Obesity Burden in the US: Latest CDC Maps and Trends

Introduction

Obesity continues to be one of the most urgent public health concerns in the United States, shaping the trajectory of chronic disease, healthcare spending, and quality of life for millions of adults and children. The latest data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) highlight the persistence of high obesity rates across the country, with little evidence of decline.

In 2023, the CDC released updated state-by-state obesity prevalence maps based on the Behavioral Risk Factor Surveillance System (BRFSS), revealing that more than 20 states had adult obesity rates of at least 35%. The highest prevalence was concentrated in the South and Midwest, continuing a regional pattern that has held for more than a decade. NCHS survey data from 2021–2023 add further context, showing that national adult obesity prevalence remains at historically high levels, while severe obesity is increasing.

The burden is not distributed evenly. Rural populations, in particular, face disproportionately higher rates, driven by limited access to healthcare, fewer opportunities for physical activity, and structural barriers in the food environment. By 2025, the rural–urban divide has widened, raising urgent questions about health equity and the need for targeted interventions.

National and Regional Patterns from the 2023 CDC Maps

The CDC’s Adult Obesity Prevalence Maps provide one of the clearest pictures of how obesity is distributed across the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), these maps track self-reported height and weight from adults in all 50 states, the District of Columbia, and U.S. territories. While the figures are based on self-reporting and may underestimate true prevalence, they remain the most consistent nationwide surveillance tool available.

The 2023 maps tell a sobering story. More than 20 states now report adult obesity prevalence at or above 35%, a threshold that would have been nearly unthinkable two decades ago. These states are concentrated primarily in the South and Midwest, regions that continue to carry the heaviest burden. Mississippi, West Virginia, and Alabama are among those with the highest prevalence, reflecting long-standing patterns of socioeconomic vulnerability and limited access to preventive care. In contrast, the lowest obesity prevalence is generally seen in some Western states, such as Colorado, and in a few Northeastern states, though even in these regions adult obesity rates remain above 25%. The maps reveal that there is no U.S. state with an obesity prevalence below one in four adults. Geographic clustering is striking. The South continues to lead the nation in obesity prevalence, with 36.5% of adults affected in 2023. The Midwest follows closely at 35.8%, while the Northeast and West report lower rates, 30.5% and 29.2% respectively. The differences reflect a complex interplay of cultural diet patterns, socioeconomic factors, healthcare access, and built environments. In rural southern states, calorie-dense diets and high poverty rates converge with fewer recreational facilities, creating an obesogenic environment that is difficult to counter through individual behavior change alone.

Disparities by race and ethnicity are also evident in the maps. Non-Hispanic Black adults continue to have the highest prevalence of obesity, with 38 states reporting rates above 35% for this group. Hispanic adults also show elevated prevalence compared to non-Hispanic White and Asian adults. These patterns reflect not only biological predispositions but also structural determinants: residential segregation, inequitable access to healthcare, food insecurity, and targeted marketing of unhealthy foods. The intersection of race, income, and geography magnifies disparities, with southern states hosting some of the largest gaps.

Another dimension of the CDC maps is the persistence of trends over time. Comparing 2023 with maps from five and ten years earlier, the overall trajectory remains upward. The South and Midwest, which already had high prevalence, have seen further increases, while regions with historically lower rates are also rising. What was once considered a “regional problem” has clearly become a national challenge. Beyond geographic clustering, the CDC notes that obesity prevalence is consistently higher among adults with lower educational attainment and household income. Adults without a high school diploma are more likely to report obesity than college graduates, and people living below the federal poverty line experience higher rates than those above it. These patterns underline the social determinants of health, which cannot be separated from larger questions of inequality.

The 2023 maps also highlight differences by age group. Adults between 45 and 64 years report the highest prevalence, though obesity is common across all age groups. Younger adults in their twenties and thirties are not exempt, with rates rising steadily, raising concerns about the early onset of obesity-related chronic diseases.

