American Heart Association Statement Highlights Structural Barriers to Obesity Prevention and Treatment

More than one-third of adults and children in the United States are living with obesity, with rates 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 a new American Heart Association scientific statement published in the Association’s flagship journal Circulation, obstacles to preventing and treating obesity—including limited access to healthy foods, limited time to prepare meals and exercise, neighborhood factors, weight stigma, and financial constraints—are more likely to affect people in lower-income communities. The statement, titled “Socioeconomic and Structural Barriers to Addressing Obesity in Communities,” emphasizes that obesity is a chronic health condition associated with harm to health, affecting individuals across all socioeconomic backgrounds, though genetic predisposition is not the primary driver of high obesity rates.

People in lower-income communities are disproportionately impacted by obesity and related health conditions, such as high blood pressure, cardiovascular disease, and Type 2 diabetes. Fatima Cody Stanford, M.D., M.P.H., M.P.A., M.B.A., FAHA, vice chair of the scientific statement writing group, noted that the latest research indicates people with fewer resources are more likely to develop obesity due to a combination of factors influencing their everyday experiences, such as socioeconomic stressors that limit access to nutritious foods and regular physical activity or healthy sleep, and cultural factors that make it hard to access obesity care and maintain a healthy weight. Stanford emphasized that obesity is not a personal choice but is highly influenced by multiple social and environmental factors, which is a critical component for addressing the obesity epidemic in the U.S. and obesity-related health conditions including cardiovascular disease.

Numerous socioeconomic factors are closely linked to obesity, with risk and prevalence highest among the aforementioned groups. Lifestyle and environmental factors, including shift work, noise pollution, and nighttime light exposure, can also increase this risk by interfering with circadian rhythms and affecting sleep quality and duration. A 2025 American Heart Association scientific statement about circadian health highlighted that disruptions to the body’s internal clock are strongly associated with an increased risk of obesity, Type 2 diabetes, high blood pressure, and cardiovascular disease. Despite greater availability of treatment options for obesity, including weight management programs focused on lifestyle changes and medications such as GLP-1 receptor agonists, there are still significant challenges in effectively treating obesity.

Weight stigma perpetuates harmful attitudes, with previous research finding that between 20% and 90% of people have negative and judgmental opinions about people with excess weight, such as viewing obesity as a personal lifestyle choice or a reflection of poor self-control. These perceptions may contribute to poor mental health as well as unhealthy eating behaviors, and experiences of weight stigma can make individuals more likely to avoid seeking care and support from health care professionals. Individuals with obesity face physical and financial challenges in the health care system, including physical barriers like medical equipment and small spaces that discourage seeking medical care, as well as cost barriers like co-pays or other out-of-pocket expenses, transportation challenges, and limitations in health insurance coverage.

Time is an often-overlooked barrier, as limited time directly affects an individual’s ability to participate in obesity prevention and treatment programs. Work and caregiver responsibilities are often prioritized to maintain financial and household stability, reducing time available for healthy lifestyle behaviors like preparing healthy meals at home and engaging in regular physical activity. Effective obesity prevention and treatment programs require 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, though the statement notes that available metrics like body mass index do not accurately reflect body fat or overall health, necessitating more clinically meaningful metrics.

Health care professionals can make a significant impact by initiating culturally sensitive discussions with patients about their beliefs around weight and care, 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 highlighted that 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. Key strategies include 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, which could have large societal impacts.