Nationwide epidemic

Individuals gain excess weight when they consume more energy each day than their bodies need to support their physical activity and basic bodily functions. Adults and children in the U.S. currently consume, on average, more calories each day than they actually need to maintain a healthy weight.1 Consuming small amounts of extra calories on a daily level promotes weight gain over time. The obesity and severe obesity epidemics are continuing to grow, unless we do something to make a difference.2

See where obesity is headed in the US & in each state

Why use BMI as a population health indicator

Among children

The current childhood obesity epidemic has been well-documented, but more research is needed on the long-term risks for children. The CHOICES team predicts that, if nothing is done to change current trends, 57% of today’s children will have obesity at age 35. In addition, we found that excess weight in childhood is highly predictive of adult obesity. This is especially true for children with severe obesity, even at very young ages. We also estimated that 79% of two year-olds with severe obesity will still have obesity by the time they are 35 years old, as will 94% of 19 year-olds with severe obesity. Racial and ethnic disparities in obesity are already present by the age of two and persist into adulthood.3

A framework for action

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. Our methods include:

      • Key partner consultation: Working with key partners & researchers to identify the most promising programs & policies for evaluation
      • U.S. population model: Building a computer model of the U.S. population & projecting Body Mass Index (BMI) changes & health outcomes over time  See details about the model parameters
      • Systematic reviews & meta-analyses: Synthesizing scientific literature to estimate the likely effects of promising obesity prevention interventions on BMI & physical activity
      • Cost-effectiveness analysis: Integrating information on the economic costs & health effects of interventions, utilizing a structured & transparent process  |  Learn more about our modeled outcomes here
      • Health equity lens: Projecting the impact of effective intervention strategies on population health and health equity  |  Learn more about our methods for projecting health equity impacts

      1. Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, Swinburn BA. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011 Aug 27;378(9793):826-37. doi: 10.1016/S0140-6736(11)60812-X
      2. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax CN, Long MW, Gortmaker SL. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019;381:2440-50. doi: 10.1056/NEJMsa1909301
      3. Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. N Engl J Med. 2017 Nov 30;377(22):2145-2153. doi: 10.1056/NEJMoa1703860

Last updated:  November 1, 2023