Explosive Growth in Extremely Severe Obesity (Under the Radar)
Happy headlines late last year told us that obesity recently “dipped” in the U.S., perhaps because of medicines like semaglutide and tirzepatide. Those headlines presented a partial and misleading truth that a new analysis in Lancet Diabetes & Endocrinology explains more fully. Yes, the prevalence of overweight and mild obesity has seemingly plateaued. But this is mainly because of explosive growth in more severe obesity – especially extremely severe obesity characterized by a BMI greater than 60.
In fact, the prevalence of extremely severe obesity grew by roughly 250% from 2001 to 2023.
The Shifting Dynamics
In that same time period, the the prevalence of people in a healthy weight range (BMI 18.5-24.9) dropped by 22%. Prevalence of mere overweight (BMI 25-29.9) dropped by eight percent. Mild obesity (BMI 30-39.9) rose until 2019 and appears to be leveling out since then.
In each higher severity grouping (BMI increments of ten) the growth is sharper after that. As we have written here before, it appears that the dynamics of obesity prevalence are changing.
About a quarter of the population seems to be resistant to weight gain, while the rest of the population is shifting toward more severe forms of obesity.
Serious Health Implications
The authors of this jarring analysis tell us the implications for population health are profound:
“Individuals with BMI ≥60 kg/m2 face greater comorbidities, higher surgical risks, and reduced responsiveness to standard weight-loss interventions compared with those with lower obesity levels; often encountering unique pathophysiological challenges that require tailored treatment strategies.
“Beyond clinical implications, extreme obesity poses significant logistical and health-care system challenges. Individuals with BMI ≥60 kg/m2 often exceed the weight limits for standard medical equipment, making radiological imaging, anaesthesia, and surgical interventions more complex. These patients might frequently be denied care due to weight restrictions of medical equipment, further exacerbating health disparities.”
Obesity medicine physician Sarah Ro puts it plainly:
“Many patients with extremely severe obesity get NO care! Just shame, blame and discrimination from our health care systems.”
The situation will only get worse if health systems do not face it and pivot to make credible medical care for severe obesity a reality. Right now, prospects for care are bleak if a person with this condition is not wealthy or resourceful or both.
Want to “Make America Healthy Again”? Take obesity seriously.
Click here for the new analysis in Lancet Diabetes & Endocrinology.
Old Radar Station at the Top of Serra da Estrela, photograph by Joaquim Alves Gaspar, licensed under CC BY-SA 3.0
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April 28, 2025
April 28, 2025 at 7:04 am, Kath Williamson said:
Thanks for highlighting this Ted, although not great news, it is a step forward to actually have some data, as the the lack of data means that both people affected and staff struggle with little evidence to guide care. Data like this, alongside lived experience of both individuals affected and staff, can help focus minds, research & the policy agenda.
April 28, 2025 at 7:02 pm, Laura Boyer, FNP said:
Dr Ro nailed it. It’s time to stop blaming the individual and start treating obesity as a chronic deadly disease. Metabolic surgery, effective drugs, and lifelong management, just like we do for heart disease. A person with severe obesity most likely will need more than one mode of treatment…just like chronic diseases such as hypertension, heart disease, and diabetes. Evidence based treatment of obesity will also help treat these diseases. It’s the most bang for our healthcare bucks!