Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity.
Level 4 - case-series / case-control
Cross-sectional survey modeling and predictive forecasting (by design analogy)
PubMed 31851800 · doi:10.1056/NEJMsa1909301
What was done
Self-reported BMI data from 6,264,226 US adults (≥18 years) in the Behavioral Risk Factor Surveillance System (BRFSS; 1993–1994, 1999–2016) were corrected for quantile-specific self-reporting bias using measured data from 57,131 adults in the National Health and Nutrition Examination Survey (NHANES). Multinomial regression models were fitted to estimate state- and demographic subgroup-specific prevalence across four BMI categories (underweight/normal weight <25, overweight 25 to <30, moderate obesity 30 to <35, and severe obesity ≥35 kg/m²) from 1990 through 2030. Predictive accuracy was evaluated by using 1990–2010 data to predict 2016 outcomes.
What was found
By 2030, national adult obesity prevalence is projected to reach 48.9% (95% CI, 47.7 to 50.1), exceeding 50% in 29 states and remaining above 35% in all states. Severe obesity prevalence is projected to reach 24.2% (95% CI, 22.9 to 25.5), exceeding 25% in 25 states. Nationally, severe obesity is projected to become the single most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic Black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).
Why it matters
Provides bias-corrected state- and subgroup-level projections establishing that severe obesity—the category carrying the highest clinical risk and healthcare cost—is rapidly expanding and will disproportionately burden vulnerable demographic groups.
Limits
Projections assume past trajectories continue through 2030 and cannot account for future macroeconomic changes, novel public health initiatives, or broad uptake of newer obesity pharmacotherapies. The analysis is based on repeated cross-sectional surveys rather than longitudinal tracking of individuals.
Cited by
- supports By the year 2030, one in two adults will be obese.