Background

Obesity Management Toolkit

Business Case

Prevalence of Obesity

Obesity is an epidemic, impacting more than 4 out of 10 American adults nationwide, and is the most prevalent chronic condition in the U.S. As a metabolic disease with genetic, environmental and psychological factors, it is associated with poorer mental health outcomes and reduced quality of life.

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Obesity affects working age adults regardless of occupation or industry. More than 24 million (31%) full-time employees have obesity and 32 million (37%) are overweight. If the current trend continues, 51% of the population will have obesity by 2030.

Overweight or Have Obesity?

When a person’s weight is higher than what is considered healthy for a given height it is described as overweight or obesity.

  • Being overweight can occur as a result of having extra body weight from muscle, bone, fat and/or water.
  • Obesity is generally a result of having a high amount of extra body fat.



According to the CDC, overweight and obesity are frequently subdivided into these BMI categories.

Body mass index (BMI) is a useful screening tool for adults to determine overweight/obesity using height and weight. View the BMI tables or use this BMI Adult Calculator.


Factors that Contribute to Obesity

There are many factors that contribute to obesity prevalence rates, including health inequities and social determinants of health. According to the 2020 CDC Adult Obesity Prevalence Maps, other factors include:

  • Education & Age: The prevalence of obesity decreases with education; 38.8% of adults without a high school diploma have obesity, decreasing to 25% for college graduates. Young adults aged 18 – 24 have the lowest prevalence of obesity (19.5%) whereas adults aged 45 – 54 years have the highest, at 38.1%.
  • Race/Ethnicity: Non-Hispanic Black adults have the highest prevalence of self-reported obesity (49.6%), followed by Hispanic adults (44.8%) and non-Hispanic White adults (42.2%). Based on gender, women have a higher estimated prevalence of extreme obesity.
  • Geography: Obesity rates vary significantly between states and regions, rural and urban areas. In 2000, no state had an adult obesity rate above 25%. According to the CDC, in 2020, fifteen states had adult rates above 40%, including Alabama, Arkansas, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, Texas and West Virginia. A recent analysis in the New England Journal of Medicine (NEJM) estimates that by 2030, obesity prevalence rates will be above 35% in all states.
Note: Rates are self-reported and likely underestimate the magnitude of the problem, especially for individuals with severe obesity.


Defining Obesity

Obesity is more than a lifestyle problem. It is the fifth-leading cause of death worldwide – a global health problem affecting more than 650 million adults. The CDC, the Food and Drug Administration and the American Medical Association recognize obesity as a multi-faceted chronic disease requiring long-term management. This is important, as historical thinking about obesity has resulted in significant stigma and bias that is pervasive throughout the health care system and can act as a barrier to effective weight management.

Obesity is second only to cigarette smoking as the leading cause of preventable death in the U.S. and is associated with chronic conditions including type 2 diabetes, heart disease and stroke. Individuals who have been diagnosed with depression are also more likely to have obesity. According to the CDC, 43% of adults with depression have obesity.

Obesity is often underdiscussed, underdiagnosed, undertreated and underreported.

Obesity is often the root cause of other medical conditions and these costly comorbidities often become the focus of treatment. It is important to recognize obesity as a chronic disease with serious health consequences. Treatment should be geared to address the underlying cause of obesity.

Other Determinants of Obesity

Genetic, behavioral and environmental factors contribute to the current high prevalence of obesity. Dietary patterns, lack of physical activity and insufficient sleep may also be contributing factors. The workplace can play a role as well if  the culture is not supportive and support for obesity prevention and management is not provided.

The role of social determinants of health in the obesity epidemic is becoming increasingly apparent. For example:

  • The neighborhood and built environment (where we live, learn, work and play) can influence overall community health and individual behaviors and impact a person’s ability to safely exercise and access healthy and affordable food.
  • Many behaviors that impact obesity are influenced by an individual’s community, family environment and cultural norms, including eating habits and physical activity.
  • Disparities in health care access and quality should not be overlooked as these factors can have a major impact on an individual’s risk of developing obesity and related comorbidities. Those with obesity who do not have access or cannot afford care are often undiagnosed and underreported.



COVID-19 and Obesity

According to the CDC, adults with obesity are at greater risk for severe illness from COVID-19. The higher a person’s BMI, the greater the risk of hospitalization, intensive care admission, use of oxygen, invasive mechanical ventilation and death. Obesity has been linked to impaired immune function, making fighting the virus more difficult. In addition, obesity decreases lung capacity, making ventilation difficult. The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition and recommends individuals with obesity receive the COVID-19 vaccine.

In addition, a 2021 survey by the American Phycological Association on Stress in America found 42% of U.S. adults reported undesired weight gain since the start of the pandemic, with an average gain of 29 pounds.