Obesity hit 40% of US adults as the GLP-1 era began

Clinical takeaway: Prevalence climbed across all obesity measures through 2023. Waist circumference adds risk information BMI misses, and women and non-Hispanic Black patients carry the heaviest burden.

The arrival of GLP-1 receptor agonists has reframed obesity as a treatable disease, but treatment capacity only matters relative to the size of the problem. New data capture that scale at the moment the therapeutic landscape shifted.

Two in five US adults and one in five youth met obesity criteria. Severe obesity, the form tied to the highest cardiovascular and mortality risk, also doubled among adults over the study period.

The first cardiovascular-kidney-metabolic guideline from the American Heart Association, published in June, designates obesity as stage 1 of CKM syndrome, the entry point to progressive metabolic, kidney, and cardiovascular disease. This new analysis shows how much of the population reached that stage, drawing on 24 years of National Health and Nutrition Examination Survey (NHANES) data to track obesity, severe obesity, and abdominal obesity across age, sex, and race and ethnic groups.

Among adults, severe obesity (BMI ≥40 kg/m²) rose to 10% from 5% and abdominal obesity to 61% from 48% between 1999 and 2023, while overall obesity (BMI ≥30 kg/m²) climbed to 41% from 30%. Youth trends ran parallel with roughly a 30% relative increase in overall obesity, 50% in severe obesity, and a three-fold rise in abdominal obesity.

By 2023, women were nearly twice as likely as men to have severe obesity (13% vs 7%) and substantially more likely to have abdominal obesity (70% vs 51%). Non-Hispanic Black individuals had the highest prevalence of all obesity measures throughout the study period.

Researchers ran cross-sectional analyses of NHANES cycles from 1999 to 2023, a median of 8,687 participants per cycle, roughly half women and one-third youth under 20. Youth obesity was defined by age- and sex-specific BMI percentiles rather than adult cutoffs, and Asian American adults were classified using lower race-specific BMI and waist circumference thresholds.

These figures set the denominator for measuring treatment results at the population level. Whether GLP-1 receptor agonists, bariatric surgery, and lifestyle programs together can start to bend more than just individual trajectories may start to show up in the next data cycle. The authors recommend tracking both BMI and waist circumference to see trends clearly.

"Examining national trends in obesity can help determine which segments of the population may benefit the most from screening, how resources should be allocated for preventive efforts and the potential impact of implementing public health initiatives to reduce the burden of obesity," said study author Anum Minhas, MD, MHS, an assistant professor of medicine in cardiology at Johns Hopkins School of Medicine.

Source: Minhas AS, et al. (2026 Jul 7) Circulation. Obesity, Severe Obesity, and Abdominal Obesity in US Youth and Adults From 1999 to 2023