Report: Obesity Is Not an Equal Opportunity Threat to Health

Black, Hispanic women among the hardest hit

In 1990, fewer than one in five adults in the U.S. were obese. By 2022, that rate surged to 42.5%. And the percentage of Americans considered obese is only expected to increase by 2035, when close to half of all adults – 46.9% – are forecast to have a body mass index of 30 or higher, according to newly published research.

But, there’s a catch, says a team of doctors who penned a new report published in the Journal of the American Medical Association, titled “US State-Level Prevalence of Adult Obesity by Race and Ethnicity From 1990 to 2022 and Forecasted to 2035.” Obesity is not an equal opportunity health problem. It varies greatly by race, ethnicity, sex and where people live – and racial minorities are often hardest hit by the nation’s obesity crisis.

“High levels of obesity are due to a lot of different causes and often interactions between these causes,” said Dr. Catherine O. Johnson of the University of Washington, the report’s lead author. “One crucial cause is what’s often referred to as the ‘built environment’ – the buildings, public spaces, transportation options, and stores (including grocery stores) in a location.”

Places that have poor access to grocery stores and a lack of safe public places to walk or exercise, such as public parks, often have higher levels of obesity, said Dr. Johnson in an email to Sampan. “It’s important to remember, though, that physical inactivity and poor diet do not exist in isolation and often reflect underlying deep socioeconomic disparities and systematic discrimination in those communities.”

Having what doctors consider high levels of excess body fat is linked to greater rates of death and health woes from a variety of causes including cancer, heart disease, diabetes, and musculoskeletal diseases. The nation’s high levels of obesity also put stress on the healthcare system as a whole, say experts.

Black Women Hit Hardest

The burden of obesity is highest among non-Hispanic Black women, according to the investigative report. In 2022, in fact, Black women were estimated to have the highest age-standardized prevalence of obesity at 56.9%, according to the report. The next most likely group to be obese are Hispanic women, at 49.4%.

This trend “suggests greater health risks in the future for those populations,” said another doctor involved in the report, Dr. Gregory A. Roth, also of the University of Washington.

Hispanic men, non-Hispanic white men and women, and non-Hispanic Black men all were found to have a similar prevalence, at around 40% to 43% in 2022.

Digging deeper into the data, the doctors found that women across all races and ethnicities “had a higher age-standardized prevalence of severe obesity.” Among men, rates of severe obesity was highest for Blacks at 8.5%, followed by white men at 6.7% and Hispanic men at 5.2%. (The prevalence of obesity and severe obesity were not separated out for American Indian, Alaska Native, Asian and Asian subgroups, and Native Hawaiian and Other Pacific Islander groups because of limitations around the availability and consistency of data from 1990 to 2022.)

State-by-State Disparities

Among the racial and ethnic groups, wrote the report’s authors, “there was a wide range in estimated age-standardized prevalence of obesity at the state level.” Rates of obesity varied dramatically state by state in 2022, according to the report, and were predicted to shift over the next 13 years. For Hispanics, for example, rates of obesity were particularly high in the Midwest and the South, both for 2022 and forecast for 2035. In 2022, for women prevalence was highest in Oklahoma at 54% and for men in Indiana. White men and women who lived in the District of Columbia, on the other hand, had the lowest rates of obesity, but the highest rates in nearby in West Virginia. Among the Black male population, the highest prevalence was in Oklahoma in 2022.

“Among non-Hispanic Black females, estimates for the prevalence of obesity were greater than 50% for all locations except Hawaiʻi” for 2022, according to the report.

For the report’s authors, the results likely are caused by underlying racial, ethnic, economic and societal problems.

“The causes of obesity often interact with each other, and result in higher levels for populations affected by multiple factors,” said Dr. Johnson. “For example, Black and Hispanic women face both more frequent discrimination based on race and ethnicity group and (face) safety concerns that could affect their ability to safely exercise in public spaces or to utilize public transportation. This results in these populations having higher levels of obesity and points to the need for interventions that address all of the underlying issues.”

Public health initiatives to help reduce obesity rates must take into account these disparities, she suggested. “Policy interventions intended to address levels of obesity should,” said Dr. Johnson, “address the underlying causes which result in disparities in diet and exercise.”

And prescribing new classes of popular weight-loss drugs for these groups is not necessarily the answer, as it won’t address underlying problems among the populations.

“While the medications result in initial weight loss, maintenance requires ongoing use. Studies show that once most people discontinue treatment, they regain the lost weight and their cardiometabolic risk factors (e.g., blood pressure, blood glucose levels) return to pre-treatment levels,” said Dr. Johnson.

“Policies and interventions aimed at preventing obesity are thus crucial and need to be prioritized for population health.”