INTRODUCTION

Obesity is a chronic health condition defined by a body mass index (BMI) of 30 kg/m² or higher in adults. Over recent decades, the United States has experienced a dramatic rise in obesity prevalence across its 50 states and territories, with some regions more severely affected than others, reaching levels widely regarded as epidemic [1–3]. Obesity has become one of the most pressing public health challenges, with detrimental consequences for individual well-being, greater disease burden, and strain on health care systems. The prevalence of obesity among United States adults increased markedly from approximately 15% in the late 1970s to more than 42.4% in 2018 [4,5].

Research has long established that obesity is not merely a disease but also a major risk factor for numerous other health conditions, including type 2 diabetes, coronary artery disease, stroke, heart failure, dyslipidemia, cancer, and sleep apnea [6–9]. Consequently, the impact of obesity on morbidity and mortality, its economic burden, and its implications for national security have been widely recognized [10–12]. Similarly, risk factors and socioeconomic determinants of obesity have been extensively studied, and the current understanding of these issues is relatively comprehensive [13–15]. Therefore, the authors determined that further examination of these topics was beyond the scope of the present review. This mini-review integrates recent findings on the obesity epidemic in the United States, focusing on overall temporal trends as well as trends stratified by age, sex, race, and interactions between sex and age and between sex and race. By highlighting current trends in specific subgroups, this review aims to help identify priority areas for research, strategy development, and public health practice in addressing obesity in the United States.

TEMPORAL TRENDS IN ADULT OBESITY

Obesity prevalence among United States adults has increased markedly since the late 1970s. The Centers for Disease Control and Prevention (CDC) reported that the age-adjusted obesity rate increased from 15% in 1976–1980 to 34% in 2007–2008, representing more than a two-fold increase over approximately 30 years [4]. Subsequent cycles of the National Health and Nutrition Examination Survey (NHANES) indicated a continuing upward trajectory. According to the 2017–2018 NHANES data, the age-adjusted prevalence of adult obesity reached a historic high of 42.4%, with 9.2% classified as severe obesity, representing a 25% increase over the preceding decade [16]. However, subsequent NHANES survey cycles suggested a possible reversal in the trend. Using NHANES 2017–March 2020 pre-pandemic data files, Stierman et al. [17] reported the first decline in adult obesity prevalence following increases during the previous 3 survey cycles. The most recent NHANES data from 2021–2023 indicate that adult obesity prevalence has declined further to 40.3% [5]. Figure 1 combines the available NHANES source data to illustrate the overall trend in adult obesity from 1988–1994 through 2021–2023. Notably, an apparent inflection point occurred in 2017–2018, after which a downward trend appeared to emerge, marking the first consecutive declines in nearly 30 years.

Although overall adult obesity prevalence is high in both sexes, females tend to exhibit a slightly higher prevalence than males, as shown in NHANES data from 1988 through 2023 (Figure 2).

Figure 3A illustrates overall upward trends across age groups. While the obesity epidemic affects all age groups, prevalence varies substantially. Younger adults (20–39 years) have the lowest prevalence, followed by older adults (≥60 years). Middle-aged adults (40–59 years) exhibit the highest prevalence in most survey years examined. Notably, between 2017–2018 and 2021–2023, obesity prevalence declined among both younger and older adults, whereas prevalence among adults aged 40–59 years increased further to its highest recorded level. Figure 3B and C examines temporal trends in obesity prevalence based on the interaction between sex and age. Middle-aged males experienced a slight decline in prevalence during the 2 consecutive survey cycles from 2017 to 2023, whereas middle-aged females experienced a marked increase in obesity prevalence following the onset of the coronavirus disease 2019 (COVID-19) pandemic.

Race is another key covariate. Previous studies and CDC Data Brief reports consistently indicate that non-Hispanic Black individuals have the highest obesity prevalence, followed by Hispanic individuals, non-Hispanic White individuals, and non-Hispanic Asian individuals [18,19]. These patterns are reflected in Figure 4A, which shows upward trends across all racial groups during the past decade. Notably, obesity prevalence increased slightly among non-Hispanic White individuals from 2018 to 2020, whereas a plateauing pattern appears present for the other 3 groups. Figure 4B and C examines temporal trends in obesity prevalence based on the interaction between sex and race. Stratification by sex and race presents a different pattern than that observed in Figure 4A alone. Specifically, non-Hispanic Black females and Hispanic males exhibit the highest obesity prevalence within their respective sex strata. Figure 5 further illustrates that the greatest burden of obesity occurs among non-Hispanic Black females, followed by Hispanic females and Hispanic males, whereas non-Hispanic Asian males and females have the lowest prevalence. Notably, non-Hispanic White males and non-Hispanic Asian males displayed a more pronounced upward trend from 2016 to 2020 [20].

