A nationwide study of 54 million adults reveals obesity is rising fastest among disadvantaged communities, with widening inequalities after the COVID-19 pandemic highlighting the urgent need for prevention that tackles the root social causes of obesity.
Study: Whole-population trends in obesity across dimensions of inequality in England, 2019–25: a retrospective, longitudinal cohort study of 54 million adults. Image credit: Halfpoint/Shutterstock.com
A recent Lancet Diabetes and Endocrinology study examined current trends in obesity prevalence in England and assessed variation by sex, age, ethnicity, geographic location, and socioeconomic background.
Social inequalities continue driving England's obesity epidemic
Obesity is a complex medical condition defined by the excessive accumulation of body fat to a degree that impairs health and increases the risk of numerous chronic diseases. Over recent decades, the prevalence of obesity has risen dramatically worldwide, posing a major public health crisis. In many high-income countries, obesity rates have more than doubled since 1990, and current projections suggest that by 2050, one-third of adults globally may be living with obesity.
Despite decades of effort, public health interventions have so far been unable to curb the obesity epidemic, as environments that promote unhealthy weight gain persist and widen health inequalities. Pharmacological treatments exist, but they only address obesity after it occurs, are costly for broad application, and do not tackle root causes.
Weight regain after stopping medication is common, underscoring the need for prevention strategies that address social determinants and genetic risk. Yet, the roles of intersecting inequalities in shaping adult obesity trends, particularly after the COVID-19 pandemic, remain poorly understood. The pandemic exposed and amplified pre-existing inequalities and may have contributed to changing obesity patterns. Building stronger evidence is crucial for effective monitoring, targeted interventions, and prevention for vulnerable groups.
Electronic health records tracked obesity across 54 million adults
The current study utilized linked electronic health records from the NHS England Secure Data Environment to provide a detailed analysis of obesity trends in over 54 million adults in England from 2019 to 2025. It examined obesity trends during and after the COVID-19 pandemic and explored variations by demographic and socioeconomic factors. The researchers later compared their prevalence estimates with national survey data to assess their validity.
Adults aged 18–99 years, alive and registered with a general practice in England from Nov 1, 2019, were included. Obesity was defined as BMI ≥30 kg/m² or a clinician diagnosis, based on routine primary care records. Prevalent obesity at study start was identified by any record of obesity in the previous 10 years. Pregnant and postpartum women were excluded to avoid misclassifying pregnancy-related weight gain.
Key clinical measures and chronic conditions were recorded for each individual near the time of first recorded obesity diagnosis. For those with only a clinician diagnosis, BMI data from five years prior to one year after diagnosis were also included.
Socioeconomic status was determined by the 2019 Index of Multiple Deprivation in area-based quintiles. Ethnicity was grouped into Asian, Black, Mixed/other, or White based on the most recent healthcare record.
Obesity burden increased fastest among disadvantaged communities
Between November 2019 and April 2025, 54.9 million people in the NHS England Secure Data Environment met the study criteria, contributing more than 270 million person-years of follow-up. During this period, 4.1 million people were newly recorded as having obesity. Women accounted for a slightly higher proportion of diagnoses than men, the median age at diagnosis was 43 years, and the average BMI was 33.4 kg/m². Men generally had more chronic diseases at diagnosis, likely reflecting their older age, while depression was more common among women.
Overall, recorded obesity was diagnosed at a rate of 22 per 1,000 person-years, increasing by 4% between 2019 and 2025. The largest increases occurred among women, particularly Black women, and adults aged 20–39 years. Recorded obesity diagnoses temporarily declined during the COVID-19 pandemic, likely because reduced healthcare access limited opportunities for diagnosis rather than reflecting a genuine fall in obesity, before rebounding as healthcare services recovered.
The researchers also found clear socioeconomic and ethnic inequalities. Recorded obesity incidence was 35% higher among the most deprived groups than the least deprived, with the greatest deprivation gap observed among Asian individuals and the smallest among Black individuals. Non-White groups had obesity recorded up to 14 years earlier than White groups. Women were diagnosed more frequently, and at younger ages than men, and deprivation-related differences were particularly pronounced among Asian women, where those living in the most deprived areas were almost twice as likely to receive an obesity diagnosis as those in the least deprived areas. The researchers found no evidence of a distinct increase in obesity incidence around the typical age of menopause.
By April 2025, recorded obesity prevalence had risen from 26.3% to 30.3%. However, this overall figure masked striking disparities across population groups, ranging from 4.3% in young, least deprived White men to 66.1% in older, most deprived Black women. Socioeconomic gradients were evident across all ethnic groups, though they were steepest among Asian individuals and smallest among Black individuals.
Obesity prevalence was generally highest among adults aged 70–79 years, but Black women aged 60–69 years had the highest prevalence overall. Among Black women older than 40 years, prevalence exceeded 40% regardless of deprivation. Caribbean and Black African groups also had particularly high prevalence, while Chinese individuals had the lowest. Applying ethnicity-specific BMI thresholds increased prevalence estimates further, often exceeding 50% among Black women over 40 years of age.
Large geographical differences were also evident. By April 2025, regional obesity prevalence ranged from 8.5% to 48.1%, with disparities widening over time. Nearly every region experienced increasing obesity prevalence, but the largest rises occurred in the least affluent areas, where obesity was already most common. Regions with lower GDP per capita consistently had higher obesity prevalence.
BMI measurements were available for approximately 40% of the study population, with the lowest coverage among younger adults and the highest among those aged 60–79 years. Although obesity was identified from routine healthcare records rather than direct measurements across the entire population, prevalence estimates closely matched national survey findings.
While people who visited primary care more frequently were more likely to have obesity recorded, the observed differences by age, ethnicity, sex, and socioeconomic status remained consistent regardless of healthcare visit frequency, suggesting the overall patterns were robust. The authors note that obesity prevalence may still be underestimated, particularly among younger adults who have less contact with healthcare services.
Targeted prevention could help narrow widening obesity inequalities
The current study revealed that obesity-related inequalities are widening, especially since the COVID-19 pandemic. Tackling these growing disparities will require collaborative efforts from policymakers, communities, and healthcare providers. By implementing evidence-based policies and targeted support for at-risk groups, future interventions can reduce health inequalities.
The authors argue that addressing the social and structural determinants of obesity, alongside clinical treatment, will be essential to reducing these widening disparities and improving long-term population health.
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