Adult Obesity Causes & Consequences

https://www.cdc.gov/obesity/adult/causes.html

Obesity is a complex health issue to address. Obesity results from a combination of causes and
contributing factors, including individual factors such as behavior and genetics. Behaviors can
include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional
contributing factors in our society include the food and physical activity environment, education and
skills, and food marketing and promotion.

Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced
quality of life, and the leading causes of death in the U.S. and worldwide, including diabetes, heart
disease, stroke, and some types of cancer.

Behavior

Healthy behaviors include a healthy diet pattern and regular physical activity. Energy balance of the
number of calories consumed from foods and beverages with the number of calories the body uses
for activity plays a role in preventing excess weight gain.1,2 A healthy diet pattern follows the Dietary
Guidelines for Americans which emphasizes eating whole grains, fruits, vegetables, lean protein,
low-fat and fat-free dairy products and drinking water. The Physical Activity Guidelines for
Americans recommends adults do at least 150 minutes of moderate intensity activity or 75 minutes
of vigorous intensity activity, or a combination of both, along with 2 days of strength training per
week.

Having a healthy diet pattern and regular physical activity is also important for long term health
benefits and prevention of chronic diseases such as Type 2 diabetes and heart disease.

For more, see Healthy Weight – Finding a Balance.

Community Environment

People and families may make decisions based on their environment or community. For example, a
person may choose not to walk or bike to the store or to work because of a lack of sidewalks or safe
bike trails. Community, home, child care, school, health care, and workplace settings can all
influence people’s daily behaviors. Therefore, it is important to create environments in these
locations that make it easier to engage in physical activity and eat a healthy diet.

Watch The Obesity Epidemic to learn about the many community environmental factors that have
contributed to the obesity epidemic, as well as several community initiatives taking place to prevent
and reduce obesity.

Learn about strategies for a Healthy Food Environment and strategies to improve the environment
to make it easier to be physically active.

Strategies to create a healthy environment are listed on the Strategies to Prevent Obesity page.
More specifically, strategies to create a healthy school environment are listed on the CDC
Adolescent and School Health website.

Genetics

Do Genes Have a Role in Obesity?

Genetic changes in human populations occur too slowly to be responsible for the obesity epidemic.
Nevertheless, the variation in how people respond to the environment that promotes physical
inactivity and intake of high-calorie foods suggests that genes do play a role in the development of
obesity.

How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in its environment. Studies have
identified variants in several genes that may contribute to obesity by increasing hunger and food
intake.

Rarely, a clear pattern of inherited obesity within a family is caused by a specific variant of a single
gene (monogenic obesity). Most obesity, however, probably results from complex interactions
among multiple genes and environmental factors that remain poorly understood (multifactorial
obesity).3,4

What about Family History?

Health care practitioners routinely collect family health history to help identify people at high risk of
obesity-related diseases such as diabetes, cardiovascular diseases, and some forms of cancer. Family
health history reflects the effects of shared genetics and environment among close relatives.
Families can’t change their genes but they can change the family environment to encourage healthy
eating habits and physical activity. Those changes can improve the health of family members—and
improve the family health history of the next generation.3,4

Learn more about genetics and obesity here: Obesity and Genomics.

Other Factors: Diseases and Drugs

Some illnesses may lead to obesity or weight gain. These may include Cushing’s disease, and
polycystic ovary syndrome. Drugs such as steroids and some antidepressants may also cause weight
gain. The science continues to emerge on the role of other factors in energy balance and weight gain
such as chemical exposures and the role of the microbiome.

A health care provider can help you learn more about your health habits and history in order to tell
you whether behaviors, illnesses, medications, and/or psychological factors are contributing to
weight gain or making weight loss hard.

Consequences of Obesity

Health Consequences

People who have obesity, compared to those with a normal or healthy weight, are at increased risk
for many serious diseases and health conditions, including the following:5,6,7

 All-causes of death (mortality)

 High blood pressure (Hypertension)

 High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)

 Type 2 diabetes

 Coronary heart disease

 Stroke
  Gallbladder disease

 Osteoarthritis (a breakdown of cartilage and bone within a joint)

 Sleep apnea and breathing problems

 Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)

 Low quality of life

 Mental illness such as clinical depression, anxiety, and other mental disorders8,9

 Body pain and difficulty with physical functioning10

For more information about these and other health problems associated with obesity, visit Health
Effects of Obesity.

For more information about these and other health problems associated with overweight and
obesity, visit Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and
Obesity in Adults[PDF 56KB].

