Background

Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.

Methods

In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m² to less than 30 kg/m² and obesity was defined as a BMI of 30 kg/m² or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.

Findings

In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years), 21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents (aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4) among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·8–111·1) in females. Forecast results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents (aged 5–14 years), 3·41 million older adolescents (aged 15–24 years), and 41·4 million adults (aged ≥25 years) will have overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will reach 43·1 million (37·2–47·4) and the total number of adults with overweight and obesity will reach 213 million (202–221). In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes from 2021 are projected in states such as Utah for adolescents and Colorado for adults.

Interpretation

Existing policies have failed to address overweight and obesity. Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains central to any intervention strategies, particularly for children and adolescents.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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1990 年至 2021 年美国儿童、青少年和成人的国家级和州级超重和肥胖患病率，以及到 2050 年的预测

 背景

在过去的几十年里，美国的超重和肥胖流行病造成了沉重的健康和经济负担。了解国家和州层面的当前趋势和未来轨迹对于评估现有干预措施的成功和为未来的卫生政策变化提供信息至关重要。我们估计了 1990 年至 2021 年儿童和青少年 （5-24 岁） 和成人 （≥25 岁） 在国家层面的超重和肥胖患病率，并预测到 2050 年。此外，我们还得出了所有 50 个州和华盛顿特区的大龄青少年（15-24 岁）和成年人的特定州估计和预测。

 方法

在这项分析中，从 134 个独特来源中提取了自我报告和测量的人体测量数据，其中包括所有主要的全国监测调查数据。进行了调整以纠正自我报告偏倚。对于 18 岁以上的个体，超重定义为 BMI 为 25 kg/m² 至低于 30 kg/m²，肥胖定义为 BMI 为 30 kg/m² 或更高，对于 18 岁以下的个体，定义基于国际肥胖工作组标准。使用时空高斯过程回归模型估计 1990 年至 2021 年超重和肥胖患病率的历史趋势。然后，假设过去的趋势和模式继续存在，则使用广义集成建模方法来得出到 2050 年的预测估计。所有估计值均在国家层面按年龄和性别计算，还计算了 50 个州和华盛顿特区的大龄青少年（15-24 岁）和成年人（≥25 岁）的估计值。95% 的不确定性区间 （UI） 来自各自估计的后验分布的第 2·5 个和第 97·5 个百分位数。

 发现

2021 年，估计有 15·100 万（95% UI 13·5-16·8）儿童和青少年（5-14 岁）、21·40 万（20·2-22·6）年龄较大的青少年（15-24 岁）和 1.72 亿（169-174）成年人（≥25 岁）在美国超重或肥胖。德克萨斯州男性青少年（15-24 岁）的年龄标准化超重或肥胖患病率最高，为 52·4% （47·4-57·6），而密西西比州女性青少年（15-24 岁）的年龄标准化患病率最高，为 63·0% （57·0-68·5）。在成年人中，北达科他州男性超重或肥胖的患病率最高，估计为 80·6% （78·5–82·6），密西西比州女性为 79·9% （77·8–81·8）。随着时间的推移，肥胖的患病率超过了超重的增加，尤其是在青少年中。1990 年至 2021 年间，男性青少年年龄标准化肥胖患病率的百分比变化增加了 158·4% （123·9-197·4），女性青少年 （15-24 岁） 增加了 185·9% （139·4-237·1）。对于成年人，肥胖患病率的百分比变化在男性中为 123·6% （112·4–136·4），在女性中为 99·9% （88·8–111·1）。预测结果表明，如果过去的趋势和模式继续下去，到 2050 年，将有 3·33 万儿童和青少年（5-14 岁）、3·41 百万老年青少年（15-24 岁）和 41·400 万成人（≥25 岁）超重或肥胖。到 2050 年，超重和肥胖的儿童和青少年总数将达到 43·100 万 （37·2-47·4），超重和肥胖的成年人总数将达到 2.13 亿 （202-221）。到 2050 年，在大多数州，预计三分之一的青少年（15-24 岁）和三分之二的成年人（≥25 岁）将患有肥胖症。 尽管预计俄克拉荷马州、密西西比州、阿拉巴马州、阿肯色州、西弗吉尼亚州和肯塔基州等南部各州的肥胖患病率将继续居高不下，但预计自 2021 年以来，犹他州的青少年和科罗拉多州的成年人百分比变化最高。

 解释

现有政策未能解决超重和肥胖问题。如果不进行重大改革，预测的趋势将在个人和人口层面上造成毁灭性影响，相关的疾病负担和经济成本将继续升级。需要加强治理，以支持和实施多方面的全系统方法，以在国家和地方层面打破超重和肥胖的结构性驱动因素。尽管应利用临床创新来公平治疗和管理现有的肥胖症，但人群层面的预防仍然是任何干预策略的核心，特别是对于儿童和青少年。

 资金

比尔和梅琳达·盖茨基金会。