2014

Survey type:Measured
Age:5-9
Sample size:1883
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 13-17yrs also available
Cutoffs:IOTF

Boys, 2013-2014

Survey type:Measured
Age:13-17
Sample size:1883 (5-9rs & 13-17yrs)
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 5-9yrs also available
Cutoffs:IOTF

Girls, 2013-2014

Survey type:Measured
Age:13-17
Sample size:1883 (5-9rs & 13-17yrs)
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 5-9yrs also available
Cutoffs:IOTF

Boys, 2007-2010

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity among children 2-19 years of age, by sex of child and education level of head of household. Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts. GED is General Educational Development high school equivalency diploma.
Cutoffs:CDC

Girls, 2007-2010

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity among children 2-19 years of age, by sex of child and education level of head of household. Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts. GED is General Educational Development high school equivalency diploma.
Cutoffs:CDC

Overweight/obesity by age

Adults, 2017-2018

Survey type:Measured
Sample size:5432 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2015-2016

Survey type:Measured
Sample size:5406
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2012

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS data brief, no 131. Hyattsville, MD: National Center for Health Statistics. 2013
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2014

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2017-2018

Survey type:Measured
Sample size:2086 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Children, 2015-2016

Survey type:Measured
Sample size:2088
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:IOTF

Children, 2011-2014

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015
Notes:Obesity in children is defined as a BMI of greater than or equal to the age- and sex-specific 95th percentile of the 2000 CDC growth charts.
Cutoffs:CDC

Children, 2011-2012

Survey type:Measured
Sample size:3355
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity is body mass index greater than or equal to the 95th percentile from the sex- and age-specific 2000 CDC Growth Charts.
Cutoffs:cdc

Overweight/obesity by region

Adults, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Behavorial Risk Factor Surveillance System, CDC. Found at http://www.cdc.gov/obesity/data/prevalence-maps.html (last accessed 20th April 2016)
Notes:NOT NHANES States N-Z (inclusive)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Behavorial Risk Factor Surveillance System, CDC. Found at http://www.cdc.gov/obesity/data/prevalence-maps.html (last accessed 20th April 2016)
Notes:NOT NHANES States A - M (inclusive)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 1999-2006

Survey type:Measured
Age:2-19
Sample size:15479
Area covered:National
References:Liu J, Jones SJ, Sun H, et al. Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: An urban and rural comparison. Child Obes 2012;8:440–448
Notes:Children were considered overweight and obese if their body mass index (BMI) was at or above the 85th percentile for age and gender according to growth charts from the National Center for Health Statistics (NCHS).
Cutoffs:Other

Girls, 1999-2006

Survey type:Measured
Age:2-19
Sample size:15479
Area covered:National
References:Liu J, Jones SJ, Sun H, et al. Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: An urban and rural comparison. Child Obes 2012;8:440–448
Notes:Children were considered overweight and obese if their body mass index (BMI) was at or above the 85th percentile for age and gender according to growth charts from the National Center for Health Statistics (NCHS).
Cutoffs:Other

Overweight/obesity by socio-economic group

Men, 2017-2018

Survey type:Measured
Age:18+
Sample size:4638 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2017-2018

Survey type:Measured
Age:18+
Sample size:4638 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2015-2016

Survey type:Measured
Age:20+
Sample size:4904
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2015-2016

Survey type:Measured
Age:20+
Sample size:4904
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2013-2014

Survey type:Measured
Age:20-80
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Total Household earnings per annum
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2013-2014

Survey type:Measured
Age:20-80
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Total Household earnings per annum
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2005-2008

Survey type:Measured
Age:20+
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Poverty income ratio (PIR): The ratio of household income to the poverty threshold after accounting for inflation and family size. In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2005-2008

Survey type:Measured
Age:20+
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Poverty income ratio (PIR): The ratio of household income to the poverty threshold after accounting for inflation and family size. In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 2017-2018

Survey type:Measured
Age:5-17
Sample size:1852 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Girls, 2017-2018

Survey type:Measured
Age:5-17
Sample size:1852 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Boys, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2208
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Cutoffs:IOTF

