Shifting Obesity Trends Point to More “Extreme” Obesity in Women, With Repercussions for Future Care

Mounting rates of obesity and, more ominously, severe obesity in women have important implications for cardiovascular disease prevalence and treatment down the road, experts said in response to new data from the National Health and Nutrition Examination Survey (NHANES). 

Take Home. Shifting Obesity Trends Point to More “Extreme” Obesity in Women, With Repercussions for Future Care

Data collected between 2005 and 2014 show that the proportion of US women with obesity and severe, “class 3” obesity has increased in a linear fashion for women, and remained static—but high—in men, Katherine M. Flegal, PhD (National Center for Health Statistics, Hyattsville, MD), and colleagues report in the June 7, 2016, issue of the Journal of the American Medical Association.

The picture painted is a troubling one, Ian J. Neeland, MD (UT Southwestern Medical Center, Dallas, TX), who wasn’t involved in the study, told TCTMD.

"One of the most interesting findings they had was that class 3 obesity . . . has shown an increase in prevalence over time even though obesity overall has relatively plateaued,” he said. “So the distribution of obesity has shifted from more mild forms to more severe forms and that's a big problem."

Obesity Trending Up, But Not For Everyone

For the study, Flegal et al analyzed NHANES data on 26,468 adults ages 20 years and older. They also collected information on sex, age, race/Hispanic origin, and smoking history.

Overall, the age-adjusted prevalence of obesity rose from 34.3% in 2005-2006 to 37.7% in 2013-2014. In men, obesity prevalence stayed relatively static, with the researchers reporting a rate of 35% for men at the later time point. In women, however, obesity prevalence in 2013-2014 was 40.4%. More worryingly, prevalence of class 3 obesity in 2013-2014 was nearly twice as high in women as in men: 9.9% versus 5.5%.

The prevalence of obesity ranged widely across specific groups. For example, obesity among non-Hispanic black women was 57.2%, while non-Hispanic Asian men ages 40 to 59 years had a prevalence of 6.2%, a figure that dropped to 4.4% in those 60 years and older.

Gender Disparity in Obesity

The fact that obesity and severe obesity is rising faster in women than in men comes on top of the fact that obesity is already a bigger problem in females than males, Neeland told TCTMD. This may underscore problems in the way physicians approach health and prevention in women versus men, he said.

The findings suggest “that either our efforts to battle obesity in women are not aggressive enough or that there's still a gender-based disparity in how we treat obesity and cardiovascular disease,” he said.

That’s a point also made in an editorial accompanying the study, by JAMA deputy editor Jody Zylke, MD, and editor-in-chief Howard Bauchner, MD, who say that obesity prevention “must start with women of child-bearing age.”

The same pattern of rising obesity in women has also been seen in children, they note, pointing to the need for interventions targeting families as a whole.

“Perhaps new incentives are needed to encourage industry to work with families and the medical community to prevent obesity,” they conclude.

Future Concerns

Indeed, the obesity figures today spell major problems for physicians treating these patients down the road, experts say.

“My worry is that the metabolic and cardiovascular problems we are going to be seeing in 2017 are probably the people who got their obesity in 2007 or 1997, and now are the ones showing up with all the problems,” Michael D. Jensen, MD (Mayo Clinic, Rochester, MN), commented to TCTMD. The number will only continue to rise in the years and decades to come.

“I think we have a big wave of problems coming, not from this latest increase in women from 2013-2014, but from all this backlog from the ‘90s and early 2000s.”


  • Flegal, Zylke, and Bauchner report no relevant conflicts of interest.

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Michael H. Wilson is the recipient of the 2016 Jason Kahn Fellowship in Medical Journalism, working as a summer intern…

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  • Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:2284-2291.

  • Zylke JW, Bauchner H. The unrelenting challenge of obesity. JAMA. 2016;315:2277-2278.