Economic and Societal Consequences

Obesity and its associated health problems have a significant economic impact on the U.S. health
care system.11 Medical costs associated with overweight and obesity may involve direct and indirect
costs.12,13 Direct medical costs may include preventive, diagnostic, and treatment services related to
obesity. Indirect costs relate to morbidity and mortality costs including productivity. Productivity
measures include ‘absenteeism’ (costs due to employees being absent from work for obesity-related
health reasons) and ‘presenteeism’ (decreased productivity of employees while at work) as well as
premature mortality and disability. 14

National Estimated Costs of Obesity

The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were
estimated to be $147 billion.15

The annual nationwide productive costs of obesity obesity-related absenteeism range between
$3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual)16.

In addition to these costs, data shows implications of obesity on recruitment by the armed forces.
An assessment was performed of the percentage of the US military-age population that exceeds the
US Army’s current active duty enlistment standards for weight-for-height and percent body fat,
using data from the National Health and Nutrition Examination Surveys. In 2007-2008, 5.7 million
men and 16.5 million women who were eligible for military service exceeded the Army’s enlistment
standards for weight and body fat.17

References
1
DHHS, AIM for a Healthy Weight, page 5. Available online[PDF-2.17MB]
2
Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, Swinburn BA.Lancet. 2011
Aug 27;378(9793):826-37.
3
Bouchard C. Defining the genetic architecture of the predisposition to obesity: a challenging but not
insurmountable task. Am J Clin Nutr 2010; 91:5-6.
4
Choquet H, Meyre D. Genetics of obesity: what have we learned? Curr Genomics. 2011;12:169-79.
5
NHLBI. 2013. Managing Overweight and Obesity in Adults: Systematic Evidence Review from the
Obesity Expert Panel.[PDF – 93KB]
6
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in
Adults.[PDF – 2MB]
7
Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass

index and risk of 22 specific cancers: a population-based cohort study of 5•24 million UK adults.
Lancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13.
8
Kasen, Stephanie, et al. “Obesity and psychopathology in women: a three decade prospective
study.” International Journal of Obesity 32.3 (2008): 558-566.
9
Luppino, Floriana S., et al. “Overweight, obesity, and depression: a systematic review and meta-
analysis of longitudinal studies.” Archives of general psychiatry 67.3 (2010): 220-229.
10
Roberts, Robert E., et al. “Prospective association between obesity and depression: evidence from
the Alameda County Study.” International journal of obesity 27.4 (2003): 514-521.
11
U.S. Department of Health and Human Services. The Surgeon General’s call to action to prevent
and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human
Services, Public Health Service, Office of the Surgeon General; [2001]. Available from: US GPO,
Washington.
12
Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United
States. Obesity Research.1998;6(2):97–106.
13
Wolf, A. What is the economic case for treating obesity? Obesity Research. 1998 Apr;6 Suppl 1:2S-
7S.
14
Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes, metabolic
syndrome and obesity : targets and therapy. 2010;3:285-295. doi:10.2147/DMSOTT.S7384.
15
Finkelstein EA1, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity:
payer-and service-specific estimates. Health Aff (Millwood). 2009 Sep-Oct;28(5):w822-31. doi:
10.1377/hlthaff.28.5.w822.
16
Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl. Indirect costs of obesity: a review of
the current literature. Obes Rev.2008;9(5):489–500.
17
Cawley J., Maclean J.C. , “Unfit for Service: The Implications of Rising Obesity for U.S. Military
Recruitment,” Health Economics 21, no. 11 (2012): 1348-66.
 Adult Obesity Prevalence Maps
https://www.cdc.gov/obesity/data/prevalence-maps.html

Obesity Prevalence in 2016 by Education and Age

 Obesity decreased by level of education. Adults without a high school degree or

equivalent had the highest self-reported obesity (35.5%), followed by high school graduates
(32.3%), adults with some college (31.0%) and college graduates (22.2%).

 Young adults were half as likely to have obesity as middle-aged adults. Adults aged 18-24
had the lowest self-reported obesity (17.3%) compared to adults aged 45-54 years who had
the highest prevalence (35.1%).

Obesity Prevalence in 2016 Varies Across States and Territories

 All states had more than 20% of adults with obesity.

 20% to less than 25% of adults had obesity in 3 states (Colorado, Hawaii, and Massachusetts)
and the District of Columbia.

 25% to less than 30% of adults had obesity in 22 states and Guam.

 30% to less than 35% of adults had obesity in 20 states, Puerto Rico, and Virgin Islands.

 35% or more adults had obesity in 5 states (Alabama, Arkansas, Louisiana, Mississippi, and
West Virginia).

 The South had the highest prevalence of obesity (32.0%), followed by the Midwest (31.4%),
the Northeast (26.9%), and the West (26.0%).

Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2016¶

Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should
not be compared to prevalence estimates before 2011.
Source: Behavioral Risk Factor Surveillance System
*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%

Top of Page

View Data Table

Prevalence of Self –Reported Obesity Among U.S. Adults by Race/Ethnicity, State and Territory,
BRFSS, 2014-2016

Combining data from 2014 through 2016, non-Hispanic blacks had the highest prevalence of self-
reported obesity (38.3%), followed by Hispanics (32.5%) and non-Hispanic whites (28.1%).

 Non-Hispanic White Adults

 Non-Hispanic Black Adults

 Hispanic Adults

 Download Maps

Prevalence of Self-Reported Obesity Among Non-Hispanic White Adults by State and Territory,
BRFSS, 2014-2016
Source: Behavioral Risk Factor Surveillance System

*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%
Behavior, environment, and genetic factors all have a role in
causing people to be overweight and obese
https://www.cdc.gov/genomics/resources/diseases/obesity/index.htm

Obesity results from the energy imbalance that occurs when a person consumes more calories than
their body burns. Obesity is a serious public health problem because it is associated with some of the
leading causes of death in the U.S. and worldwide, including diabetes, heart disease, stroke, and
some types of cancer.

Do Genes Have a Role in Obesity?

In recent decades, obesity has reached epidemic proportions in populations whose environments
promote physical inactivity and increased consumption of high-calorie foods. However, not all
people living in such environments will become obese, nor will all obese people have the same body
fat distribution or suffer the same health problems. These differences can be seen in groups of
people with the same racial or ethnic background and even within families. Genetic changes in
human populations occur too slowly to be responsible for the obesity epidemic. Nevertheless, the
variation in how people respond to the same environment suggests that genes do play a role in the
development of obesity.

How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in its environment. Studies of
resemblances and differences among family members, twins, and adoptees offer indirect scientific
evidence that a sizable portion of the variation in weight among adults is due to genetic factors.
Other studies have compared obese and non-obese people for variation in genes that could
influence behaviors (such as a drive to overeat, or a tendency to be sedentary) or metabolism (such
as a diminished capacity to use dietary fats as fuel, or an increased tendency to store body fat).
These studies have identified variants in several genes that may contribute to obesity by increasing
hunger and food intake.

Rarely, a clear pattern of inherited obesity within a family is caused by a specific variant of a single
gene (monogenic obesity). Most obesity, however, probably results from complex interactions
among multiple genes and environmental factors that remain poorly understood (multifactorial
obesity).

Any explanation of the obesity epidemic has to consider both genetics and the environment. One
explanation that is often cited is the mismatch between today’s environment and “energy-thrifty
genes” that multiplied in the distant past, when food sources were unpredictable. In other words,
according to the “thrifty genotype” hypothesis, the same genes that helped our ancestors survive
occasional famines are now being challenged by environments in which food is plentiful year round.
Other hypotheses have been proposed including a role for the gut microbiome as well as early life
exposures associated with epigenetic changes.

Can Public Health Genomics Help?

With the exception of rare genetic conditions associated with extreme obesity, currently, genetic
tests are not useful for guiding personal diet or physical activity plans. Research on genetic variation
that affects response to changes in diet and physical activity is still at an early stage. Doing a better
job of explaining obesity in terms of genes and environment factors could help encourage people
who are trying to reach and maintain a healthy weight.

What about Family History?

Health care practitioners routinely collect family health history to help identify people at high risk of
obesity-related diseases such as diabetes, cardiovascular diseases, and some forms of cancer. Family
health history reflects the effects of shared genetics and environment among close relatives.
Families can’t change their genes but they can change the family environment to encourage healthy
eating habits and physical activity. Those changes can improve the health of family members—and
improve the family health history of the next generation.

How Can You Tell If You or Your Family Members Are Overweight?

Most health care practitioners use the Body Mass Index (BMI) to determine whether a person is
overweight. Check your Body Mass Index with a BMI calculator.

Recent References

 Toward Precision Approaches for the Prevention and Treatment of Obesity.

Yanovski SZ, Yanovski JA. JAMA January, 2018

 On the origin of obesity: identifying the biological, environmental and cultural drivers of
genetic risk among human populations.
Qasim A et al. Obesity reviews : an official journal of the International Association for the
Study of Obesity 2018 Feb 19(2) 121-149

 Precision Medicine in Obesity and Type 2 Diabetes: The Relevance of Early-Life Exposures.
Estampador Angela C et al. Clinical chemistry 2018 Jan 64(1) 130-141

 Gene-nutrient interactions and susceptibility to human obesity.

Castillo Joseph J et al. Genes & nutrition 2017 1229

 From genetics and epigenetics to the future of precision treatment for obesity.
Sun Xulong et al. Gastroenterology report 2017 Nov 5(4) 266-270

 The Microbiome and Risk for Obesity and Diabetes. Komaroff AL. JAMA. 2017 Jan
24;317(4):355-356