October 28, 2021, 3:52 p.m. Michael Devitt — At the start of the 21st century, no state in the United States had an adult obesity rate over 25%.
As recently as 2012, no state had an adult obesity rate over 35%.
Today, 48 states have an adult obesity rate of 25% or higher, and in 16 states, the adult obesity rate is 35% or higher.
Those are just some of the findings from The State of Obesity 2021, an annual report from Trust for America’s Health. Published in September with support from the Robert Wood Johnson Foundation, the 92-page report features a special section that examines the relationship between COVID-19, obesity and social determinants of health, which shows how the pandemic impacted longstanding racial and economic inequities that furthered the obesity crisis throughout the country, especially in low-income communities and communities of color. It also assesses the latest data on adult and childhood obesity rates, reviews current policies and programs, and outlines potential policy actions for federal, state and local agencies.
The report examines the obesity crisis from several perspectives.
A section titled “COVID-19, Obesity and Social Determinants of Health” summarizes the pandemic’s effects on various aspects of American society, and includes
The “Obesity-Related Data and Trends” section analyzes data from the National Health and Nutrition Survey and the Behavioral Risk Factor Surveillance System to track recent changes in obesity rates in American adults. Among the key findings:
It should be noted that, given the report’s findings, substantial evidence exists to indicate that elements of structural racism have historically contributed to higher obesity rates in underserved communities and communities of color. A 2019 International Journal of Environmental Research and Public Health study, for example, found that racial inequality with regard to poverty, unemployment and home ownership were associated with higher obesity rates, and concluded that structural racism was associated not only with higher obesity rates, but also fewer grocery stores, more fast food restaurants and higher fast food-to-grocery store ratios.
It should also be noted that a section in The State of Obesity on social determinants of health states that “real change in reducing obesity and improving health at the population level requires understanding and action on all the drivers of high obesity rates — from addressing historical to present-day inequities and underinvestment that result in limited resources in communities to ensuring availability and encouraging culturally appropriate, healthy choices for individuals.”
The “Obesity-Related Policies and Programs” section functions as a reference point for people interested in learning more about existing federal, state and local policies and programs. It provides important background information for those seeking historical context, along with current developments, budgetary data and research, and is divided into four subsections:
Finally, the “Recommendations” section states that the obesity crisis cannot be overcome without addressing the social, economic and environmental factors that underpin it, such as poverty, a lack of resources that support health and wellness, and food insecurity. To effect change, the report’s authors state, a systems approach is required that will reduce longstanding inequities, target obesity prevention programs in communities with the highest needs, and implement evidence-based initiatives that promote healthy behaviors and outcomes.
The section includes five general recommendations intended to increase health equity, decrease food insecurity, update marketing strategies that lead to health disparities, improve safety and access to opportunities for more physical activity, and strengthen obesity prevention measures throughout the health care system. Each general recommendation is supplemented by specific actions and directives for federal, state and local government agencies.
In an email to AAFP News Keisha Harvey Mansfield, M.D., founder and medical director of Dr. K’s Family Medicine in Bogalusa, La., and co-author of an Academy guide on lifestyle medicine, explained why the report’s findings should matter to family physicians.
“The social determinants of health are great predictors of health and compliance,” Mansfield said. “Considering that we are still battling a pandemic, these findings are important because of the apparent risk of having complications from COVID-19 are linked to having obesity, whether you are an adult or child.”
Mansfield also suggested that FPs pay attention to their patients’ social needs and the ways obesity can be managed.
“People with unmet social needs have poorer health outcomes. They were the most impacted by the coronavirus socially, financially and medically,” said Mansfield. She called obesity “a multifaceted chronic disease that deserves a multifactorial approach to be adequately addressed and treated” that would involve meeting a patient’s social, environmental and health needs.
Mansfield provided additional details on how FPs can manage obesity in underserved communities and communities of color.
“The first step is screening your patient population and finding where the greatest needs are, then working with local groups to help meet those needs,” she said.
“Family physicians will have to dedicate more time learning about nutrition, physical activity and obesity management. We will also have to advocate for more time and the appropriate reimbursement to discuss obesity as a disease and its short- and long-term consequences if untreated with our patients. Lastly, we will have to advocate for more insurance benefits for our patients for obesity management, including prescription coverage.”
The Academy has several resources for FPs interested in learning more, including educational materials for patients, policies and clinical service recommendations, and a collection of content from American Family Physician.