Obesity is on the rise, reaching levels of severity we are ill-equipped to manage

In an age dominated by news about revolutionary weight loss medications, a far more sobering reality is unfolding beneath the surface: the dramatic and escalating crisis of severe obesity in America.

First, it is crucial to note that obesity is a chronic disease, as recognized by major health organizations. It is currently diagnosed using the Body Mass Index (BMI), which is calculated from height and weight. However, the BMI is an imperfect tool. It was developed primarily by studying European body types and often fails to account for the diverse physiques of different ethnic backgrounds, such as the generally smaller stature of Asian bodies or the greater muscle mass found in some other ethnic groups such as African Americans.

While flawed, the BMI provides a standardized, if general, reference point: Normal: 18.5 to 24.9; Overweight: 25.0 to 29.9; Obesity Class 1: 30.0 to 34.9; Obesity Class 2: 35.0 to 39.9; Obesity Class 3 (Severe): 40.0 and above.

What should truly alarm us is the dramatic rise in the most severe categories of the disease. Class 3 obesity, once rare, is now shockingly common. The Centers for Disease Control and Prevention (CDC-P) reports that 9.2 percent of American adults are now living with Class 3 obesity, and this proportion continues to climb. Furthermore, new, extreme categories are emerging: Obesity Class 4: BMI of 50.0 to 59.9; Obesity Class 5 (or “Super Obesity”): BMI of 60.0 and above.

Data from the National Health and Nutrition Examination Survey (NHANES) reveals that approximately one in 270 Americans now has a BMI of 60 or higher—a category that barely existed before the early 2000s. This unprecedented severity rings an immediate alarm because Class 3 obesity is strongly associated with debilitating co-morbidities like Type 2 diabetes, obstructive sleep apnea, and non-alcoholic fatty liver disease—all conditions that severely diminish both the quality and quantity of life. 

This health crisis is compounded by systemic issues within the healthcare system. Patients with severe obesity face significant barriers, including weight stigma that translates into substandard care. Many facilities lack appropriate equipment, such as reinforced exam tables, wider waiting room chairs, or CT and MRI scanners that can accommodate these patients. This combination of internalized stigma and external barriers delays preventive and diagnostic care. Individuals facing prejudice and physical discomfort may avoid the medical system altogether, placing their health in extreme jeopardy.

In this environment, new therapeutic options offer a genuine lifeline. The advent of new GLP-1 receptor agonist medications (the “weight loss shots”) allows patients to achieve significant, sustained weight loss, with studies showing an average of 15-23 percent total body weight reduction, and some patients reaching 30 percent. This level of loss is indeed life-altering, resulting in the reduction or improvement of Type 2 diabetes, sleep apnea and fatty liver disease.

However, three major obstacles remain. Acquisition: Many patients struggle to gain consistent access to the medications due to supply shortages. Cost: The high cost of these drugs creates a significant financial barrier without robust insurance coverage. Therapeutic Ceiling: Despite their efficacy, these drugs have a limit to their potential. This reality is renewing clinical interest in bariatric surgery - the most effective and durable treatment for severe obesity, capable of achieving greater and more permanent weight loss for many patients.

Obesity is on the rise, reaching levels of severity we are ill-equipped to manage. As a society and a healthcare system, we are simply not ready for the scale of this escalating crisis.

Dr. Veita Bland is a board-certified Greensboro physician and hypertension specialist. Dr. Bland’s radio show, “It’s a Matter of Your Health,” can be heard live on Wednesdays, 5:30 p.m. on N.C. A&T State University’s WNAA, 90.1 FM. Listeners may call in and ask questions. The show is replayed on Sirius 142 at 5 p.m. on Wed. Email Dr. Bland at ideas@blandclinicpa.com.