According to the CDC, the United States is more obese than ever before, hitting a new high of 42.4% obesity in adults (Hales et al. 2018). Curiously, not all populations are affected equally. To investigate the obesity epidemic on the state level, medical professionals from multiple top universities performed and published a study in The New England Journal of Medicine titled “Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity.” The authors predict that in the near future, over half of US states will have a majority-obese population.
It is important to know that someone is officially recognized as obese when their BMI (body mass index) is 30 or higher. For comparison, normal BMI ranges from 18.5 to 24.9, and to be classified as severely obese, one must have a BMI of 35 or higher. Despite its frequency, obesity is a serious medical condition with numerous negative financial and health side-effects. People who are classified as obese have an increased risk of high blood pressure, abnormal cholesterol, type two diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, mental illness, cancer, and more (CDC 2020). Compared to non-obese patients, obese patients paid, on average, 42% more (or $1,429) on health care in a year (Finkelstein et al. 2006). The endemic is also expensive for the government; by 2030, obesity is expected to cost the US an additional $48-66 billion in nationwide healthcare expenses (Wang 2011).
The purpose of this study was to make a prediction regarding the prevalence of state-wide obesity in 2030, hopefully providing future insight to other medical professionals and policy makers who can help reduce the disease’s impact. The researchers conducted this study in response to the lack of accurate numbers analyzing state-by-state obesity. Researchers acknowledge how much is known about national obesity levels but not state obesity levels. It is important to understand highly varying state obesity levels because it is a larger problem in some states than in others, and states should handle it accordingly.
To create applicable data, two nation-wide data collection samples were compared and synthesized. The first data set used was from the Behavioral Risk Factor Surveillance System Survey (BRFSS), which included self-reported data from 6,264,226 adult participants. The second data set came from the National Health and Nutrition Examination Survey (NHANES) and included official measurements from 57,131 adults. Since NHANES data was scientifically accurate and BRFSS data was more of an estimate, BRFSS numbers were adjusted to mimic the distribution of NHANES data, essentially making the BRFSS information more accurate and realistic. The authors then omitted data from population subgroups that did not have enough members to be statistically representative of their group; for example, the data provided by non-Hispanic black adults in Maine were suppressed because the subgroup averaged less than 50 respondents per year. The authors then used historical trends and projections to make their 2030 predictions. However, they first tested their prediction method by comparing their predictions for 2016 BMI distributions versus what 2016 BMI distributions actually were. The method produced highly accurate predictions for 2016, validating estimates for 2030.
After performing the study, these were the researchers’ 2030 predictions: national adult obesity and severe-obesity prevalence in adults will rise to 48.9% and 24.2%, respectively. In twenty-nine states, the prevalence of overall obesity will rise above 50%, and the prevalence will not be below 35% in any state. The researchers also project that the prevalence of severe obesity will rise above 25% in half of the states. Interestingly, the data also showed strong correlations between race and income related to obesity prevalence. The data displayed that generally, non-Hispanic black and Hispanic adults had a higher obesity prevalence than non-Hispanic white adults. As far as income goes, the authors noted, “Our projections show that severe obesity will be the most common BMI category in 44 states among adults with an annual household income of less than $20,000, as compared with only 1 state among adults with an annual household income of greater than $50,000” (Ward et al. 2019). The influence of income and race on obesity prevalence has also been noted in other scientific research. This includes a CDC study claiming that in the US, Black adults have the highest prevalence of obesity (38.4%), followed by Hispanic adults (32.6%), and White adults (28.6%) (Peterson et al. 2019).
Although the scholarly article was conducted in a very official and professional manner, there are still two problems with the research. The largest issue was admitted by the authors: Predicting data of this type over a decade in the future is a difficult task, no matter the resources one has. The authors did their best to create an accurate prediction by using the year 2016 as a test. They found that they were able to accurately predict the BMI distributions of state level prevalence, but it was slightly more difficult to predict the BMI distributions in state sub-categories, likely because there were fewer subjects. The second issue, which was practically unavoidable, was that the researchers could not use precisely accurate data for those represented by the BRFSS. The BRFSS provided much of the data, and the authors used it to the best of their ability to make it highly accurate; however, the data is still not perfect. Overall, the only room for improvement would be for the authors to obtain more perfect data, like the NHANES, if it exists.
This study is important and significant because it predicts how severe the obesity problem will be in the United States in 2030 and serves as a warning to the country. Possibly after reading about the study, local, state, and federal lawmakers will install policies to protect their people against becoming obese. If the lawmakers aren’t concerned about the mental and physical health of their own people, then maybe they will be concerned when considering the huge negative financial impact this expected growth has on the economy. The study should also concern any American reader. If someone lives in the U.S., it is near certain they will know someone who is obese if they are not obese themselves. This implies that everyone will either be affected or have a friend or family member who is directly affected by the poor health and financial complications of obesity.
The United States general population, government, and healthcare workers need to know the future of American obesity in order to stop the current progression. It is now essential for other scientists and researchers to find ways to prevent obesity, especially in populations that are more affected than others. If people do not realize the magnitude of the issue, it will continue to grow and negatively impact the financial, mental, and physical health of the nation.
References
Adult obesity causes and consequences. 2020. Center for Disease Control and Prevention; [accessed 2020 Aug 29]. https://www-cdc-gov.libproxy.lib.unc.edu/obesity/adult/causes.html
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. 2009. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs. [accessed 2020 4 Sep]; 28:822–831. doi:10.1377/hlthaff.28.5.w822
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. [accessed 2020 19 Aug].
Petersen R, Pan L, Blanck HM. 2019. Racial and ethnic disparities in adult obesity in the United States: CDC’s tracking to inform state and local action. Prev Chronic Dis. 16. [accessed 2020 19 Aug]. doi:10.5888/pcd16.180579
Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. 2011. Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet. [accessed 2020 Aug 29]; 378(9793):815-825. doi: 10.1016/S0140-6736(11)60814-3
Ward Z, Bleich S, Cradock A, Barrett J, Giles C. 2019. Projected U.S. state-level prevalence of adult obesity and severe obesity. The New England Journal of Medicine. [accessed 2020 Aug 25]; 381(25):2440-2450. doi:10.1056/NEJMsa1909301
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