DISCUSSION

NHANES data reveal a long-standing upward trajectory in adult obesity prevalence over the past several decades. Importantly, recent NHANES cycles demonstrate the first consecutive declines in overall adult obesity prevalence in nearly 3 decades, decreasing from 42.4% in 2017–2018 to 40.3% in 2021–2023. These findings suggest that the epidemic, although still widespread, may be entering a period of stabilization or modest decline. This change likely reflects a combination of clinical, behavioral, and policy-related influences rather than a single dominant driver. Rader et al. [21] suggested that the increased use of weight loss medications, as well as demographic and behavioral changes associated with the COVID-19 pandemic, may have contributed to these trends. Peiper et al. [22] also noted the temporal association between declining obesity prevalence and increased use of weight loss medications; however, they cautioned that pharmacological approaches focused on short-term weight reduction may lead to unintended consequences. Accordingly, they emphasized that gradual lifestyle modifications should be prioritized.

Substantial variation across age, sex, and racial subgroups is observed throughout the NHANES survey years. Although 5 sex–age interaction groups show stable or declining trends, females aged 40–59 years continue to exhibit an upward trajectory and have maintained the highest obesity prevalence across most NHANES cycles from 1988 to 2023. In addition, the prevalence of obesity among non-Hispanic Black females continues to increase gradually, albeit at a relatively slow pace. If this trend continues, prevalence in this subgroup could approach 60%. Lofton et al. [18] suggested that culturally tailored interventions, including community-based and faith-based programs, may be particularly effective for addressing obesity among African American populations.

These subgroup differences underscore the complexity of obesity as a multifactorial epidemic and highlight the need for targeted interventions. Sustained progress in reversing obesity trends will require prevention and intervention strategies that address both individual behaviors and structural determinants. Public health initiatives should promote equitable access to healthy foods, expanded opportunities for physical activity, and robust health education tailored to cultural and community contexts. Clinical strategies—including early screening for elevated BMI, counseling, and structured management programs—remain essential for individuals at greatest risk. At the same time, community-based programs that emphasize social support, behavioral change, and neighborhood-level improvements can extend the impact of clinical interventions.

Looking ahead, the modest declines in obesity prevalence suggest that ongoing prevention and treatment efforts may be having a measurable impact. To sustain progress and address persistent disparities, future strategies must be comprehensive. Policies that align federal, state, and community-level initiatives with clinical care and public health programs may help maintain momentum and support continued reductions in obesity prevalence across all population groups in the United States.

CONCLUSION

Obesity remains one of the most significant public health challenges in the United States. Although recent NHANES data suggest the first consecutive declines in adult obesity prevalence in nearly 30 years, the overall burden of obesity remains high and disparities persist across age, sex, and racial groups. Middle-aged adults, particularly non-Hispanic Black females, continue to experience disproportionately high prevalence rates, highlighting the ongoing need for targeted prevention and intervention strategies. Substantial changes in both individual behavior and broader social and environmental determinants of health are needed. Continued surveillance through NHANES and other national monitoring systems will remain essential for evaluating trends, identifying high-risk populations, and guiding evidence-based public health policies and clinical practices aimed at reducing obesity and its associated health consequences in the United States.

Notes

Ethics Statement

Ethical review and approval were waived for this study, because this study was not involving humans nor animals.

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Acknowledgements

None.

Author Contributions

Conceptualization: Zhang Z, Zhang L, Payton M. Data curation: Zhang Z. Formal Analysis: Zhang Z. Methodology: Zhang Z, Zhang L, Payton M. Visualization: Zhang Z. Writing – original draft: Zhang Z. Writing – review & editing: Zhang L, Payton M.

Figure 1

Adult obesity prevalence in the United States (National Health and Nutrition Examination Survey [NHANES] 1988–2023).

Figure 2

Adult obesity prevalence in the United States by sex (National Health and Nutrition Examination Survey [NHANES] 1988–2023).

Figure 3

Adult obesity prevalence in the United States by age (National Health and Nutrition Examination Survey [NHANES] 1988–2023). (A) Total, (B) male, and (C) female.

Figure 4

Adult obesity prevalence in the United States by race (National Health and Nutrition Examination Survey [NHANES] 2011–2020). (A) Total, (B) male, and (C) female.

Figure 5

Adult obesity prevalence in the United States by sex/race (National Health and Nutrition Examination Survey [NHANES] 2011–2020).

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Figure & Data

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