Girls, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2208
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Cutoffs:IOTF

Boys, 2005-2008

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal, KM. Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Obesity defined as Body mass index (BMI) ≥ age- and sex-specific 95th percentile of the 2000 CDC growth charts. Poverty income ratio (PIR): In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Cutoffs:CDC

Girls, 2005-2008

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal, KM. Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Obesity defined as Body mass index (BMI) ≥ age- and sex-specific 95th percentile of the 2000 CDC growth charts. Poverty income ratio (PIR): In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Cutoffs:CDC

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Estimated per-capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per-capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Oesophageal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Breast cancer

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

Colorectal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Pancreatic cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Gallbladder cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Kidney cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Cancer of the uterus

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014-2019

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014-2019

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Health systems

Economic classification: High Income

Health systems summary

Healthcare coverage in the USA is fragmented, with several public and private sources. Public coverage provided by the government include Medicare, a federal program for the disabled and adults over 64, and Medicaid, a means-tested insurance programme that provides free or low-cost care to those who do not have insurance through their employers or cannot afford insurance through the private market. There is also publicly provided military coverage. Publicly financed care is typically funded by a combination of taxation, premiums, federal revenues and co-payments. On the other hand, private sources of health coverage, which include employer-provided health insurance and private insurance, are funded by employers, employees and private spending.

Efforts have been made since the 2010 Affordable Care Act to reduce the number of underinsured and uninsured Americans. There is evidence that the expansion of Medicaid under the Act reduced the percentage of the population uninsured from 16% to 8% and has improved financial risk protection for the low-income population. The USA is an outlier among large, rich countries by not having universal healthcare.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?Some progress
Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’?Some progress
In practice, how is obesity treatment largely funded?Not known
Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity?Yes
Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in rural areas?No
Are there any obesity-specific recommendations or guidelines published for adults?Partial
Are there any obesity-specific recommendations or guidelines published for children?Partial

Perceived barriers to treatment

  • Lack of training for healthcare professionals
  • Stigma
  • High cost of out of pocket payments
  • Failure to recognise or accept all available treatment options
  • Lack of financial investment and lack of coverage
  • Healthcare professionals disinterested in obesity training and treatment
  • Poor adherence to or fear of treatment
  • Obesity not recognised as a disease

Summary of stakeholder feedback

Stakeholders felt that obesity was not yet recognised as a disease, both at a government and a health provider level. It was recognised that there has been some progress - with the American Medical Association and numerous groups and government agencies recognising obesity as a disease - but not enough. There are still some state governments and insurers who explicitly consider obesity to not be a disease and it was noted that obesity is certainly not yet treated in the same way as other chronic diseases such as diabetes and cancer.

Those living with obesity reportedly present to the system in primary care, but only when they have comorbidities. Despite this, stakeholders noted that obesity is rarely managed in primary care due to a lack of provider knowledge and poor reimbursement of treatment options. Instead, obesity medicine specialists were said to increasingly be the main source of care for people with obesity, a practice that is unsustainable. Stakeholders felt that people tended to leave the system because of lack of specialist referral and poor follow-up.

Once in the system, the type of treatment available to patients is highly dependent on type of health coverage the individual has and the state they live in. This results in great inequality and inequity in the accessibility of treatment. Medicare covers surgery if BMI criteria is met, but what Medicaid covers varies across states. Pharmacotherapy was said to be poorly covered across the board. As a result, many pay out of pocket for treatment across the country.

There are many guidelines and recommendations for treatment of obesity in adults and children. Examples include recommendations/guidelines from the U.S. Preventive Services Task Force, the American Association of Clinical Endocrinologists, and The Obesity Society. One stakeholder highlighted that the issue was not a lack of guidelines, but how existing guidelines could be met. Stakeholders felt that healthcare practitioners were generally not appropriately trained to manage people with obesity, with there being inadequate numbers of trained professionals in both urban and rural areas. There is training available through the America Board of Obesity Medicine, it was said that many have to self-fund. There is another certification by the Academy of Nutrition and Dietetics for dietitians and other integrated health professionals.

Based on interviews/survey returns from 8 stakeholders

Last updated: June 2020

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