Diabetes and obesity rising in young Americans, study finds

Diabetes and obesity are rising among young adults in the United States, an alarming development that puts them at higher risk for heart disease, according to a study of 13,000 people between 20 and 44 years old.

The authors of the study, published Sunday in a major medical journal, warn the trends could have major public health implications: a rising generation dying prematurely of heart attacks, strokes and other complications. And Black and Hispanic people, particularly Mexican Americans, would bear the brunt.

“We’re witnessing a smoldering public health crisis,” Rishi K. Wadhera, assistant professor of medicine at Harvard Medical School and one of the study authors, wrote in an email.

Deaths from heart attacks and other effects of cardiovascular illnesses had been declining in the United States because of medical advances in prevention and treatment. That progress stagnated during the past decade.

The study, published in the Journal of the American Medical Association, aimed to examine whether young adults were increasingly at risk, using data between 2009 and 2020.

The results were mixed. There was a rise in obesity (from 33% to 41%) and diabetes (from 3% to 4%). Hypertension showed no meaningful improvement: It rose slightly, from 9% to 11.5%, but the increase did not quite reach statistical significance.

Hyperlipidemia - high levels of cholesterol or triglycerides - declined from 40.5% to 26%.

Young Black adults face the greatest risk. Hypertension is twice as prevalent among them as it is in other racial and ethnic groups. Diabetes and obesity are also more common.

The study’s authors pinpointed structural racial inequities in American society as a driver of the gaps.

“Younger Black individuals are more likely to live in lower-income households that experience housing instability and food insecurity, as well as in socioeconomically disadvantaged neighborhoods,” Wadhera said. “Black individuals also disproportionately face challenges accessing primary and preventive care, and are more likely to reside in ‘pharmacy deserts’” - a reference to areas where medication is harder to access.

Hypertension is rising among Hispanics, a trend not evident among other groups.

Sodium-heavy diets and ultra-processed foods are among the factors behind the increase in hypertension among Hispanics, researchers say. They emphasized that it transcends lifestyle choices. When people struggle to pay the bills, they often turn to cheaper, unhealthier food. Fresh produce is harder to come by in areas with few grocery stores.

Researchers suspect the decline in young adults with high cholesterol is partially explained by greater regulation of trans fats in food.

The study did not identify much difference in cardiovascular risk factors between men and women.

They also cautioned it is unclear whether the trends have persisted since the coronavirus pandemic began, because the study covered only up to 2020.

Here are some ways the study’s authors proposed addressing the disparities:

• Expanding large-scale efforts to screen and treat young Black adults for hypertension.
• Screening people for diabetes earlier in life because current guidelines often apply to people 35 and older.
• Starting a public health campaign addressing the rise in diabetes among Mexican American adults that is culturally competent and shaped by community leaders.
• Creating more green spaces in communities that encourage exercise to counter sedentary lifestyles contributing to the rise in obesity.

Without action to reverse the trends, the public health consequences could be dire, the study warned.

“The rising burden of risk factors that we observed among young adults - particularly if these trends continue - could result in a tsunami of cardiovascular disease over the long-term, and ultimately, increases in cardiovascular mortality as the U.S. population ages,” Wadhera said.