More than one-third of adults and children in the United States 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 scientific statement from the American Heart Association. 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 due to a combination of socioeconomic and structural barriers.
These barriers include limited access to healthy foods, lack of time to prepare meals and engage in regular physical activity, financial constraints such as lack of health insurance, and pervasive weight stigma. The statement, titled "Socioeconomic and Structural Barriers to Addressing Obesity in Communities," highlights that while obesity affects people across all socioeconomic backgrounds, those with fewer resources face disproportionate impacts and related health conditions like high blood pressure, cardiovascular disease, and Type 2 diabetes.
"We must recognize that obesity is not a personal choice. It is highly influenced by multiple social and environmental factors," said Dr. Fatima Cody Stanford, vice chair of the scientific statement writing group. "This is a critical component for addressing the obesity epidemic in the U.S. and obesity-related health conditions including cardiovascular disease." The statement notes that previous research has found genetic predisposition is not the primary driver of high obesity rates, pointing instead to everyday lived experiences shaped by socioeconomic stressors.
Numerous factors contribute to obesity risk, including neighborhood safety for outdoor exercise, access to affordable healthy foods, and environmental factors like shift work, noise pollution, and nighttime light exposure that disrupt circadian rhythms. A 2025 American Heart Association scientific statement about circadian health highlighted that such disruptions are strongly associated with increased risk of obesity and related conditions.
Despite greater availability of treatment options, including weight management programs and medications like GLP-1 receptor agonists, significant challenges remain in effectively treating obesity. Weight stigma presents a major barrier, with research indicating that between 20% and 90% of people hold negative opinions about people with excess weight, viewing obesity as a personal lifestyle choice or reflection of poor self-control. These perceptions contribute to poor mental health, unhealthy eating behaviors, and avoidance of health care.
Physical barriers in health care settings, such as inadequate medical equipment and small spaces, along with financial challenges like co-pays, transportation costs, and insurance limitations, further discourage people with obesity from seeking care. Time constraints represent another often-overlooked barrier, as work and caregiver responsibilities reduce availability for healthy lifestyle behaviors like meal preparation and physical activity.
The statement calls for a multifaceted approach involving collaboration among government, health care professionals, community organizations, and individuals. Community-based interventions, including faith-based and cultural programs, show effectiveness across different populations. However, current metrics like body mass index (BMI) do not accurately reflect body fat or overall health, necessitating development of more clinically meaningful measures to advance obesity reduction efforts.
Health care professionals can make significant impacts by initiating culturally sensitive discussions about weight, offering referrals to local resources, and providing personalized care. Education about biases may help 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. Key strategies include improving affordability of culturally specific fruits and vegetables, increasing access to healthy weight management programs, promoting physical activity, and advocating for public policies like insurance coverage of obesity medications.
The scientific statement was prepared by a volunteer writing group representing multiple American Heart Association councils. The Association receives more than 85% of its revenue from sources other than corporations, with overall financial information available here. Additional resources include previous statements on obesity care gaps and health information on understanding weight, healthy eating, and losing weight available through the Association's educational materials.
