More than one-third of adults and children in the United States are living with obesity, with rates highest among non-Hispanic Black children and adults, low-income families, people living in rural areas, and adults with a high school education or less, according to a new scientific statement from the American Heart Association. The statement, published in the Association's flagship journal Circulation, emphasizes that obesity is not a personal choice but is highly influenced by multiple social and environmental factors, making this a critical public health issue with significant implications for cardiovascular disease and other health conditions.
The statement identifies multilevel barriers to obesity prevention and management, with an emphasis on social drivers of health. People with fewer resources are more likely to develop obesity due to a combination of factors that influence everyday experiences, such as socioeconomic stressors that limit access to nutritious foods and regular physical activity. Barriers include limited access to healthy foods, lack of time to prepare meals and engage in regular physical activity, financial constraints including lack of health insurance, and pervasive stigma around body weight.
"We must recognize that obesity is not a personal choice. It is highly influenced by multiple social and environmental factors. This is a critical component for addressing the obesity epidemic in the U.S. and obesity-related health conditions including cardiovascular disease," said Fatima Cody Stanford, M.D., M.P.H., M.P.A., M.B.A., FAHA, vice chair of the scientific statement writing group. Lifestyle and environmental factors, including shift work, noise pollution, and nighttime light exposure, can also increase risk by interfering with circadian rhythms, a connection highlighted in a 2025 American Heart Association scientific statement about circadian health.
Despite greater availability of treatment options, significant challenges remain in effectively treating obesity. Weight stigma perpetuates harmful attitudes, with previous research finding that between 20% and 90% of people have negative and judgmental opinions about people with excess weight. These perceptions may contribute to poor mental health and unhealthy eating behaviors, and experiences of weight stigma can make individuals more likely to avoid seeking care. Physical barriers in health care settings, such as inadequate medical equipment, along with financial challenges like co-pays and insurance limitations, further discourage people from seeking medical care for weight management.
The statement calls for a multifaceted approach involving collaboration among government, health care professionals, community organizations, and individuals. Community-based interventions, such as faith-based and cultural programs, are noted as effective. Health care professionals can make a significant impact by initiating culturally sensitive discussions, offering referrals to local resources, and providing personalized care. Educating health care professionals about biases may also help reduce weight stigma in health care settings.
"The most effective weight management programs are culturally and socially informed and involve stakeholders from across all levels of society working together to support people at risk for or living with obesity," Stanford said. Key strategies include improving the affordability of fruits and vegetables specific to cultural diets, increasing access to healthy weight management programs, promoting physical activity, and advocating for public policies such as insurance coverage of obesity medications. The statement notes that current metrics like body mass index do not accurately reflect body fat or overall health, and the development of more clinically meaningful metrics will be necessary to advance efforts in reducing obesity rates.
