On Wednesday, a new study published in JAMA by researchers at the University of Washington in Seattle projected that by 2035, nearly half of all American adults, about 126 million individuals, will be living with obesity. The study draws on data from more than 11 million participants via the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination and Behavioral Risk Factor Surveillance System, and from the independent Gallup Daily Survey.

The projections show a striking increase in the prevalence of obesity over the past few decades in the U.S. In 1990, only 19.3% of U.S. adults were obese, according to the study. That figure more than doubled to 42.5% by 2022, and is forecast to reach 46.9% by 2035.

The study highlights significant disparities across states, ages, and racial and ethnic groups. While every state is expected to see increases, the sharpest rises are projected for Midwestern and Southern states.

For example, nationwide, by 2035, the study projects that 60% (11.5 million adults) of Black women and 54% (14.5 million) of Latino women will suffer from obesity when compared with 47% (36.5 million) of white women. Similarly, 48% (13.2 million) of Latino men will suffer from the disease compared with 45% (34.4 million) of white men and 43% (7.61 million) of Black men.

The findings say California will see similar trends in gender and racial disparities. The study projects that by 2035, obesity rates among Latino and Black women in California will reach nearly 60%, compared with nearly 40% for their white counterparts. Additionally, Latino men in California could see rates over 50%, compared with nearly 40% for their white counterparts.

“These numbers are not surprising, given the systemic inequalities that exist,” in many California cities, said Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Hospital, pointing to economic instability, chronic stress and the car-dependency of Los Angeles and other California metro areas. “There are challenges for access to nutritious foods, depending on where you’re at in the city,” Velazquez said. ”There’s also disparities in the access to healthcare, especially to treatment for obesity.”

That’s recently become more of a challenge, since changes in Medi-Cal plans that went into effect at the beginning of this year mean obesity medication and treatment are no longer covered for hundreds of thousands of low-income Californians. “To take that away is devastating,” said Velazquez.

Despite these disparities, California is projected to fare better than most other states, with its rates of obesity growing more slowly than the national average.

“There are statewide and local policies that influence food, nutrition and social determinants of health for individuals,” said Velazquez.

Church pointed to measures such as SB 12 and SB 677, passed in the mid 2000s, which set strict nutritional standards for schools, existing menu labeling laws at both the state and federal levels requiring restaurants to provide nutritional facts on menu items, and cities like Berkeley and Oakland imposing local soda taxes as key local and statewide initiatives to keep obesity at bay.

To keep up this momentum, both doctors stressed that California must continue to strengthen school nutrition standards, expand transportation infrastructure that encourages walking instead of driving, maintain and expand economic disincentives to unhealthy foods, such as beverage taxes, and address food deserts by incentivizing new grocery stores and farmers’ markets in underserved neighborhoods.

Future efforts, Church says, should prioritize the Black and Latino populations identified by the study as most affected.

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