Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity
Open accessAbstract
BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the 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). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).
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Rising obesity rates lead to millions of avoidable deaths each year from cardiovascular disease, type 2 diabetes, various cancers, and other complications.
“Rising obesity rates place enormous strain on healthcare systems, economies, and personal health and lead to millions of avoidable deaths each year from cardiovascular disease, type 2 diabetes, various cancers, and other complications [2].”
From Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies (2025) · cites this paper as [2]
The Discussion (page unavailable) links severe obesity to higher mortality, morbidity, health care costs, chronic disease, and reduced life expectancy. The paper projects rising obesity prevalence, but our copy does not substantiate millions of avoidable deaths each year or attribute those deaths to the specific diseases listed. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBy 2030, 48.9% of US adults will have obesity and racial differences in rates of obesity will increase.
“It is anticipated that by 2030, 48.9% of US adults will have obesity and that racial differences in rates of obesity will increase.17”
From Obesity Management in Adults (2023) · cites this paper as [17]
The Results project that 48.9% of U.S. adults will have obesity by 2030. The Trends and Projections and Discussion sections describe racial disparities, but do not say that the differences between racial groups will increase; the Discussion calls them persistent disparities. Page numbers were not provided in our copy. (LLM, conf=0.88)
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“By the end of this decade, half of US adults are expected to have obesity and nearly a fourth will have severe obesity [3].”
- Authors
- Ward, Z. J., Bleich, S. N., Cradock, A. L., Barrett, J. L., Giles, C. M., Flax, C., Long, M. W., & Gortmaker, S. L.
- Affiliations
- Milken Institute (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2019-12-19
- Volume
- 381
- Issue
- 25
- Pages
- 2440-2450
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2995420665
- Cited by
- 2,009
- References
- 28
- Citations by year
- 2026: 197 · 2025: 319 · 2024: 386 · 2023: 340 · 2022: 306 · 2021: 275 · 2020: 180 · 2018: 1
- FWCI
- 175.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- adult obesity, morbid obesity, obesity prevalence projections, body mass index, Behavioral Risk Factor Surveillance System, NHANES, underweight, overweight, obesity trends, women, non-Hispanic Black adults, low-income adults, United States, 2030 projections
- MeSH terms
- Adult, Female, Forecasting, Humans, Income, Male, Obesity, Obesity, Morbid, United States, Body Mass Index, Prevalence, Sex Distribution, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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