Taken together, the CDC’s maps for 2023 paint a picture of widespread and entrenched obesity across the United States. The high prevalence in the South and Midwest reflects longstanding structural issues, while the growing rates in other regions show that no area is immune. When placed alongside demographic data by race, income, and education, the maps illustrate that obesity is not simply an individual health behavior issue but a population-level challenge deeply linked to social determinants of health.

NCHS Data (2021–2023) and National Trends

While the CDC maps highlight geographic variation, the National Center for Health Statistics (NCHS) provides a broader picture of national obesity prevalence and its trajectory. Between 2021 and 2023, data from the National Health and Nutrition Examination Survey (NHANES) confirmed that obesity rates remain historically high, affecting more than four in ten adults. The figure (roughly 42% of U.S. adults) has held steady in recent years, but stability at such a high level is itself concerning. The NCHS summary points to a persistent upward trend in severe obesity. Approximately 9% of adults now fall into this category, defined as a body mass index (BMI) of 40 or higher. Severe obesity is associated with elevated risks of diabetes, heart failure, certain cancers, and mortality. The rise in this subgroup underscores how obesity in the U.S. has not only become widespread but also more clinically severe, stretching the capacity of healthcare systems to manage complex comorbidities.

Childhood and adolescent obesity rates remain troubling. Data from 2021–2023 suggest that about 20% of children and adolescents ages 2–19 have obesity, with a notable proportion meeting criteria for severe obesity. These early patterns matter because children with obesity are more likely to become adults with obesity, perpetuating a cycle of health risks. Pediatric obesity also carries unique psychosocial consequences, including stigma, reduced physical activity, and higher rates of depression.

The NCHS data highlight the role of socioeconomic determinants in shaping obesity prevalence. Adults with lower income and less education show consistently higher obesity rates. Food insecurity is a major driver, with households lacking stable access to nutritious foods relying more heavily on calorie-dense, low-cost items. Geographic access plays a role as well: neighborhoods with limited grocery stores and abundant fast-food outlets create environments where healthy choices are difficult to sustain.

Another trend emphasized by NCHS is the disparity across racial and ethnic groups. Non-Hispanic Black adults report the highest prevalence, followed by Hispanic adults, while non-Hispanic Asian adults show the lowest rates. These patterns echo the findings of the CDC maps, but the NCHS data provide more detailed national estimates that reinforce how obesity is intertwined with broader inequities in healthcare access, housing, and income distribution.

Beyond demographics, the 2021–2023 data highlight the multifactorial nature of obesity. Factors include dietary patterns, physical activity, sleep quality, stress, and environmental influences. The COVID-19 pandemic also played a role, with disruptions to daily routines, reduced access to recreational facilities, and increased food insecurity likely contributing to weight gain in many populations. Importantly, NCHS emphasizes that obesity should be treated as a chronic disease rather than an individual failing. This framing aligns with evolving medical consensus and has policy implications for how prevention and treatment programs are designed. Viewing obesity through a chronic disease lens shifts the focus toward systemic interventions, long-term management, and integration into primary care rather than short-term or stigmatizing approaches.

In summary, the 2021–2023 NCHS data confirm that U.S. obesity prevalence remains at a plateau of historically high levels, with severe obesity increasing and disparities widening. These findings provide essential context for interpreting CDC maps and underscore the urgent need for interventions that address the socioeconomic and structural factors driving the epidemic.

The Rural vs. Urban Gap in 2025

One of the most striking patterns in recent obesity data is the widening rural–urban divide. While obesity affects adults in every part of the country, prevalence is consistently higher in rural counties than in metropolitan areas, and the gap has grown by 2025. This divide reflects not only individual behavior but also deep structural and environmental differences between communities. National CDC surveillance and analyses from the USDA Economic Research Service (ERS) show that adults living in rural areas have a higher risk of obesity than their urban counterparts. In 2023, obesity prevalence in many rural counties exceeded 40%, compared with an average closer to 33% in urban areas. By 2025, this gap had widened, driven by persistent socioeconomic disparities and limited healthcare infrastructure.

