America’s big health problem just got bigger

By Ben Pilkington
Published October 6, 2021

Key Takeaways

The CDC has released its latest obesity data for the United States—so what’s new? The data reveal a sharp rise in prevalence as well as significant discrepancies in obesity rates among states and populations—plus new links between obesity and the pandemic.

Below is a closer look at the CDC’s findings, along with some practical advice to help physicians talk to patients about their weight.

What are the latest stats?

The headline-grabbing statistic from the latest data release is disheartening: At least one in five adults in every US state and territory is obese.

In many areas, that figure is much worse. In 16 states, for example, 35% of adults—or more than one in three people over the age of 18 years—are obese. In 2019, just 12 states had such high rates, which means we’ve seen a 33% increase in just 2 years.

The Midwest and Southern regions have the highest prevalence of obesity at 34.1%. In the West and Northeast, roughly 29% and 28% of adults, respectively, have obesity.

All that couch time during lockdown seems to have had a significant effect on obesity rates, as well as on the number of people who experienced severe COVID-19 symptoms following infection. Some 30% of the 900,000 adult COVID-19 hospitalizations in the United States as of November 18, 2020 were attributable to obesity.

Disparities among populations

Obesity levels vary not just by state, but by race and ethnicity, CDC data show.

None of the states with sufficient data reported obesity levels of 35% or more among Asian adults. However, in 35 states and the District of Columbia, 35% or more of Black adults were obese.

Only seven states have obesity levels higher than 35% among White adults. But for Hispanic adults, 35% or more of the population in 22 states is obese. 

These state-level findings are also borne out by the national data. About 50% of Black adults had obesity in America in 2018, compared to 44.8% of Hispanic adults, 42.2% of White adults, and 17.4% of Asian adults.

Racial and ethnic disparities revealed in this data highlight the need to address social determinants of health such as poverty, education, and housing. Increasing access to healthy food, providing better opportunities for physical activity, and improved neighborhood design can help, the report suggests.

The latest CDC release also breaks down obesity levels data by education and age.

The more education a person has received, the less likely they are to be obese. One in four Americans with a college degree has obesity, compared to one in three high school graduates who haven’t been to college and 38.8% of adults without a highschool diploma.

In terms of age, middle-aged Americans are the most likely to have obesity of any age group—38.1% of Americans aged 45-54 years are obese. The age group with the lowest levels of obesity is young adults aged 18 to 24 years, at 19.5%.

Obesity and COVID-19

The link between poorer COVID-19 outcomes and obesity is unequivocal, the CDC data shows.

Americans with obesity may be three times more likely to be hospitalized with a COVID-19 infection. Their risk of severe illness from COVID-19 is higher, too—even individuals with a high BMI who are not obese may be at higher risk.

The link between obesity and impaired immune function is relevant here, as is the fact that obesity can make breathing more difficult by decreasing lung capacity.

With a higher BMI, the risk of more severe outcomes from COVID-19 increases. The higher a patient’s BMI, the more likely they are to experience hospitalization, intubation, and death after infection with the SARS-CoV-2 virus.

Fewer opportunities for improving health for Hispanic and Black adults make it more likely that these individuals will get sick and die as a result of obesity, COVID-19, and many other conditions.

How to speak to patients about their weight

Considering the increased risk of severe outcomes from COVID-19 in people with a higher BMI, now is a good time to speak to patients about their weight.

As physicians, it is important to understand how to address patients’ weight issues without offending them. Building rapport with patients and bringing the subject up sensitively and with respect to their unique cultural backgrounds improves the chances of success.

Research has shown that patients across social and economic backgrounds are more open to discussing obesity when physicians use the words “weight” and “BMI” to refer to the condition instead of “obesity” and “fat” or “fatness.” 

According to the National Institutes of Health, “Using terms that patients prefer may improve patient communication and care.” Try opening the discussion with phrases like this:

  • "Mr. Jones, could we talk about your weight today?”

  • “Ms. Jones, how are you feeling about your weight at this time?”

There’s no one-size-fits-all strategy for weight loss. Success hinges upon a clinician’s ability to remain nonjudgmental while custom-tailoring plans to each patient’s unique needs and readiness for change.

For more coverage on obesity, check out the following articles on MDLinx

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