Comment on “US State-Level Prevalence of Adult Obesity by Race and Ethnicity From 1990 to 2022 and Forecasted to 2035”

Abstract

The prevalence of obesity has been rising in the United States over the past decades. It is a major contributor to all-cause mortality, cancers, cardiovascular disease, diabetes, and other morbidities. It also contributes to increased health care costs. The aim of this study is to estimate trends in the prevalence of obesity in the United States from 1990 to 2022 and estimate the prevalence through 2035, based on age, sex, race, ethnicity, and state. This was a cross-sectional analysis of body mass index (BMI) from nationally representative survey data. Estimates were modeled from 11,243,644 participants in the Behavior Risk Surveillance System (BRFSS) and Gallup Daily Survey, plus 71,777 participants from the National Health and Nutrition Examination Survey (NHANES). Obesity was defined as a BMI ≥30. Estimates through 2035 were generated using an ensemble modeling approach. Analyses were stratified by sex and race/ethnicity, including Hispanic, non-Hispanic Black, and non-Hispanic White populations. The prevalence of obesity among individuals 20 years or older increased from 19.3% [95% uncertainty intervals (UI), 17.3% to 21.3%] in 1990 to 42.5% (95% UI, 40.2% to 45.0%) in 2022. By 2035, the prevalence of obesity was estimated to increase to 126 million individuals, or 46.9% (95% UI, 43.9% to 49.9%) of the adult population in the United States. Disparities were observed across race and ethnicity and age. In 2022, obesity prevalence was highest among non-Hispanic Black females (56.9%; 95% UI, 54.1% to 59.9%), followed by Hispanic females (49.4%; 95% UI, 46.3% to 52.4%). For Hispanic males, non-Hispanic White males and females, and non-Hispanic males, the prevalence of obesity ranged from 40.1% (95% UI, 36.8% to 42.5%) to 42.6% (95% UI, 39.1% to 46.2%). Adults aged 45 to 64 years had the highest obesity prevalence, and females >35 years of age had the largest increase from 1990 to 2022. At the state level, the highest prevalence of obesity among Hispanics was in the Midwest and South in 2022 and 2035. By 2035, the prevalence was estimated to be 53.6% (95% UI, 45.1% to 59.3%) for males in Indiana and 59.5% (95% UI, 51.8% to 64.7%) for females in South Dakota. In conclusion, the prevalence of adult obesity in the United States has increased from 19.3% in 1990 to 42.5% in 2022 and is estimated to rise to 46.9% by 2035. Variation in obesity prevalence was observed across states, age, sex, race, and ethnicity. (Summarized from DeCleene NK, Kahn E, Yuan C-W. US State-Level Prevalence of Adult Obesity by Race and Ethnicity From 1990 to 2022 and Forecasted to 2035. JAMA. 2026; 335(11):975-985. doi:10.1001/jama.2025.26817).