Access to healthcare is a central factor. Rural communities often have fewer physicians, nutritionists, and weight-management programs. Preventive care is harder to obtain, and rural hospitals frequently operate under financial strain, limiting their capacity to provide specialized services such as bariatric surgery or structured obesity treatment. Patients may need to travel long distances for appointments, creating practical barriers to sustained care. The food environment also differs. Many rural regions qualify as “food deserts,” with limited access to supermarkets or fresh produce. Convenience stores and fast-food outlets are often more accessible than full-service groceries, reinforcing diets high in processed foods. In contrast, urban residents, despite facing their own challenges, are more likely to have access to diverse food retail options and community-based nutrition initiatives.

Opportunities for physical activity are likewise constrained. Rural residents may live far from recreational facilities, gyms, or safe walking trails. Harsh weather and long commuting distances add further obstacles. While open space is abundant, the infrastructure to support active lifestyles is often lacking, unlike in cities where sidewalks, public parks, and transit encourage movement.

Cultural and economic factors also play roles. Higher poverty rates, lower educational attainment, and employment in physically demanding but low-paying jobs contribute to stress, fatigue, and reliance on calorie-dense, inexpensive food. These conditions create environments where obesity risk is almost unavoidable.

The health consequences are stark: rural adults are more likely to develop obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular disease, conditions that in turn stress already limited healthcare resources. As the rural–urban gap grows, the burden on small hospitals and local clinics intensifies, raising concerns about sustainability. Policy responses are beginning to target these disparities. Federal and state programs have expanded SNAP-Ed nutrition education in rural schools and community centers. Telehealth initiatives are attempting to bring weight-management counseling and diabetes prevention programs to remote areas. There is also growing interest in tailoring interventions to cultural norms in rural communities, recognizing that solutions effective in cities may not translate directly to smaller towns.

By 2025, the rural–urban gap is no longer just a data point; it is a public health fault line. Without targeted interventions, rural America risks falling further behind, with higher rates of obesity feeding into cycles of chronic disease and economic strain. Closing this gap will require sustained investment, innovative delivery models, and recognition that geography is as powerful a determinant of health as biology or behavior.

Conclusion

The latest data from the CDC and NCHS confirm what public health experts have warned for years: obesity in the United States remains a widespread, entrenched epidemic with profound consequences. The 2023 CDC maps show that no state is immune, with more than 20 states now reporting obesity prevalence above 35% and none falling below 25%. NCHS figures from 2021–2023 reinforce the point, highlighting not only the persistence of high prevalence but also the continued rise of severe obesity, particularly among adults and children at the highest health risk.

The disparities exposed by these datasets are equally significant. Racial and socioeconomic inequalities persist, and the rural–urban gap is widening in 2025, reflecting differences in access to healthy food, preventive care, and supportive environments. These divides underline that obesity is not merely a matter of individual responsibility but a systemic challenge requiring structural solutions.

As the U.S. enters 2025, the maps serve as both a warning and a call to action. Reducing obesity prevalence will demand coordinated policies, investment in prevention, and equity-focused strategies that address the environments where Americans live, work, and eat.

References

• Centers for Disease Control and Prevention. (2023). Adult obesity prevalence maps. U.S. Department of Health and Human Services. Retrieved from https://www.cdc.gov/obesity/data-and-statistics/adult-obesity-prevalence-maps.html
• Centers for Disease Control and Prevention, National Center for Health Statistics. (2023). Obesity prevalence among adults and youth: United States, 2021–2023. U.S. Department of Health and Human Services. Retrieved from https://www.cdc.gov/nchs
• U.S. Department of Agriculture, Economic Research Service. (2025). Rural America at a glance: Obesity and health disparities. U.S. Department of Agriculture. Retrieved from https://www.ers.usda.gov