Background

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

Many factors contribute to obesity prevalence rates. According to the 2020 CDC Adult Obesity Prevalence Maps, these 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.


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.

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.

Impact of Obesity: Two Examples

Obesity is the root cause of many medical conditions, often called comorbidities. Studies have shown that weight loss benefits for some comorbidities can be seen after as little as a 3% weight loss. Continued weight loss can lead to even greater improvement in certain comorbidities.

Two examples of common obesity-related comorbidities are musculoskeletal issues like chronic back pain and osteoarthritis of the knee and hip, and mental health issues like depression and anxiety.

Musculoskeletal Disorders

Obesity has a direct impact on the development of many musculoskeletal disorders including chronic low back pain, disc degeneration, sciatica and osteoarthritis (OA), a highly disabling progressive degenerative disease of the joints – especially hips and knees. According to the American Academy of Orthopaedic Surgeons, carrying just 10 pounds of extra weight puts an extra 40 to 60 pounds of pressure on each knee. Individuals with obesity are 20 times more likely to need a knee replacement than those who are not overweight.

According to the Arthritis Foundation, incidence of OA, the most common type of arthritis, is increasing. This is directly attributable to the increasing prevalence of obesity. Having obesity makes the development of OA more likely and the disease can get worse if you have it. The risk of knee OA is five times higher in women with obesity and four times higher for men with obesity.

Total knee and/or hip replacement surgery has become the last resort treatment for people with severe OA. Estimates suggest that 80% - 95% of people needing total joint replacement surgery also were overweight or had obesity. With the incidence of obesity increasing and the population aging, the economic burden could be significant.

Mental Health and Depression

Studies have found a complex, two-way relationship between obesity and mental health conditions such as depression and anxiety. Data showed that 43% of adults with depression have obesity. An inverse relationship also exists – according to a recent meta-analysis, in patients with obesity, there is a 55% increased risk in developing depression over time. Research that a higher BMI causes increased risk of having depression and lowers well-being scores. As such, mental health considerations should be a key factor in the development of any weight management intervention.

Screening for both obesity and mental health issues is important in the evaluation, diagnosis and treatment of both conditions. For example, identifying and treating depression can lead to more successful weight loss and weight loss often improves symptoms of depression and anxiety.

A better understanding of the link between obesity and mental health issues helps health providers and mental health professionals identify appropriate, effective, individualized interventions. Unfortunately, few interventions address both simultaneously.