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When Trust for America’s Health (TFAH) released its latest State of Obesity 2025 report, the news for West Virginia was not surprising. This state once again had the highest percentage of overweight adults in the nation.
The report also explored what’s driving those grim health statistics so high – and some of the biggest risk factors have nothing to do with food.
Maria Young caught up with TFAH President and CEO Dr. Nadine Gracia to find out what’s behind this alarming trend and what can be done.
This transcript has been edited for brevity and clarity.
Young: If you would, summarize the findings of this year’s report. There was some good news, but also some areas for concern.
Gracia: So this year’s State of Obesity report shows that in the latest national data that are available, the rate of adult obesity is 40.3%, which is slightly down from the previous survey of 41.9% but it’s still alarmingly high. Where we saw what may look like a positive step in terms of progress are that 19 states have adult obesity rates at or above 35% and that’s a decrease from 23 states that had that obesity level at or above 35% the previous year. That’s the first time there has been a decrease in the number of states at that level since this data set began in 2011.
Young: So that’s great news nationwide, and for those states that have managed to show a decline, but for, unfortunately, West Virginia, we’ve been at or near the top of this kind of data for quite some time now. Can you talk to me a little bit about what the figures show about West Virginia?
Gracia: Yes, so specifically in West Virginia, the rate of adult obesity in 2024 is 41.4%. That is above the national rate, and it continues to be slightly increased from the previous year. And as you noted, West Virginia has had higher rates of adult obesity over the years, and we’ve actually seen that it’s not only in terms of obesity, but also other related chronic diseases like diabetes and high blood pressure.
We also see that in terms of children, the rate of obesity for children and youth in the ages of six to 17 – and this is older data from 2022 to 2023 – that the rate is about 24.1% and that is the second highest in the nation, in that year.
And I’ll note that obesity really is an important public health issue. It’s impacting all states, and so even for states that have lower rates, it’s still showing that obesity is an important public issue that really needs to be addressed across the nation.
Young: I looked at some of the data, not just about West Virginia, but nationwide. For example, Colorado has a pretty low obesity rate. And if you look at West Virginia and Colorado, we have a lot of outdoor activities. We have a lot of mountainous terrain. We have a lot of hiking trails. We have a lot of white water rafting, and a pretty big emphasis on people getting out and about. So I’m wondering, what is it that Colorado is doing, or what is it that states are doing that are successful and effective in combating these higher numbers? What are those states doing that West Virginia isn’t?
Even our governor has put an emphasis on this. He’s trying to lose a little weight himself, and he’s been emphasizing the Mountaineer Mile, and putting up hiking trails and having press conferences at locations where people can go out and be active. So I feel like the state’s tried to do some things and tried to put a focus on this. But what are we not doing that Colorado is doing? And what can a state like ours do to combat these figures?
Gracia: Yeah, that’s a really important question to ask. And I’ll say that even as we see states that have the lowest levels of adult obesity, you’ve pointed to Colorado and to other states that have those lower rates, one of the things I’ll also point out is that in this year’s report, this is the first time in the data set that we’re also seeing that no state had an adult obesity rate below 25%. So even with Colorado having 25% previously, we’ve had states even lower than 25%, so these are movements that we’re seeing in terms of what’s happening in the states – that we’re not even seeing even some of the lower rates that we had in prior years.
Obesity in and of itself, it’s a complex chronic disease, and it’s important to know that as we address obesity, it really does involve more than solely individual behavior. There are structural, there are systemic factors that contribute to obesity. And we know some of those factors, for example, are rooted in economics and environmental factors.
So whether that’s issues like food insecurity or households that have lower income and higher rates of poverty, housing instability, lack of access to health care, those are some of the types of systemic barriers that we can also see to healthy eating and access to healthy and affordable nutrition that can drive the different types of rates of obesity that we may see across populations.
When you look at what’s happening in the state of West Virginia, what we see, for example, is that there is a higher rate than the national average in terms of poverty in the nation, and that’s both adult and child poverty. And you pointed out, in particular, the governor launching the Mountaineer Mile program, which is important, a great way to encourage residents of the state to engage in physical activity.
When we look at actually the built environment and kind of the community conditions and structures to promote walking and biking, the state has a very low percentage of children who have access, for example, to sidewalks or walking paths, parks and playgrounds in their neighborhoods, and that’s a way to get that kind of physical activity and active transportation that’s also helpful in addressing obesity and chronic disease.
And then there’s also high rates of food insecurity, meaning households that have either limited or uncertain availability of foods that are nutritionally adequate and safe foods. And so those are some opportunities. I will say conversely, though, there’s really high and strong participation in the SNAP program and in the WIC program. Those are important nutrition support programs, also demonstrating that there’s a need for those types of programs.
Young: You mentioned food insecurity. And on the surface, it would seem that that would fly in the face of an issue like obesity, because if you don’t have enough food, logically speaking, how can you have a weight problem? How can you be eating too much if you don’t have enough to begin with? But that’s not really quite how it plays out, is it?
Gracia: That’s right, it’s not how it plays out actually. If you’ve got a family, a household, where they’re just struggling to make ends meet and put food on the table, healthy, nutritious foods are often more expensive. And the food that is available that is lower cost, it may have higher calories. So that it helps you to feel full, and feel like you’re addressing hunger, but at the same time, they’re less nutritious, and actually therefore can increase the risk of being overweight or having obesity.
