US Obesity Hits 41% in Adults, 20% in Youth Over 24-Year Period

Obesity prevalence among US adults climbed from 30% to 41% between 1999 and 2023, with severe obesity doubling from 5% to 10% and abdominal obesity rising from 48% to 61%, according to a new data brief published in Circulation. The findings, drawn from more than 2 decades of National Health and Nutrition Examination Survey (NHANES) data, represent what investigators describe as the most contemporary evaluation of obesity trends among US adults and youth to date.^1,2

The analysis, led by Anum S. Minhas, MD, MHS, assistant professor of medicine in cardiology at the Johns Hopkins School of Medicine, examined youth (aged ≤20 years) and adults (aged ≥20 years) surveyed across NHANES cycles between 1999 and 2023, with a median of 8687 participants per cycle. Investigators defined obesity as a body mass index (BMI) of at least 30 kg/m², severe obesity as a BMI of at least 40 kg/m², and abdominal obesity using sex-specific waist circumference thresholds of at least 88 cm in women and at least 102 cm in men. Race-specific lower thresholds were applied for Asian American adults in stratified analyses.^1,2

Youth Trends Accelerate Faster Than Adult Trends

Among youth, investigators observed an approximate 30% relative increase in overall obesity, a 50% increase in severe obesity, and a 3-fold increase in abdominal obesity comparing 1999 with 2023. By the end of the study period, roughly 20% of youth met criteria for obesity. Among adults, relative increases over the same window were approximately 30% for overall obesity, 2-fold for severe obesity, and nearly 40% for abdominal obesity (P < .001 for all).^1,2

Adults aged 40 to 59 years carried the highest prevalence of overall obesity (P < .01). Sex-based disparities were pronounced. As of 2023, women had higher rates of severe obesity (13%) and abdominal obesity (70%) than men (7% and 51%, respectively), with hormonal differences and changes across the lifespan potentially contributing to this gap. Non-Hispanic Black individuals consistently demonstrated the highest prevalence of all obesity measures compared with other demographic groups throughout the study period.^1,2

Context Within the CKM Framework

The findings arrive weeks after the first-ever 2026 American Heart Association/American College of Cardiology/American Diabetes Association/American Society of Nephrology guideline on the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic (CKM) syndrome, which positions obesity as stage 1 of the CKM continuum and emphasizes diet and lifestyle modification as foundational to long-term health. Nearly 90% of US adults have at least 1 CKM risk factor.³

Notably, the Circulation estimates diverge somewhat from the CDC's most recent National Center for Health Statistics data brief, which reported an age-adjusted adult obesity prevalence of 40.3% during August 2021 to August 2023 and found that adult obesity prevalence did not change significantly over the preceding 10 years. This was observed even as severe obesity rose from 7.7% to 9.7%. The distinction matters for interpretation—the long-arc trajectory since 1999 is unambiguously upward, but the most recent decade may reflect a plateau in overall prevalence alongside continued growth in the most severe phenotypes.⁴

What This Means for Pharmacists

For pharmacists, the abdominal obesity signal deserves particular attention. Waist circumference captures cardiometabolic risk independent of BMI, and the near 3-fold increase among youth suggests risk accumulating well before conventional screening thresholds are triggered. Pharmacists who conduct point-of-care health screenings, medication therapy management encounters, or glucagon-like peptide-1 (GLP-1) receptor agonist consultations are positioned to reinforce that BMI alone may understate risk.

“Pharmacists can encourage healthy lifestyle behaviors, including adequate physical activity; following a healthy diet; achieving and maintaining a normal weight; sleep hygiene; smoking cessation; and stress reduction,” Minhas explained in an exclusive interview with Pharmacy Times. “In addition, pharmacists can consider recommending that patients consult with their health care providers regarding pharmacologic interventions to target underlying chronic medical comorbidities such as obesity or hypertension.

Minhas emphasized the need to better identify which patients benefit most from weight loss medications or other treatments, citing GLP-1 receptor agonists, bariatric surgery, and other FDA-approved interventions with demonstrated benefit on metabolic risk factors and cardiovascular health. As GLP-1 access expands through initiatives such as the CMS Medicare GLP-1 Bridge Program, pharmacists will increasingly serve as the touchpoint for adherence counseling, adverse effect management, and escalation to prescriber-led intensification.^2,5

Additionally, Minhas discussed the essential nature of pharmacist-led screening for obesity and other CKM concerns. “Screening for obesity can be performed in several settings, including the pharmacy, including weight and waist circumference measurements. In addition, blood pressure assessment can be performed as well. This can enable health care providers to screen early and intervene with either weight or BP management,” Minhas noted.

REFERENCES

1. Minhas AS, Wallace AS, Zhang S, Barrett RB, Ndumele CE. Obesity, severe obesity, and abdominal obesity in US youth and adults from 1999 to 2023. Circulation. 2026;154(1):58-62. doi:10.1161/CIRCULATIONAHA.126.080146

2. Obesity rates in the US climbed to about 40% of adults and 20% of youth in 2023. News release. American Heart Association. July 7, 2026. Accessed July 15, 2026. https://www.eurekalert.org/news-releases/1134717

3. Halpern L. First-ever guideline on cardio-kidney-metabolic syndrome calls for earlier screening, coordinated care. Pharmacy Times. Updated June 9, 2026. Accessed July 15, 2026. https://www.pharmacytimes.com/view/first-ever-guideline-cardio-kidney-metabolic-syndrome-earlier-screening-coordinated-care

4. Emmerich SD, Fryar CD, Stierman B, Ogden CL. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief no. 508. National Center for Health Statistics. September 2024. Accessed July 15, 2026. doi:10.15620/cdc/159281

5. Halpern L. Medicare's new GLP-1 bridge program: what pharmacists need to know before dispensing. Pharmacy Times. Published July 9, 2026. Accessed July 15, 2026. https://www.pharmacytimes.com/view/medicare-s-new-glp-1-bridge-program-what-pharmacists-need-to-know-before-dispensing