How The Pandemic Triggered The Obesity Surge In America

Below is a complimentary Demography Unplugged research note written by Hedgeye Demography analyst Neil Howe. Click here to learn more and subscribe.

NH: This is not a good news story.

During the pandemic, most American adults gained significant weight, due to inactivity, anxiety, and changed sleep patterns. According to both remote measurement and self-reporting, this gain averaged 20 to 30 pounds.

Who gained the most? The youngest, the poorest, and (by ethnicity) Hispanics and African-Americans. Who gained the least? The oldest, the most affluent, and Asians, followed by whites.

This new study suggests that roughly the same pattern prevailed among kids. A network of providers in the greater Philadelphia region analyzed roughly 500K visits by children ages 2 to 17 during two full years.

Overall, from the last six months of 2019 to the last six months of 2020, the share of kids classified as obese rose from 13.7% to 15.4%, a +12% rate gain. The highest absolute rates and gains were among pre-adolescents (age 10-12); the next highest were among adolescents (age 13-17).

As with adults, the shift was most severe among the poorest families and for Hispanics and African-Americans. Pre-pandemic, nonwhite kids had an obesity rate of roughly 20%, which rose during the pandemic to 27%. That's a +35% rate gain.

The following charts track both the pre-pandemic and pandemic comparison periods.

A related WSJ story covers parents' worries about weight gain in their children. And a matching NYT story covers the blitz marketing of new weight-loss programs and apps (like Noom) now that Americans are starting to resume normal lives.

Let me focus on a broader, longer-term issue: the adverse impact of more obesity on America's rates of chronic disease and mortality. 

For several years back around 2010, many experts saw hopeful signs that America's seemingly relentless rise in the obesity rate was plateauing among all age brackets. (See, for example, "Kids Getting Active.") Alas, that hope turned out to be a mirage. Here are the latest trend statistics from the CDC.

Back in 1962, at first official count, 23% of American adults classified as obese according to the simple BMI formula. And roughly 2-3% classified as severely obese. Those rates began to rise in the late 1960s and rose more rapidly in the 1980s. By 2000, obesity had broached 30% and severe obesity was approaching 5%. By 2017-18, the obesity rate hit 42.4%. We are on track to double our Kennedy-era incidence of obesity by the end of the 2020s--and multiply our incidence of severe obesity by 4X or 5X.

BTW, you may be wondering how the CDC or WHO uses BMI to classify adults into weight categories. Here's an example. For someone who is 5'9" tall, you are "overweight" if you are over 170 pounds; "obese" when over 205; and "severely obese" when over 240. It's easy to argue about where to establish the boundaries. It's harder to argue about the direction of change over time.

The consequences are apparent for all to see. Aside from Kuwait and several Polynesian islands, the United States has today become the fattest country on earth. Obesity is a conspicuous feature about Americans that foreign visitors routinely comment on. 

According to health experts, it is by far the largest contributor to America's recent declining trend in life expectancy, both in absolute terms and (especially) relative to other nations, rich or poor. Obesity is also responsible for a sizable share of America's massive spending on acute-care health interventions.

What I find most distressing about this ill trend is that it is advancing by birth cohort--that is, the highest obesity rates by age are being pioneered by the latest-born cohorts.

Alternatively, to turn this thought around, any future improvement would need to show up first as a decline in the obesity rates among children. But that's not happening.

Here again are the latest data. The first chart shows the longer-term trend since the 1960s for children ages 6 to 19. The second shows more detail after 2000 for children ages 2 to 19.

Bottom line: The trend in obesity among children continues to rise. Which brings, in its train, rising rates of juvenile hypertension, hyperlipidemia, diabetes, sleep apnea, earlier puberty, and depression.

Bad enough in themselves, these syndromes are highly correlated, later on in life, with higher adult morbidity and mortality rates.

That's why the findings of the Pediatrics study are so alarming. By ratcheting up the rate of childhood obesity another notch during the pandemic, Americans have allowed a bad situation to deteriorate further.

And by so doing, they may be setting up the next generation of adults for a significantly lower quality of life. It's hard enough for an individual to overcome obesity once his or her body has become habituated to it in childhood.

It may be even harder for an entire generation once it has "renormed" itself to a less healthy standard.