So it is a paradox in that if you have food insecurity, it actually can place you at higher risk of obesity, similarly to poverty. Poverty is a strong indicator for overweight and obesity for some similar reasons, that if you have lower income, don’t have access to healthy, affordable foods, are in more under-resourced settings, that what may be available to you, while it may be high in calories, it likely is less nutritious, and so therefore also increases the risk of obesity and other chronic diseases.
Young: It’s really very interesting, because a lot of folks, I think, follow or certainly acknowledge, a stigma that comes from having a weight problem or obesity. They look at the person as perhaps having a lack of self control or lack of discipline, not caring enough about themselves, making a choice not to take good care of themselves. And what you’re suggesting, and what these figures suggest, is that there’s a lot more to it than a simple lack of discipline. Is that a fair statement?
Gracia: That is a fair statement, and it is true that there is stigma that exists around weight and discrimination that can happen because of weight. It can happen even in job settings and educational settings, even in healthcare. But what we know from the research about obesity, is that it really is a complex condition, and multiple factors influence obesity.
It’s more than individual behavior. It’s: Do you live in a neighborhood where you can access healthy and nutritious foods? And are those healthy and nutritious foods, like fruits and vegetables? Are they affordable? Do you live in an area where you have walking paths, biking paths, trails, rec centers, so that you can easily engage in physical activity? Or is safety a concern because you may not have that type of structure and design of your community? Or families that are just working multiple jobs to try to make ends meet that there’s not even a time to be able to engage in regular physical activity.
And so it’s really important to understand those types of root causes and drivers of obesity that goes beyond individuals’ control. And when you also look at the trends of obesity in the nation, it’s impacting all population groups. It has been, over decades. And so when you see something that is increasing like that across the population over time that’s really a system level population issue.
And it’s important that we address our food system and our food environment such that it’s a healthy food environment that everyone has access to. And that we also think about the design of our neighborhoods and communities, that it fosters that ability to be able to engage in physical activity, and that we also think about those other root causes, like poverty and housing stability, all of those issues when you’ve got to make these decisions about whether to put food on the table or make sure you’ve got a roof over your head and not paying the bills. Those are challenging things when you’ve got a limited income.
And so it’s really important that we not stigmatize individuals who have obesity, but understand that it’s a chronic condition, but that there are also programs and an opportunity to be able to help prevent and reduce and treat and manage obesity.
Young: There are so many specific challenges that might be facing someone who is living at or below the poverty level, who’s working one, two, maybe three jobs, trying to raise a family, trying to keep a roof over their heads, and a lot of really hard challenges in that kind of a lifestyle. And then to add lack of availability of fresh, affordable food and healthy, nutritious food. What can a person in that kind of a circumstance do? Is there one change that someone in that circumstance could make that might, long term, make a difference for them and for their families?
Gracia: Yeah, I think it’s important that we acknowledge that there are these broader systemic factors that contribute to obesity and then also really help to empower individuals and families to be able to have healthy choices. There’s movement now with regards to developing a front of pack label on packaged foods to help better inform consumers in a way that’s understandable, right, so that you know whether the food that you’re saying, is it high in sugar, or is it added sugar, or is it high in salt or other, what we call nutrients of concern. It’s trying to get movement. And consulting with your health care provider, if you have a health care provider, to just talk about what types of steps and activities that you can take.
The US Department of Agriculture has the My Plate Program, which can help guide families about understanding portions and knowing how to really create that kind of a healthy diet for you and your family. And then also for physical activity, which doesn’t have to mean you’ve got to join a gym, but even any kind of movement that just is helping you to be physically active is really helpful with regards to really gearing towards a healthy weight. And especially when we talk about obesity, it’s not size, it’s not a person’s size or how they look, it’s about assuring that they have a healthy weight, so that they then have a lower risk of these types of other chronic conditions like diabetes or high blood pressure or certain types of cancer.
Young: So as you might imagine, in a state with a fairly high poverty level, and a lot of folks on Medicare, Medicaid, the state itself has a lot of challenges, right? And just in thinking about the state budget and how all those dollars get divided, there’s an awful lot of priorities that are competing, and I’m not sure playgrounds and sidewalks rise to the top in that environment. Is there one thing in particular that you can think of that the state can do to tackle, just begin to chip away, at this kind of an issue?
Gracia: Well, I think importantly, investing in public health and prevention is so important. You know, the state and local health departments, they are really at the front lines of working with communities, in partnership with communities, to be able to provide and offer the types of programs and supports to communities to help address high rates of obesity and other chronic diseases.
What we know, though, is that public health has been chronically underfunded for many decades, and this is where, yes, the state public health funding is important. It’s also important to use your voice to advocate as well for that federal funding, because we know that states rely as well on federal funding to help support providing resources that are needed in the state.
And while we talked about where there’s that positive step, in terms of the number of states that have adult obesity rates that are at or above 35%, that decrease, that progress, is at risk and is vulnerable, because there are these federal funding cuts that have already taken place, that are proposed to take and also being proposed, as well as workforce cuts. And that can put that progress at risk.
And what we know is, for example, if you look at the CDC, 80% of CDC domestic budget goes to fund states and local communities and community based organizations and academic partners and others. And so it’s really important that we invest in public health and prevention because there’s a return on investment. We see improved health and we see reduced costs in terms of health care spending when you actually invest in public health and prevention.
And we know there are numerous priorities that states have. Making that investment in public health and prevention really has a strong return on investment in improving the health of your residents and helping to control those rising health care costs that you see due to chronic diseases.