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Medical Updates: Weight and America

 

Nearly two-thirds of adults in the United States are overweight, and 30.5 percent are obese, according to data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES). This fact sheet presents statistics on the prevalence of overweight and obesity in the U.S., as well as their disease, mortality, and economic costs. To understand these statistics, it is necessary to know how overweight and obesity are defined and measured. This fact sheet also explains why statistics from different sources may not match.

Overweight and obesity are known risk factors for:

  • diabetes

  • heart disease

  • stroke

  • hypertension

  • gallbladder disease

  • osteoarthritis (degeneration of cartilage and bone of joints)

  • sleep apnea and other breathing problems

  • some forms of cancer (uterine, breast, colorectal, kidney, and gallbladder)

Obesity is also associated with:

  • high blood cholesterol

  • complications of pregnancy

  • menstrual irregularities

  • hirsutism (presence of excess body and facial hair)

  • stress incontinence (urine leakage caused by weak pelvic-floor muscles)

  • psychological disorders such as depression

  • increased surgical risk

What are overweight and obesity?

Overweight refers to an excess of body weight compared to set standards. The excess weight may come from muscle, bone, fat, and/or body water. Obesity refers specifically to having an abnormally high proportion of body fat.[1] A person can be overweight without being obese, as in the example of a bodybuilder or other athlete who has a lot of muscle. However, many people who are overweight are also obese.

How are overweight and obesity measured?

A number of methods are used to determine if someone is overweight or obese. Some are based on the relation between height and weight; others are based on measurements of body fat. The most commonly used method today is body mass index (BMI).

BMI can be used to screen for both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and other health professionals, as well as the definition used in most published information on overweight and obesity. BMI is a calculation based on height and weight, and it is not gender-specific. BMI does not directly measure percent of body fat, but it is a more accurate indicator of overweight and obesity than relying on weight alone.

BMI is found by dividing a person’s weight in kilograms by height in meters squared. The mathematical formula is:
weight (kg) / height squared (m²).

To determine BMI using pounds and inches, multiply your weight in pounds by 704.5,* then divide the result by your height in inches, and divide that result by your height in inches a second time.

* The multiplier 704.5 is used by the National Institutes of Health. Other organizations may use a slightly different multiplier; for example, the American Dietetic Association suggests multiplying by 700. The variation in outcome (a few tenths) is insignificant.


Body Mass Index Table

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

 

BMI

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Weight
(Pounds)
Height (Inches)                                            
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255
68 125 131 138 144 151 158 164 171 177 184 190 197 204 210 216 223 230 236 243 249 256 262
69 128 135 142 149 155 162 169 176 182 189 196 203 210 216 223 230 236 243 250 257 263 270
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328

An expert panel convened by the National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), both part of the National Institutes of Health (NIH) identified overweight as a BMI of 25–29.9 kg/m², and obesity as a BMI of 30 kg/m² or greater. However, overweight and obesity are not mutually exclusive, since people who are obese are also overweight.[1] Defining overweight as a BMI of 25 or greater is consistent with the recommendations of the World Health Organization <[2] and most other countries.

Calculating BMI is simple, quick, and inexpensive—but it does have limitations. One problem with using BMI as a measurement tool is that very muscular people may fall into the “overweight” category when they are actually healthy and fit. Another problem with using BMI is that people who have lost muscle mass, such as the elderly, may be in the “healthy weight” category—according to their BMI—when they actually have reduced nutritional reserves. BMI, therefore, is useful as a general guideline to monitor trends in the population, but by itself is not diagnostic of an individual patient’s health status. Further evaluation of a patient should be performed to determine his or her weight status and associated health risks.

For more information on measuring overweight and obesity, see Weight and Waist Measurement: Tools for Adults.


 

Why do statistics about overweight and obesity differ?


The definitions or measurement characteristics for overweight and obesity have varied over time, from study to study, and from one part of the world to another. The varied definitions affect prevalence statistics and make it difficult to compare data from different studies. Prevalence refers to the total number of existing cases of a disease or condition in a given population at a given time. Some overweight- and obesity-related prevalence rates are presented as crude or unadjusted estimates, while others are age-adjusted estimates. Unadjusted prevalence estimates are used to present cross-sectional data for population groups at a given point or time period. For age-adjusted rates, statistical procedures are used to remove the effect of age differences in populations that are being compared over different time periods. Unadjusted estimates and age-adjusted estimates will yield slightly different values.

Previous studies in the United States have used the 1959 or the 1983 Metropolitan Life Insurance tables of desirable weight-for-height as the reference for overweight.[3] More recently, many Government agencies and scientific health organizations have estimated overweight using data from a series of cross-sectional surveys called the National Health Examination Surveys (NHES) and the National Health and Nutrition Examination Surveys (NHANES). The National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) conducted these surveys. Each had three cycles: NHES I, II, and III spanned the period from 1960 to 1970, and NHANES I, II, and III were conducted in the 1970’s, 1980’s, and early 1990’s. Since 1999, NHANES has become a continuous survey.

