January 6, 2020

Obesity costs the U.S. health care system an estimated $147 billion a year— and those costs will only climb as nearly half of adults are projected to have obesity by 2030, according to a recent study in the New England Journal of Medicine.

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How common is obesity?

An estimated 39.8% of U.S. adults had obesity in 2015-2016—but there was significant state-to-state variation in obesity rates, according to CDC data from the Behavioral Risk Factor Surveillance System (BRFSS):

In addition, obesity afflicts certain racial and ethnic groups more than others, according to the CDC data: 

Is obesity really rising? (Hint: Yes.)

Researchers in the New England Journal of Medicine study developed a method to estimate the prevalence of obesity from 1990 through 2030 using data from CDC's BRFSS and the National Health and Nutrition Examination Survey. (Their numbers are slightly different than the CDC figures illustrated in the above charts, since those figures rely on individuals' self-reported data.)

The researchers found the number of adults who are projected to have obesity will rise over the next decade. Specifically, they estimated the share of U.S. adults with obesity is expected to reach to 48.9% in 2030—up from an estimated 42% in 2020. However, the estimated share of U.S. adults with obesity will vary across age groups, racial groups, sex, educational-attainment levels, and income levels

According to the researchers, by 2030, no state will have an obesity rate below 35%—and the rate in some states will hit 60%:

As obesity rates climb over the next decade, the researchers also project more adults will have severe obesity, with 24.2% of adults having severe obesity by 2030:

The researchers wrote that "the projected rise in the prevalence of severe obesity" is "[e]specially worrisome" because severe obesity is "associated with even higher mortality and morbidity and health care costs."

How much does obesity cost the health care system?

Research shows that, as the prevalence of obesity has increased, so has its cost to the health system. Specifically, the share of U.S. medical expenditures linked to obesity increased by 29% from 6.13% in 2001 to 7.91% in 2015: 

When broken down by demographics, the researchers estimated variations in obesity rates. For example, the researchers estimated obesity rates in 2030 will be above 48.9% for adults who:

  • Are between the ages of 40 to 64;
  • Are women;
  • Are non-Hispanic black;
  • Are Hispanic;
  • Have incomes less than $20,000 or equal to $50,000;
  • Have less than a high school education; and
  • Have a high school education and some college education.

How providers can help

In NEJM, the researchers suggested "a range of sustained approaches to maintain a healthy weight over the life course, including policy and environmental interventions at the community level that address upstream social and cultural determinants of obesity, will probably be needed to prevent further weight gain across the BMI distribution."

Still, there are ways individual providers can help their patients tackle obesity.

Angela Fitch, associate director of the Massachusetts General Hospital Weight Center and secretary/treasurer of the Obesity Medicine Association, recommends providers educate themselves on the treatment options available for managing obesity. Fitch said, "[M]any providers aren't well-versed in obesity medication therapy and bariatric surgery, so they aren't comfortable prescribing either."

Fitch added, "The main tenets of obesity management are nutrition, physical activity, behavior change, medication, and surgery," which means providers must offer multidisciplinary care to patients with obesity and "match treatment intensity to disease burden."

Fitch also recommends that health systems use a team approach for obesity management, including a "dietitian, pharmacist, health coach—or other team members who are better-trained and better-positioned to support these elements of care."

One key to success is ensuring that every provider treat patients respectfully. Paul Aveyard of the University of Oxford said that in his research, "[m]any patients recounted tales where they had been patronized, marginalized unintentionally, or occasionally insulted."

Kristen Glenister of the University of Melbourne, advised, "Discussions regarding overweight and obesity … need to be undertaken with the appropriate language and tone, permissive approach, with trusted clinicians, adequate time and tailored advice."

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The impact of social factors such as food insecurity, poverty, and transportation on health status is undeniable. Extensive research estimates that up to 20 percent of health outcomes are a result of social and environmental risk factors. To address patients’ unmet social needs before an acute care episode, population health managers increasingly extend care model interventions into the community.

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