A new scientific statement from the American Heart Association published in Circulation highlights that obstacles to preventing and treating obesity are more likely to affect people in lower-income communities. The statement, "Socioeconomic and Structural Barriers to Addressing Obesity in Communities," emphasizes multilevel barriers with a focus on social drivers of health, societal culture, and biases that may perpetuate harmful attitudes related to body weight.
Obesity affects more than one-third of all people in the U.S., both children and adults, across all socioeconomic backgrounds. While genetic factors can contribute, previous studies have found genetic predisposition is not the primary driver of high obesity rates. People in lower-income communities are disproportionately impacted by obesity and related health conditions such as high blood pressure, cardiovascular disease and Type 2 diabetes.
"The latest research indicates that people with fewer resources are more likely to develop obesity because of a combination of factors that influence their everyday, lived experiences," said Fatima Cody Stanford, M.D., M.P.H., M.P.A., M.B.A., FAHA, vice chair of the scientific statement writing group. "We must recognize that obesity is not a personal choice. It is highly influenced by multiple social and environmental factors."
Risk and prevalence of obesity are highest among non-Hispanic Black children and adults, low-income families, people living in rural areas and adults with a high school education or less. Living in a neighborhood where it is safe to exercise outdoors and being able to access affordable, healthy foods are linked to a reduced risk of developing obesity. Lifestyle and environmental factors, including shift work, noise pollution and nighttime light exposure, can also increase this risk by interfering with circadian rhythms. A 2025 American Heart Association scientific statement about circadian health highlighted that disruptions to the body's internal clock are strongly associated with an increased risk of obesity.
Despite greater availability of treatment options for obesity, including weight management programs and medications such as GLP-1 receptor agonists, significant challenges remain. Weight stigma perpetuates harmful attitudes, with previous research finding that between 20% and 90% of people have negative opinions about people with excess weight. These perceptions may contribute to poor mental health and unhealthy eating behaviors, and experiences of weight stigma can make individuals more likely to avoid seeking care.
Individuals with obesity face physical and financial challenges in the health care system. Physical barriers, such as medical equipment and small spaces, often discourage people from seeking medical care. Other barriers include the cost of co-pays, transportation challenges and limitations in health insurance coverage. Time is an often-overlooked barrier that directly affects an individual's ability to participate in obesity prevention and treatment programs.
Effective obesity prevention and treatment programs require collaboration among government, health care professionals, community organizations and individuals. Community-based interventions, such as faith-based and cultural programs, are effective and may improve outcomes across different populations. However, the statement notes that available metrics for gauging intervention success, such as body mass index (BMI), do not accurately reflect body fat or overall health.
Health care professionals can make a significant impact by initiating culturally sensitive discussions with patients, offering referrals to local resources and providing personalized care. Educating health care professionals about biases may also help reduce weight stigma in health care settings. "The most effective weight management programs are culturally and socially informed and involve stakeholders from across all levels of society working together," Stanford said. "Improving the affordability of fruits and vegetables specific to cultural diets, increasing access to healthy weight management programs, promoting physical activity and advocating for public policies such as insurance coverage of obesity medications, are key strategies that could have large societal impacts."
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association's Council on Lifestyle and Cardiometabolic Health, the Council on Cardiovascular and Stroke Nursing, the Council on Clinical Cardiology and the Council on Quality of Care and Outcomes Research. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. The Association receives more than 85% of its revenue from sources other than corporations, with overall financial information available here.
