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.
Keywords: forecast; health disparities; menopause; midlife women; obesity; prevalence.
Obesity and overweight have increased sharply in U.S. women ages 40 to 64 over the past 30 years. This study shows where rates are highest, how they have changed in each state, and what these trends may look like by 2050.Overweight and obesity have increased sharply among U.S. women aged 40–64 over the past three decades and are expected to keep rising. In 1990, about one in two women in this age group were overweight or obese; by 2021, more than seven in ten were affected. National projections suggest that by 2050, over eight in ten midlife women will be living with excess weight. Rates are not the same everywhere. Women in Southern states such as Mississippi and Alabama have some of the highest obesity levels, while those in states like Colorado and Hawaii have lower rates – likely due to differences in access to healthy foods, physical activity, and local health policies. This trend matters because carrying excess weight increases the risk of serious conditions such as diabetes, heart disease, stroke, and several cancers. Hormonal and metabolic changes that occur during midlife and the menopause transition also make weight management more challenging. The study emphasizes that prevention and intervention should begin earlier in life and continue through midlife, with programs that address both biological and social factors influencing health. New medications, such as GLP-1 receptor agonists (including semaglutide and tirzepatide), show promise for effective weight reduction. However, these treatments are expensive, not equally accessible to all women, and their long-term outcomes are still being studied. Together, these findings highlight an urgent need for better access to prevention programs, affordable and equitable treatments, and supportive policies that can help women maintain a healthy weight and improve their quality of life as they age.