Trends and projections of overweight and obesity among midlife women in the United States, 1990-2050: A sub‑study of the Global Burden of Disease 2021.

BACKGROUND: Overweight and obesity are rising globally. During perimenopause years, declining estrogen and changes in body composition increase visceral fat and insulin resistance, increasing cardiometabolic risk. OBJECTIVE: To estimate trends in overweight and obesity among U.S. women aged 40-64 years, examine variations by age and state, and project prevalence to 2050. DESIGN: Secondary analysis of publicly available body mass index (BMI) data accessed through the Global Burden of Disease (GBD) Health Data Exchange, using pooled cross-sectional estimates and hierarchical logistic growth modeling.This sub‑study is not part of the official GBD analysis. METHODS: Harmonized data from the GBD Health Data Exchange integrated National Health Interview Survey, National Health and Nutrition Examination Survey (NHANES), and Behavioral Risk Factor Surveillance System microdata (1990-2021) for nonpregnant women aged 40-64 years, with calibration of self-reported BMI to measured NHANES data. BMI categories followed WHO cutoffs. Weighted estimates were age-standardized, and hierarchical logistic models projected state-specific trends to 2050. The pooled sample included 150,842 women, representing about 90 million weighted person-years. All data were de-identified and publicly available; ethics approval and consent were not required. RESULTS: Combined overweight/obesity prevalence increased from 49.2% (95% uncertainty interval (UI) 45.8-52.2; 17.7 million (95% UI 16.5-18.8 million)) in 1990 to 74.2% (95% UI 68.8-79.1; 33.4 million (95% UI 31.0-35.6 million)) in 2021, and projected to reach 83.4% (95% UI 75.5-88.3; 41.7 million (95% UI 37.8-44.2 million)). In 2021, rates ranged from 68.3% in Colorado to 82.8% in Mississippi. CONCLUSION: Overweight and obesity among midlife women have increased sharply with a continuing shift from overweight to obesity. Menopause-specific preventive strategies and policies promoting physical activity and healthy diet are critical to slow future increases.