Many reports in the literature use a statistically derived definition of overweight from NHANES II (1976–1980). This definition (based on the gender-specific 85th percentile values of BMI for 20 to 29 year olds) is a BMI greater than or equal to (>) 27.3 for women and 27.8 for men. NHANES II further defines “severe overweight” (based on 95th percentile values) as BMI > 31.1 for men and BMI > 32.2 for women.[4] Some studies round these numbers to a whole number, which affects the statistical prevalence. In 1995, the World Health Organization recommended a classification for three “grades” of overweight using BMI cutoff points of 25, 30, and 40.[5] The International Obesity Task Force suggested an additional cutoff point of 35 and slightly different terminology.[6]

The expert panel convened by NHLBI and NIDDK released a report in June 1998, that provided definitions for overweight and obesity similar to those used by the World Health Organization. The panel identified overweight as a BMI > 25 to less than (<)30, and obesity as a BMI > 30. These definitions, widely used by the Federal government and increasingly by the broader medical and scientific communities, are based on evidence that health risks increase more steeply in individuals with a BMI > 25.

BMI cutoff points are a guide for definitions of overweight and obesity and are useful for comparative purposes across populations and over time; however, the health risks associated with overweight and obesity are on a continuum and do not necessarily correspond to rigid cutoff points. For example, an overweight individual with a BMI of 29 does not acquire additional health consequences associated with obesity simply by crossing the BMI threshold > 30. However, health risks generally increase with increasing BMI.


 

Prevalence statistics related to overweight and obesity*

* The statistics presented here are based on the following definitions unless otherwise specified: overweight = BMI> 25 to < 30; obesity = BMI > 30.

Overweight and obesity are found worldwide, and the prevalence of these conditions in the United States ranks high along with other developed nations. Approximately 300,000 adult deaths in the United States each year are attributable to unhealthy dietary habits and physical inactivity or sedentary behavior.[7]

Below are some frequently asked questions and answers about overweight and obesity statistics. Data are based on NHANES 1999-2000. Unless otherwise specified, the figures given represent age-adjusted estimates. Population numbers are based on the U.S. Census Bureau Census 2000.

Q: How many adults are overweight?

A: Nearly two-thirds of U.S. adults are overweight (BMI > 25, which includes those who are obese).[8]

All adults (20+ years old): 129.6 million (64.5 percent)
Women (20+ years old): 64.5 million (61.9 percent)
Men (20+ years old): 65.1 million (67.2 percent)

Q: How many adults are obese?

A: Nearly one-third of U.S. adults are obese (BMI > 30).[8]

All adults (20+ years old): 61.3 million (30.5 percent)
Women (20+ years old): 34.7 million (33.4 percent)
Men (20+ years old): 26.6 million (27.5 percent)

Q: How many adults are at a healthy weight?

A: Less than half of U.S. adults have a healthy weight (BMI > 18.5 to < 25).[9]

All adults (20-74 years old): 67.3 million (33.5 percent)
Women (20-74 years old): 36.7 million (35.3 percent)
Men (20-74 years old): 30.6 million (31.8 percent)

Q: How has the prevalence of overweight and obesity in adults changed over the years?

A: The prevalence has steadily increased over the years among both genders, all ages, all racial/ethnic groups, all educational levels, and all smoking levels.10 From 1960 to 2000, the prevalence of overweight (BMI > 25 to < 30) increased from 31.5 to 33.6 percent in U.S. adults aged 20 to 74.[9]The prevalence of obesity (BMI > 30) during this same time period more than doubled from 13.3 to 30.9 percent, with most of this rise occurring in the past 20 years.8 From 1988 to 2000, the prevalence of extreme obesity (BMI > 40) increased from 2.9 to 4.7 percent, up from 0.8 percent in 1960.3,8 In 1991, four states had obesity rates of 15 percent or higher, and none had obesity rates above 16 percent. By 2000, every state except Colorado had obesity rates of 15 percent or more, and 22 states had obesity rates of 20 percent or more.11 The prevalence of overweight and obesity generally increases with advancing age, then starts to decline among people over 60.[3]

Q: What is the prevalence of overweight and obesity in minorities?

A: The age-adjusted prevalence of combined overweight and obesity (BMI > 25) in racial/ethnic minorities—especially minority women—is generally higher than in whites in the United States.[8]

Non-Hispanic Black women: 77.3%
Mexican American women: 71.9%
Non-Hispanic White women: 57.3%
Non-Hispanic Black men: 60.7%
Mexican American men: 74.7%
Non-Hispanic White men:
67.4%

(Statistics are for populations 20+ years old)

Studies using this definition of overweight and obesity provide ethnicity-specific data only for these three racial-ethnic groups. Studies using definitions of overweight and obesity from NHANES II have reported a high prevalence of overweight and obesity among Hispanics and American Indians. The prevalence of overweight (BMI > 25) and obesity (BMI > 30) in Asian Americans is lower than in the population as a whole.[1]



 

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