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Trends in Diagnosing Obesity: The CALOR Study
Deborah B Horn1, Eva Lesén2, Christen M Gray3
1Center for Obesity Medicine and Metabolic Performance, Departments of Medicine and Surgery, UT McGovern Medical School, Houston, Texas, USA.
Obesity (Silver Spring, Md.)
|July 18, 2026
Summary
Obesity is underdiagnosed in individuals with elevated BMI, leading to a higher prevalence of related diseases like type 2 diabetes and kidney disease in the US and Japan.
Area of Science:
- Medical research
- Public health
- Epidemiology
Background:
- Elevated Body Mass Index (BMI) is a significant global health concern.
- Obesity diagnosis rates vary across different populations and healthcare systems.
- Understanding the characteristics of individuals with elevated BMI is crucial for effective health management.
Purpose of the Study:
- To describe characteristics of individuals with elevated BMI, differentiating between those with and without an obesity diagnosis.
- To analyze trends in obesity diagnosis and associated health conditions over time.
- To compare the prevalence of interrelated diseases in individuals with and without a recorded obesity diagnosis.
Main Methods:
- Analysis of deidentified health data from adults in the United States (BMI ≥ 30 kg/m²) and Japan (BMI ≥ 25 kg/m²) between 2016 and 2024.
- Stratification of individuals based on the presence or absence of a prior obesity diagnosis at the index date.
- Description of patient characteristics and comorbidities, including type 2 diabetes, chronic kidney disease, and heart failure.
Main Results:
- In the US, 70.1% of individuals with elevated BMI had an obesity diagnosis. Those with a diagnosis had higher rates of type 2 diabetes (49.3%), chronic kidney disease (32.9%), and heart failure (23.3%) compared to those without (29.9%, 18.8%, 9.8% respectively).
- In Japan, only 2.3% had an obesity diagnosis. Similar to the US, those with a diagnosis showed higher comorbidity rates for type 2 diabetes (42.2% vs. 25.9%) and chronic kidney disease (14.3% vs. 8.6%).
- In the US, the burden of interrelated diseases was higher for individuals diagnosed more recently (2024) compared to those diagnosed earlier (2016-2020).
Conclusions:
- A significant underdiagnosis of obesity exists among individuals with elevated BMI in both the United States and Japan.
- Elevated BMI, particularly when undiagnosed as obesity, is associated with a high prevalence of serious interrelated diseases.
- Healthcare systems need to improve obesity identification and management to mitigate the burden of associated chronic conditions.
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