More than one-third of adults and children in the U.S. 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 American Heart Association scientific statement. The statement, published in the Association’s flagship journal Circulation, emphasizes that obstacles to preventing and treating obesity are more likely to affect people in lower-income communities.
These obstacles 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 stigma around body weight. Fatima Cody Stanford, M.D., M.P.H., M.P.A., M.B.A., FAHA, vice chair of the scientific statement writing group, stated, "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."
Numerous socioeconomic factors are closely linked to obesity. Living in a neighborhood where it is safe to exercise outdoors and being able to access affordable, healthy foods are linked to a reduced risk of developing obesity. Conversely, lifestyle and environmental factors, including shift work, noise pollution, and nighttime light exposure, can increase this risk by interfering with circadian rhythms. A 2025 American Heart Association scientific statement about circadian health highlighted that disruptions to the body’s internal clock are strongly associated with an increased risk of obesity, Type 2 diabetes, high blood pressure, and cardiovascular disease.
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. Individuals with obesity also face physical and financial challenges in the health care system, including medical equipment and small spaces that discourage care-seeking, the cost of co-pays, transportation challenges, and limitations in health insurance coverage.
Time is an often-overlooked barrier, directly affecting an individual’s ability to participate in obesity prevention and treatment programs. Work and caregiver responsibilities are often prioritized to maintain financial and household stability, reducing time available for healthy lifestyle behaviors. The statement calls for a multifaceted approach, noting that effective obesity prevention and treatment programs include collaboration among government, health care professionals, community organizations, and individuals. Community-based interventions, such as faith-based and cultural programs, are effective and may improve outcomes across different populations.
Health care professionals can make a significant impact by initiating culturally sensitive discussions with patients, offering referrals to local resources, and providing personalized care. Educating health care professionals about biases may also help to 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," Stanford said. 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 available metrics for gauging intervention success, such as body mass index (BMI), do not accurately reflect body fat or overall health, and the development of more clinically meaningful metrics will be necessary to advance efforts.
