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Obesity and Related Factors

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.

Maintaining a healthy body weight and preventing excess weight gain throughout the lifespan are highly preferable to losing weight after weight gain. Once a person becomes obese, reducing body weight back to a healthy range requires significant effort over a span of time, even years. People who are most successful at losing weight and keeping it off do so through continued attention to calorie balance.

The prevalence of overweight and obesity in the United States is dramatically higher now than it was a few decades ago. This is true for all age groups. One of the largest changes has been an increase in the number of Americans in the obese category. In the 1970s, the prevalence of obesity was 5% for children ages 2 to 5 years, 4% for children ages 6 to 11 years, 6% for adolescents ages 12 to 19 years, and 15% for adults. As of 2015-16, the prevalence of obesity has reached 14% for children 2 to 5 years, 18% for children 6 to 11 years, 21% for adolescents 12 to 19 years, and 40% for adults. In the early 1990s, no state had more than 25% of adults with obesity. As of 2017, 47 states have an adult obesity prevalence of 25% or higher and in 29 states 30% of adults have obesity.

People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions, including the following:
  • All-causes of death (mortality)
  • High blood pressure (hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis (a breakdown of cartilage and bone within a joint)
  • Sleep apnea and breathing problems
  • Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders
  • Body pain and difficulty with physical functioning

The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion. The annual nationwide productive costs of obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual).

During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2015-2016, almost 2 in 5 U.S. adults (39.8%) and 18.5% of children and adolescents aged 2-19 years were obese (NHANES).

Obesity affects some groups more than others.
  • Nationally, Hispanics (47.0%) and non-Hispanic blacks (46.8%) have the highest age-adjusted rate of obesity followed by non-Hispanic whites (37.9%) and non-Hispanic Asians (12.7%). Obesity is higher among middle age adults, 40-59 years old (42.8%) than among younger adults, age 20-39 (35.7%).
  • In Hawai'i, while 24.4% of adults have obesity, prevalence is significantly higher among Other Pacific Islanders (59.8%) and Native Hawaiians (42.8%) and lowest among Chinese (11.8%) and other Asians (18.8%) (BRFSS). While roughly 16% of adults aged 18-24 years and 75 years and older have obesity, 29.3% of those 45-54 years and 28.5% of those 35-44 years have obesity.

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.

BMI is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness and having a low BMI can be an indicator of having too low body fatness.
  • If BMI is less than 18.5, it falls within the underweight range.
  • If BMI is 18.5 to 24.9, it falls within the normal or Healthy Weight range.
  • If BMI is 25.0 to 29.9, it falls within the overweight range.
  • If BMI is 30.0 or higher, it falls within the obese range.

Another way to estimate potential disease risk is to measure waist circumference. Excessive abdominal fat may be serious because it places a person at greater risk for developing obesity-related conditions, such as type 2 diabetes, high blood pressure, and coronary artery disease. Waistlines that are associated with a higher risk of developing obesity-related conditions include:
  • Waist circumference of more than 40 inches among men
  • Waist circumference of more than 35 inches among non-pregnant women

As with BMI, waist circumference can be used as a screening tool but is not diagnostic of the body fatness or health of an individual. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks.

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.
  • Personal efforts--Knowing your body mass index (BMI), achieving and maintaining a healthy weight, and getting regular physical activity are all actions you can take for yourself to combat obesity.
  • Community efforts--should focus on supporting healthy eating and active living in a variety of settings. Learn about different efforts that can be used in early childhood care, hospitals,schools, and food service venues.

The key to achieving and maintaining a healthy weight isn't about short-term dietary changes. It's about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories consumed with the number of calories used by the body.

Tips for individuals:
  • Stay in control of your weight. This contributes to good health now and as you age.
  • Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.
  • Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.
  • Increase physical activity and reduce time spent in sedentary behaviors.

Maintain appropriate calorie balance during each stage of life-childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.

Self-reported weight status is tracked at the national and state levels primarily through two surveys:

National information based on clinical measurements is also tracked through the National Health And Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS), CDC/NCHS.

For more information on tracking nutrition health objectives, please visit the Nutrition and Weight Status topic at

Behavioral Risk Factor Surveillance System (BRFSS)

Pregnancy Risk Assessment Monitoring System (PRAMS)

Youth Risk Behavior Survey (YRBS) - BMI and Perceived Weight

Youth Risk Behavior Survey (YRBS) - Weight Control Practices