Adolescent obesity is a major public health concern in the United States. Around 20% of adolescents aged 12 to 19 are classified as obese based on body mass index (BMI) at or above the 95th percentile, while those in the 85th to 95th percentile are categorized as overweight. This condition is associated with different physical and psychological complications like type 2 diabetes, hypertension, dyslipidemia, sleep apnea, depression, and low self-esteem. Many of these conditions persist into adulthood, which increases the risks of morbidity and mortality. It is important to monitor trends in obesity and weight-related behaviors among adolescents to develop effective public health methods. However, there is limited data focusing on how weight loss attempts differ across demographic groups like sex, race/ethnicity, and grade level.
A study published in the Ochsner Journal aimed to evaluate trends in overweight, obesity, and self-reported attempts to lose weight in U.S. high school students over a 10-year period from 2013 to 2023.
This study used data from the Youth Risk Behavior Survey (YRBS), a nationally representative, biennial, school-based survey conducted by the Centers for Disease Control and Prevention (CDC). The YRBS collects information on health-related behaviors among students in grades 9 through 12 in public and private schools across all 50 states and the District of Columbia. The analysis included data from six survey cycles (2013, 2015, 2017, 2019, 2021, and 2023) with sample sizes ranging from 12,140 to 17,814 participants per cycle. Key variables examined included obesity (BMI ≥95th percentile), overweight (BMI ≥85th to <95th percentile), and attempts to lose weight on the basis of self-reported responses. Trends were assessed overall and stratified by sex, race/ethnicity (White, Black, Asian, Hispanic/Latino), and grade level (9th to 12th). Statistical analysis was conducted using percentages as effect measures, and 95% confidence intervals (CI) were applied to determine significance, with P-values <0.05 considered statistically significant. Survey weights were applied to account for sampling design and nonresponse bias, which ensures national representativeness.
The results showed a statistically significant increase in obesity prevalence among adolescents, which increased from 13.7% in 2013 to 15.9% in 2023 (P<0.01), with a peak of 16.3% in 2021 before a slight decline. Obesity rates increased steadily from 16.6% in 2013 to 18.9% in 2019, followed by a modest decrease to 18.2% in 2023 in men. Female adolescents showed more variability, with rates ranging from 10.8% to 13.7% over the study period.
The prevalence of overweight decreased significantly from 16.6% in 2013 to 14.7% in 2023 (P<0.01), with both women and men contributing to this downward trend, although fluctuations were observed in intermediate years. The proportion of adolescents attempting to lose weight declined from 47.7% in 2013 to 44.5% in 2023 (P<0.01). Females consistently reported higher rates of weight-loss attempts than males, although their rates declined significantly from 62.6% to 55.1% over the study period. Men showed lower and relatively stable rates, which elevate at 37% in 2019 and decreased to 34.8% in 2023.
Racial and ethnic disparities were evident with Black and Hispanic/Latino adolescents exhibiting the highest obesity prevalence, reaching 21.2% and 20.2%, respectively, in 2021. Asian adolescents had the lowest rates, although these increased from 5.6% in 2013 to 11.0% in 2023 (P<0.01). Overweight prevalence declined in all racial/ethnic groups but remained higher among Black and Hispanic/Latino youth. Hispanic/Latino adolescents consistently reported the highest rates of weight-loss attempts. White adolescents showed a significant decline from 47.1% to 41.0% (P<0.01).
By grade level, obesity increased significantly among 9th and 11th graders, with 11th graders reaching 17.3% in 2023 (P<0.05). Overweight prevalence decreased significantly among 9th and 12th graders. The most pronounced declines in weight-loss attempts were observed among 10th and 12th-graders (P<0.05).
This study highlights a relative shift in adolescent weight trends over the last decade. It is caused by increasing obesity despite decreasing overweight prevalence and reduced engagement in weight loss efforts. These findings underscore the need for comprehensive, targeted, and culturally sensitive public health methods that address both behavioral and structural determinants of obesity. Interventions must incorporate gender-specific approaches, promote healthy body image, improve access to nutritious foods and physical activity opportunities, and integrate school- and community-based programs. Continued surveillance and research are essential to better understand underlying drivers and to develop effective methods to improve adolescent health outcomes.
Reference: Yang J, Krill E, Llorens C, Kunz-Lomelin A, Hennekens CH, Kitsantas P. Trends in obesity, overweight, and attempted weight loss among United States high school students. Ochsner J. 2026. doi:10.31486/toj.25.0111
