Q&A: The epidemic of obesity in the US

IHME's Dr. Marie Ng shares key findings and policy recommendations from our latest research on BMI, overweight, and obesity in the United States.

This transcript has been lightly edited for clarity

Read the research

What are the key findings from the research?

Over the last three decades there has been a startling increase in the prevalence of obesity and overweight in the United States. Our study found that in 2021 there were an estimated 208 million people living with overweight or obesity. The situation is especially severe in the Southern states. If no action is taken, we projected that by 2050 over 260 million people will be experiencing overweight and obesity in the country.

What are the drivers of increasing overweight and obesity since 1990?

Obesity in the United States is driven by various factors, including lifestyle factors such as high calorie diet and low physical activities. There are also multiple structural factors that are propelling the obesity epidemic. These include suboptimal urban planning with limited safe space for exercising, aggressive marketing from the food industry to promote unhealthy food, food deserts where access to healthy food choices are very, very restricted.

In addition, currently in the United States, the health care system do not provide adequate support for obesity prevention and treatments. People with low income are especially vulnerable to these risk factors.

Have existing interventions helped, and what more needs to be done?

At the individual level, obesity increases the risk of diseases such as diabetes, cardiovascular diseases, cancer, and shortening life expectancy. As many may recall, during the COVID pandemic patients with obesity were disproportionately affected, with higher mortality rate. At a societal level, treatment and management of obesity is going to pose substantial pressure on the existing health care system. The economic cost of obesity is also stunning. A Congress report last year suggested that the health care costs associated with obesity will increase to $4.11 trillion in the next ten years.

And a Senate report earlier this year suggests that if half of the adult population with obesity were prescribed the latest medication, it would cost the health care system $411 billion each year. Obesity does not just affect individual health, it also has a profound societal impact.

What are the consequences if levels of obesity are not brought under control?

The mechanism behind obesity epidemic in the United States is much more complex than simply energy imbalance. Existing interventions, often emphasizing lifestyle and behavioral changes, have not produced a significant impact. Addressing structural drivers of population obesity, with an emphasis on prevention, is going to be key for any future strategies. These may include increased subsidies for healthy food, regulating food marketing and nutritional content, enhancing health care access, with better insurance coverage for obesity management, as well as modernizing urban planning with the inclusion of safe spaces for physical activities.