National, State, and County Estimates of Adult Overweight and Obesity From Electronic Health Records and Kiosks in Retail Locations, 2024-2025.

Abstract

This study aimed to describe near real-time, county-level prevalence of overweight and obesity among individuals aged 18 years and older using electronic health records (EHRs) from Epic Cosmos and kiosks in retail locations. Using cross-sectional data (January 2024-July 2025) from 85 million patients from EHRs and 1.2 million users of Pursuant Health kiosks, we estimated the prevalence of overweight (BMI: 25 to < 30 kg/m²) or obesity (BMI ≥ 30 kg/m²) using height (EHRs: measured, kiosks: self-reported) and measured weight. Prevalence was estimated directly for EHRs and using multilevel regression and post stratification based on sociodemographic variables for kiosks, then compared with direct and modeled estimates from the Centers for Disease Control and Prevention (CDC) surveys: National Health and Nutrition Examination Survey and Behavioral Risk Factor Surveillance System. Nationally, the prevalence of overweight was 39.1% and 33.6% (95% CI: 32.8%-34.4%), and obesity was 43.7% and 43.3% (95% CI: 42.3%-44.4%) from EHRs and kiosks, respectively, which was similar to national surveys. Higher prevalence was observed among Non-Hispanic Black adults, those aged 45-64 years, and rural residents. County hot spots were observed across Southern and Midwestern states and were correlated with modeled CDC estimates (EHRs: 0.64, kiosks: 0.34). Recent EHR and kiosk samples of US adults show a high prevalence of overweight and obesity and identify local hot spots that are masked in surveys.