Trends and Sex-Specific Rates of Obesity and Severe Obesity in US Hospitalized Adults, 2012-2021

Rising national obesity rates may increase clinical and operational challenges for hospitals. However, trends and distributions in obesity and severe obesity among hospitalized adults are incompletely described.

To examine trends in hospital-coded obesity and severe obesity rates among adults, by year, sex, age-groups, race/ethnicity, and US Census divisions.

Cross-sectional analyses of patients with hospital-coded obesity and severe obesity, using US National Inpatient Sample data, from 2012 through 2021. Rates were stratified by demographic group, and trends were calculated using logistic regression models, and prevalence ratios (PR) were used to compare male-to-female rates.

Hospitalized adults with obesity (body mass index [BMI] ≥ 30 kg/m²) or severe obesity (BMI ≥ 40 kg/m²) codes excluding pregnancy-related hospitalizations.

Hospital-coded obesity and severe obesity rate per year, annual average change, absolute percent change, and PR of male-to-female obesity and severe obesity.

From 2012 through 2021, among 51,669,013 hospitalizations, 16.9% (n = 8,733,196) had hospital-coded obesity and 9.0% (n = 4,638,219) had severe obesity. Obesity rates increased from 13.0% to 21.4% (0.88% per year [95% CI, 0.81-0.95%], P < 0.001) while severe obesity rates increased from 6.6% to 11.2% (0.48% per year [95% CI, 0.43-0.53%], P < 0.001). Compared to other female age-groups and all male age-groups, females aged 30-49 years had the largest annual increase in obesity (1.25% [95% CI, 1.09-1.41%], P < 0.01) and severe obesity (0.95% [95% CI, 0.84-1.05%], P < 0.01). When compared across age and racial/ethnic groups, the largest sex differences in obesity rates were observed among adults aged 18-29 years, particularly of White (weighted average PR, 0.49 [95% CI, 0.48-0.49]) and Black (weighted average PR, 0.43 [95% CI, 0.43-0.44]) race.

From 2012 through 2021, US hospital-coded obesity and severe obesity rates increased and revealed sex differences, underscoring the need for hospitals to adapt care delivery and operations.