A decade-long national survey reveals a troubling trend: More American teens are becoming obese as motivation to lose weight wanes, raising urgent questions about changes and disparities in youth health behaviors.
Study: Trends in obesity, overweight, and weight loss efforts among United States high school students.. Image Credit: Sergio Arjona/Shutterstock.com
Rising obesity rates among American teens pose a growing public health concern, according to a new study published in Ochsner Journal.
One in five teens in America is affected by obesity
Approximately 22% of American teens are obese, which affects their mental and physical health. Adverse health outcomes such as type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, depression, and low self-esteem are commonly associated with obesity and may extend into adulthood.
The trajectory of obesity and weight loss efforts in adolescents has not been fully evaluated, which motivated the current study.
Large US survey reveals teen health behaviors
Data for this cross-sectional study were taken from the Youth Risk Behavior Survey (YRBS), a biennial school-based survey conducted by the US Centers for Disease Control and Prevention from 2013 to 2023. The survey polls a nationally representative sample of students in grades 9 through 12 attending public and private high schools across the United States. Participants self-report a range of health-related behaviors and experiences that can contribute to major health risks, including injury and death.
For this analysis, researchers examined trends in obesity, overweight status, and weight loss efforts across multiple survey cycles, using standardized body mass index (BMI) percentage definitions by age and sex. Sample size varied by survey year, ranging from 13,324 participants in 2013 to 17,814 in 2023. Subgroup analyzes were conducted based on gender, race/ethnicity, and grade level to better understand differences in the adolescent population.
Despite increase in obesity, weight loss efforts have decreased
The findings show that obesity among adolescents is projected to increase from 13.7% in 2013 to 15.9% in 2023, showing a modest but statistically significant increasing trend over the decade. Rates rose steadily during the study period, reaching a peak of 16.3% in 2021 before falling slightly in the latest data.
When examined by gender, men had consistently higher rates of obesity than women. Among men, prevalence increased from 16.6% in 2013 to a peak of 18.9% in 2019, then decreased slightly to 18.2% in 2023. In contrast, women’s trends were more variable, with rates fluctuating over time, falling to a low of 10.8% in 2015 and later reaching a peak of 13.7% in 2021.
Racial disparities reveal higher risk among minority teens
By ethnicity, Black and Hispanic/Latino adolescents were most likely to be obese (reaching approximately 20%–21% in 2021), while Asians had the lowest rates but are still increasing (11% in 2023, up from 5.6% in 2013). This is consistent with previous research suggesting that socioeconomic and environmental factors, such as limited access to healthy foods, low health literacy, and low physical activity, may have a higher risk of obesity in these groups.
To address these disparities, the authors suggest that policy efforts could focus on reducing the availability and proximity of fast-food outlets near schools while promoting the development of grocery stores, particularly in disadvantaged communities. They also highlight the importance of improving public transportation access and encouraging healthy exercise habits among teens.
Along with rising rates of obesity, the proportion of overweight adolescents is expected to decline from 16.6% in 2013 to 14.7% in 2023, with the decline being more pronounced among boys. At the same time, fewer adolescents reported trying to lose weight. In 2023, 44.5% said they are attempting to lose weight, down from 47.7% a decade ago and a high of 48.3% in 2019.
This decline was most pronounced among class 10th and 12th students. In contrast, the prevalence of obesity was highest among 11th grade students in 2023, while 9th grade students also saw a significant increase over time.
Social and environmental factors shape obesity risk in adolescents
Among racial and ethnic groups, Hispanic/Latino adolescents consistently reported the highest rates of weight loss attempts, reaching approximately 55% in 2017, while other groups showed less or more variable patterns. While 55% of female students tried to lose weight, this proportion decreased from 62.6% in 2013. only 34.8 % of men attempting to lose weight in 2023 is once again down from 37% seen in 2013. However, the proportion increased between 2015 and 2019, with the authors suggesting that this trend may be related to men seeking greater muscle development and athleticism.
Overall, this is consistent with other recent studies showing that while American teens are becoming more obese and making less weight loss efforts, it is more so among women. According to the authors, this may reflect broader trends, including lower rates of body dissatisfaction and fewer dietary behaviors among women.
The authors also note that gender-dependent differences in weight loss efforts warrant further investigation. They suggest the need for different approaches to teenagers of any gender, to help them appreciate their bodies despite current fashion. Importantly, teens with such a healthy outlook are more likely to adopt healthy long-term weight-loss strategies.
Cultural, structural, and preventive health care can be integrated to help reduce disparities in health outcomes between race and ethnicity.
Limitations of the study
While the study used a nationally representative sample, researchers lacked access to individual-level data, limiting the depth of the analysis. Reliance on self-reported measures introduces the possibility of social acceptability bias.
Furthermore, the cross-sectional design prevents longitudinal follow-up of individuals and does not allow causal inference, leaving room for potential residual confounding. Additionally, the timing of data collection in 2021 was affected by the COVID-19 pandemic, which may have introduced additional variability into the findings.
There is an urgent need to promote healthy behavior among adolescents
Survey data shows that the proportion of adolescents who are obese is high, but overweight is low, and efforts to lose weight are also decreasing. The reasons for these observations should be investigated in further studies. In the meantime, “These findings underscore the need for targeted clinical and public health strategies to reduce rising obesity rates and promote healthy behaviors among US high school students.”
