Trends and Disparities in Clinician Diagnosis of Overweight and Obesity

While obesity is a highly visible condition, adiposity often goes undetected by individuals and community members, especially as larger body sizes become more common and recalibrate expectations. However, there are no contemporary data about such underdiagnosis.

To examine trends in clinician diagnoses of overweight or obesity by race, ethnicity, and socioeconomic disadvantage.

Repeated cross-sectional study.

Noninstitutionalized adults age 20 or older who responded to the 2011-2018 National Health and Nutrition Examination Survey (NHANES).

Clinician diagnosis of overweight or obesity was defined as affirming the question, "Has a doctor or health professional ever told you that you were overweight?" Weight-related perception and desire to lose weight were also assessed.

We included 8311 adults with obesity (weighted, 356,426,842). From 2011 to 2018, the proportion of participants receiving a clinician diagnosis of overweight or obesity increased from 67.5 to 73.0% (p = 0.019). In multivariable logistic regression, Black people with obesity were less likely to receive a diagnosis (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.48-0.75, p < 0.001) than non-Hispanic White people, while citizens (OR, 1.73; 95% CI, 1.22-2.45; p < 0.001) and college graduates (OR, 2.17; 95% CI, 1.55-3.05; p < 0.001) were more likely to be diagnosed than non-citizens and non-high school graduates. Hypertension (OR, 1.40; 95% CI, 1.12-1.75) and diabetes (OR, 2.52; 95% CI, 1.86-3.49) were also associated with a greater likelihood of a diagnosis. People with a diagnosis were more likely to perceive themselves as overweight (94.6% vs. 75.2%, p < 0.001) and preferred to weigh less rather than stay at the same weight (96.4% vs. 83.7%, p < 0.001).

While rates of overweight and obesity diagnoses improved over time, almost a third of people with obesity remain undiagnosed, with higher rates among Black Americans, non-citizens, non-high school graduates, sicker patients, and other marginalized groups.