A new national study warns that nearly half of U.S. adults could be living with obesity within a decade, underscoring widening racial, ethnic and geographic disparities — and prompting renewed calls from physicians for systemic change.
Published in JAMA, the analysis found that 42.5% of American adults — about 107 million people — were living with obesity in 2022. That’s more than double the 19.3% recorded in 1990. By 2035, researchers project the rate will climb to 46.9%, or roughly 126 million adults.
The study, led by Nicole K. DeCleene and colleagues, analyzed data from more than 11 million people using national survey data and advanced statistical modeling to estimate state-level trends by race, ethnicity, sex and age.
“It’s sobering,” said Dr. Katelin Mirkin of Mercy Bariatric and General Surgery, who reviewed the findings. “We’re going from one in three Americans with obesity to nearly half. But if you look at how we live now, it’s not entirely surprising.”
Stark disparities across states and demographics
Researchers found sharp differences across the country. Rates were highest in many Southern and Midwestern states and lowest in parts of the West and Northeast. Disparities were also pronounced by race and sex.
In 2022, age-standardized obesity prevalence ranged from 40.1% among non-Hispanic white men to 56.9% among non-Hispanic Black women. Women overall experienced larger disparities by race and ethnicity than men. Middle-aged adults had the highest prevalence, but some of the steepest increases were seen among younger adults — particularly young women.
Those patterns mirror what Mirkin sees in her practice.
“Lower socioeconomic status, minority populations, the South — these are trends we’ve known about for years,” Mirkin told Straight Arrow News. “Access plays a huge role: access to healthy food, to health care, to safe places to exercise, to time.”
She noted that women often shoulder primary caregiving responsibilities and domestic work, limiting time for exercise and self-care. In her experience, when mothers or grandmothers undergo weight-loss surgery and adopt healthier habits, the benefits often ripple through entire households.
A more sedentary nation
Experts point to sweeping lifestyle shifts over the past several decades.
Americans are increasingly sedentary, working desk jobs or from home. Cities are often built around cars rather than walking or biking. Screen time has expanded across work, school and leisure. And ultra-processed foods — typically inexpensive, calorie-dense and shelf-stable — are widely available and heavily marketed.
“If you buy fresh fruits and vegetables, you’re going to the store every few days,” Mirkin said. “Processed, packaged food is easy, it’s quick, it’s cheaper. That matters.”
The normalization of obesity may also blunt public alarm, she added.
“When one-third of the country has obesity, it doesn’t seem shocking. If half of us do, that will feel even more normal,” she said. “But medically, it’s not benign.”
Obesity increases the risk of heart disease, diabetes, certain cancers, joint disease and a range of other conditions and is associated with shorter life expectancy.
Industry and incentives
Mirkin said multiple industries intersect with the obesity epidemic — from food and diet companies to pharmaceutical manufacturers and even fitness businesses.
“I don’t think there’s a sinister plan,” she said. “But there are financial incentives tied to selling more food, larger portions, medications to treat diabetes and high blood pressure.”
New medications known as GLP-1 receptor agonists have surged in popularity. Patients often lose significant weight while taking them, she said, but many regain weight if they stop without making lasting lifestyle changes.
“These drugs are designed to be long-term,” she said. “If we treat them like a quick fix and don’t change anything else, that’s a slippery slope.”
Surgery, stigma and solutions
Despite decades of evidence supporting bariatric surgery as one of the most effective long-term treatments for severe obesity, fewer than 1% of eligible patients undergo the procedure, Mirkin said. Insurance barriers, misinformation and stigma all play a role.
“We don’t shame people for taking medication for diabetes or high blood pressure,” she said. “Why do we shame people for treating obesity?”
She emphasized that obesity is a complex, multifactorial disease influenced by genetics, environment, behavior and biology. While some people have a stronger genetic predisposition, she said, that does not mean outcomes are predetermined.
“Behavior matters, but it’s not the whole equation,” she said. “Many of my patients are some of the hardest-working people I’ve ever met. This isn’t about laziness.”
Public health experts say meaningful progress will likely require systemic changes: making healthy foods more affordable, designing more walkable communities, increasing physical activity in schools, expanding access to medical and surgical treatments and addressing socioeconomic inequities.
Mirkin argues that messaging also matters.
“This isn’t about aesthetics,” she said. “It’s not about how we look. It’s about how we feel, how long we live, how healthy and strong our communities are.”
With projections showing obesity continuing to rise across every demographic group, she said the new data should be viewed not as condemnation but as a call to action.
“It’s going to take all of us,” Mirkin said. “We have to weave healthier habits into everyday life — more walking, better access to nutritious food, using the medical tools available when we need them. And we need to stop shaming people for trying to get healthy.”
