Trends in the Prevalence of Clinical and Preclinical Obesity Among US Adults by Social Determinants of Health.

Abstract

This study examined trends in clinical and preclinical obesity prevalence among US adults and their association with social determinants of health (SDOH) from 1999 to 2023. We analyzed data from 60,506 adults aged ≥ 20 years in 11 cycles of the National Health and Nutrition Examination Survey (1999-2023). Clinical obesity was defined per the Lancet Diabetes & Endocrinology Commission on the definition and diagnosis of clinical obesity and preclinical obesity by excess adiposity without obesity-attributable complications. Eight SDOH domains were assessed individually and as a cumulative burden score. Age-standardized prevalence and associations were estimated using survey-weighted regression models. From 1999-2000 to 2021-2023, age-standardized prevalence of clinical obesity nearly doubled (14.3% to 26.6%; p < 0.001), driven by increases in class III obesity. Preclinical obesity increased modestly (17.1% to 20.6%; p = 0.038). Disparities widened significantly between those with highest (> 6) vs. lowest (< 3) cumulative SDOH burdens. In multivariable-adjusted analyses, unemployment (OR 1.50), food insecurity (OR 1.38), and high cumulative SDOH burden (OR 1.48) were strongly associated with clinical versus preclinical obesity, particularly class II-III severity. Clinical obesity increased dramatically, showing a strong dose-response relationship with social disadvantage and widening SDOH-based disparities, underscoring the need for targeted interventions addressing structural determinants among vulnerable populations.