Obesity in North Dakota

North Dakota

Obesity is a complex health condition with biological, economic, environmental, individual and societal causes. Contributing factors to obesity include social and physical environment, genetics, prenatal and early life influences, and behaviors such as poor diet and physical inactivity.

Adults with obesity are at an increased risk of developing serious health conditions, including hypertension, Type 2 diabetes, heart disease and stroke, sleep apnea and breathing problems, some cancers, and mental illnesses like depression and anxiety. 

A 2017 study estimated the annual medical cost of obesity in the United States at nearly $173 billion. 

While body mass index (BMI) can serve as an easily accessible proxy for obesity at the population level, it has its limitations. BMI does not distinguish between excess fat and muscle or bone mass, and the relationship between BMI and body fat is influenced by sex, age and ethnicity. Further, it does not capture the complexity of human health. For example, individuals can have a high BMI and good cardiovascular health, while others can have what is categorized as a “healthy” or “normal” BMI and poor cardiovascular health. The American Medical Association has adopted a new policy in 2023 addressing the shortcomings of BMI as a clinical health measure and suggesting that BMI be used with other valid measures, such as body composition. 

Additionally, weight stigma — also known as weight-based discrimination or weight bias — can have many negative impacts, including mood and anxiety disorders and avoidance of exercise. Weight stigma is pervasive in health care, with reports of medical professionals spending less time with higher-weight patients, engaging in less education and even being reluctant to perform certain procedures on patients with a higher BMI. Weight stigma in the clinical environment can make individuals feel uncomfortable or marginalized, resulting in avoidance of seeking health care.

According to America’s Health Rankings data, the prevalence of obesity is higher among:

• Adults ages 45-64 compared with adults age 65 and older and adults ages 18-44.
• Black and American Indian/Alaska Native adults compared with Asian and white adults.
• Adults with less than a college education compared with college graduates. 
• Adults with an annual household income less than $25,000 compared with those with incomes of $75,000 or more.
• Adults living in nonmetropolitan areas compared with those in metropolitan areas.

Addressing obesity requires a multifaceted approach involving policymakers, state and local governments, health care and child care professionals, schools, families and individuals. The Centers for Disease Control and Prevention (CDC) identifies prevention strategies for the state, local and community levels, as well as tips for living a healthy lifestyle. 

The Community Preventive Services Task Force has compiled a list of resources for community-level interventions that can lower obesity rates by supporting healthy eating and active living in various settings. 

Examples of policy recommendations that address obesity include: 

• Increasing funding for evidence-based obesity prevention programs to reach underserved and high-risk communities.
• Supporting pedestrian safety and accessibility initiatives like Safe Routes to School and Complete Streets, which can encourage walking and outdoor physical activity. 
• Expanding Medicaid coverage for obesity-related health services and increasing eligibility to give more people access to health insurance. 

The Healthy Weight Checklist can be a practical and/or educational resource for maintaining healthy habits. It provides information on eating healthy, getting enough sleep and physical activity, limiting screen time and reducing stress.

Healthy People 2030 has several objectives related to weight and nutrition, including:

• Reducing the proportion of adults with obesity. 
• Reducing consumption of added sugars.
• Increasing the proportion of adults who walk or bike to get places.

Gutin, Iliya. “In BMI We Trust: Reframing the Body Mass Index as a Measure of Health.” Social Theory & Health 16, no. 3 (August 2018): 256–71. https://doi.org/10.1057/s41285-017-0055-0.

Tomiyama, A. Janet, Deborah Carr, Ellen M. Granberg, Brenda Major, Eric Robinson, Angelina R. Sutin, and Alexandra Brewis. “How and Why Weight Stigma Drives the Obesity ‘Epidemic’ and Harms Health.” BMC Medicine 16, no. 1 (December 2018): 123. https://doi.org/10.1186/s12916-018-1116-5.

Tomiyama, A. Janet, J. M. Hunger, J. Nguyen-Cuu, and C. Wells. “Misclassification of Cardiometabolic Health When Using Body Mass Index Categories in NHANES 2005–2012.” International Journal of Obesity 40, no. 5 (May 2016): 883–86. https://doi.org/10.1038/ijo.2016.17.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. “Dietary Guidelines for Americans, 2020-2025.” Washington, D.C.: U.S. Department of Agriculture and U.S. Department of Health and Human Services, December 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

U.S. Department of Health and Human Services. “Physical Activity Guidelines for Americans, 2nd Edition.” Washington, D.C.: U.S. Department of Health and Human Services, 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.

Warren, Molly, Madison West, and Stacy Beck. “The State of Obesity 2023: Better Policies for a Healthier America.” Trust for America’s Health, September 2023. https://www.tfah.org/wp-content/uploads/2023/09/TFAH-2023-ObesityReport-FINAL.pdf.