Hawaiʻi Health Data Warehouse

Overweight and Obesity

Achieving and sustaining appropriate body weight across the lifespan is vital to maintaining good health and quality of life. Many behavioral, environmental, and genetic factors have been shown to affect a person’s body weight. Calorie balance over time is the key to weight management. Calorie balance refers to the relationship between calories consumed from foods and beverages and calories expended in normal body functions and through physical activity. People cannot control the calories expended in metabolic processes, but they can control what they eat and drink, as well as how many calories they use in physical activity.

Why It’s Important

People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions, including:1

  • All-causes of death (mortality)
  • High blood pressure, high cholesterol
  • Type 2 diabetes
  • Heart disease and stroke
  • Gallbladder disease
  • Joint issues, body pain, difficulty with physical activity
  • Sleep apnea and breathing problems
  • Some cancers
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders

The medical care costs of obesity in the United States (US) are high. In 2019, these costs were estimated to be $173 billion. The annual nationwide productivity costs of obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual).1

What Is Known

During the past 20 years, there has been a dramatic increase in obesity in the US and rates remain high. Prevalence rates in the US rose from 30.5% in 1999-2000 to 41.9% in 2017-2020 (NHANES). In the early 1990s, no state had more than 25% of adults with obesity. As of 2020, 47 states had an adult obesity prevalence of 25% or higher and all states had more than 20% of adults with obesity (BRFSS).

In Hawai‘i, the percentage of adults with obesity increased over time from 21.9% in 2011 to 24.5% in 2020 (BRFSS). In 2019-2020 15.8% of youth 10-13 years and 15.0% of youth 14-17 years were obese (NSCH) and in 2019 16.4% of public high school students were obese (YRBS).

Obesity affects some groups more than others.

  • Nationally from 2018-2020, the highest prevalence of obesity was seen in non-Hispanic Black adults (40.7%) and Hispanic adults (35.2%), followed by non-Hispanic White adults (30.3%), and non-Hispanic Asian adults (11.6%).2
  • In Hawai’i, while 24.5% of adults had obesity in 2020, prevalence is significantly higher among Other Pacific Islanders (43.6%) and Native Hawaiians (40.0%) and lowest among Other Asian (13.2%) and Japanese (18.1%) (BRFSS). A similar pattern is seen among high school students.

Who Is at Risk

A high amount of body fat can lead to weight-related diseases and other health issues, and being underweight can also put one at risk for health issues. Body mass index (BMI) and waist circumference are two measures that can be used as screening tools to estimate weight status in relation to potential disease risk. However, BMI and waist circumference are not diagnostic tools for disease risks. A trained healthcare provider should perform other health assessments in order to evaluate disease risk and diagnose disease status.3

Some groups are more at risk for obesity than others.4,5 These include:

  • Adults with high school education or less.
  • Middle-aged adults (45-54 years) are at higher risk of obesity than younger adults (18-24 years).
  • Non-Hispanic Blacks, Hispanics, and Native Hawaiians/Pacific Islanders (NHPI) have higher rates of obesity than non-Hispanic Whites and Asians.

How To Reduce Risk

There is no single or simple solution to the obesity epidemic. It’s a complex problem which will require a multifaceted approach for a solution. Policy makers, state and local organizations, business and community leaders, school, childcare and healthcare professionals, and individuals must work together to create an environment that supports a healthy lifestyle.

The CDC recommends that communities should focus their efforts in a variety of settings:6

For individuals, the CDC states that the key to achieving and maintaining a healthy weight isn’t about short-term dietary changes. It’s about a lifestyle that includes:6

  • Eating healthful food
  • Getting regular physical activity
  • Balancing the number of calories consumed with the number of calories used by the body
  • Maintaining appropriate calorie balance during each stage of life-childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

Page last updated July 28, 2022.

Indicator Reports


A health indicator is a measure designed to summarize information about a given topic in population health or health systems performance.  Indicator reports provide numeric data for a health indicator as well as public health context (such as why it is important and what is being done to improve it).


1 Consequences of Obesity. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/basics/consequences.html. Updated July 15, 2022. Accessed July 21, 2022.
2 Adult Obesity Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html Updated May 17, 2022. Accessed July 20, 2022.
3 Assessing Your Weight. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/index.html Updated June 3, 2022. Accessed July 21, 2022.
4 Adult Obesity Maps. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/prevalence-maps.html Updated July 15, 2022. Accessed July 21, 2022.
5 Obesity and Native Hawaiians/Pacific Islanders. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=85#:~:text=Native%20Hawaiians%2FPacific%20Islanders%20were,non%2DHispanic%20whites%20in%202016 Updated March 26. 2020. Accessed July 20, 2022.
6 Strategies to Prevent & Manage Obesity. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/strategies/index.html Updated April 5, 2022. Accessed July 21, 2022.