A new American Heart Association scientific statement published in Circulation reveals that obstacles to preventing and treating obesity are more likely to affect people in lower-income communities, highlighting the need for more resources and collaboration. The statement, "Socioeconomic and Structural Barriers to Addressing Obesity in Communities," emphasizes that obesity affects more than one-third of all people in the U.S., both children and adults, across all socioeconomic backgrounds, with prevalence highest among non-Hispanic Black children and adults, low-income families, people living in rural areas, and adults with a high school education or less.
According to the statement, barriers include limited access to healthy foods, lack of time to prepare meals and engage in regular physical activity, financial constraints including lack of health insurance, and stigma around body weight. Fatima Cody Stanford, M.D., M.P.H., M.P.A., M.B.A., FAHA, vice chair of the writing group, stated, "We must recognize that obesity is not a personal choice. It is highly influenced by multiple social and environmental factors. This is a critical component for addressing the obesity epidemic in the U.S. and obesity-related health conditions including cardiovascular disease." The statement notes that while genetic factors can contribute, previous studies have found genetic predisposition is not the primary driver of high obesity rates.
Lifestyle and environmental factors, including shift work, noise pollution, and nighttime light exposure, can increase risk by interfering with circadian rhythms and affecting sleep. A 2025 American Heart Association scientific statement about circadian health highlighted that disruptions to the body's internal clock are strongly associated with increased risk of obesity, Type 2 diabetes, high blood pressure, and cardiovascular disease. People in lower-income communities are disproportionately impacted by obesity and related conditions such as high blood pressure, cardiovascular disease, and Type 2 diabetes.
Despite greater availability of treatment options, including weight management programs and medications such as GLP-1 receptor agonists, significant challenges remain. Weight stigma perpetuates harmful attitudes, with previous research finding that between 20% and 90% of people have negative opinions about people with excess weight. These perceptions may contribute to poor mental health, unhealthy eating behaviors, and avoidance of health care. Physical barriers, such as medical equipment and small spaces, often discourage people with obesity from seeking care, while financial barriers include costs of co-pays, transportation challenges, and limitations in health insurance coverage.
Time is an often-overlooked barrier, as limited time affects ability to participate in prevention and treatment programs. Work and caregiver responsibilities are often prioritized to maintain financial and household stability, reducing time available for healthy lifestyle behaviors. The statement calls for effective obesity prevention and treatment programs that include collaboration among government, health care professionals, community organizations, and individuals. Community-based interventions, such as faith-based and cultural programs, are effective and may improve outcomes across different populations.
However, the statement notes that available metrics for gauging intervention success, such as body mass index (BMI), do not accurately reflect body fat or overall health. The development of more clinically meaningful metrics will be necessary to advance efforts in reducing obesity rates. Health care professionals can make a significant impact by initiating culturally sensitive discussions with patients, offering referrals to local resources, and providing personalized care. Educating health care professionals about biases may also help reduce weight stigma in health care settings.
Stanford emphasized, "The most effective weight management programs are culturally and socially informed and involve stakeholders from across all levels of society working together to support people at risk for or living with obesity. Improving the affordability of fruits and vegetables specific to cultural diets, increasing access to healthy weight management programs, promoting physical activity, and advocating for public policies such as insurance coverage of obesity medications, are key strategies that could have large societal impacts." The statement was prepared by the volunteer writing group on behalf of several American Heart Association councils.
