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Obesity in Missouri

Written by Dr. Jill Barnas
Published on December 4, 2020
Research Highlights

Statewide policies to improve nutrition, exercise, and health in schools and communities are a promising approach to address the primary risk factors of obesity.

  • Missouri obesity rates continue to grow with associated costs projected to be $13 billion by 2030.
  • Healthy eating habits and physical activity reduce the risk of developing obesity for children and adults.
  • Obesity prevention initiatives that educate and develop healthy, active behaviors in childhood might have the greatest chance to reduce obesity rates.

Executive Summary

Obesity is the result of causal, behavioral factors such as physical inactivity and poor dietary habits. Statewide policies to improve nutrition, exercise, and health in schools and communities are a promising approach to address the primary risk factors of obesity.


  • The prevalence of obesity and physical inactivity is generated from self-report data and can have inherent variability. Individuals may inaccurately report weight and physical activity metrics.
  • Missouri has several obesity prevention initiatives; however, the effectiveness of these programs to reduce obesity remains undetermined.

Research Background

Prevalence and Costs of Obesity

Body mass index (BMI) is a person’s weight in kilograms (kg) divided by their height in meters squared (m2). Adult obesity is defined as a BMI (kg/m2) greater than 30kg/m2; childhood obesity is defined as having a BMI greater than the 95th percentile for children of the same age and sex.1 In Missouri, 35.0% of adults and 16.3% of children are classified as obese, ranking it within the top 20 most obese states.2-4 The prevalence of obesity in Missouri is greater in females (Figure 1a), ethnic minorities (Figure 1b), and those of low social-economic status (Figure 1c); these differences are mirrored in childhood obesity.5 Obesity is associated with many costly, fatal chronic diseases such as cardiovascular disease, type II diabetes, and cancer.6 If obesity trends continue, Missouri healthcare expenditures can reach $13 billion by 2030.7

Obesity is the Result of Energy Imbalance

Genetic, behavioral, and environmental factors contribute to the development of obesity; however, the two most significant causes are physical inactivity and poor dietary habits. Obesity is the result of an imbalance between energy in (dietary patterns) and energy out (physical activity). Obesity develops when an individual chronically consumes more calories than expended per day (Figure 2a). This continued energy imbalance results in weight gain, which can progress to obesity and the development of its associated chronic diseases. Reversing obesity is also the result of an energy imbalance; the calories consumed are less than caloric expenditure creating weight loss (Figure 2b).

Physical Inactivity

Habitual physical inactivity in the US has led to increased obesity rates and associated chronic diseases. The national health guidelines for physical activity recommend that children participate in at least 60 minutes of moderate-to-vigorous physical activity (MVPA) per day and at least 30 minutes of MVPA per day for adults. In Missouri, it is estimated that 74.9% of children and 30.6% of adults do not meet current physical activity guidelines.8 Physical activity declines as children progress through adolescence into adulthood. Youth who are active in childhood are likely to remain active into adulthood while those who are inactive remain sedentary throughout the lifespan.9 These findings highlight the importance of developing active lifestyle behaviors in youth to have a better chance of growing into healthy adults. Schools are an ideal environment to encourage physical activity, however, opportunities to engage in physical activity during the school day have been reduced.

Poor Dietary Habits

Most adults tend to overestimate how many calories are expended during an activity and underestimate how many calories are consumed, creating an energy imbalance.10 Easy access to high-calorie processed foods is a major contributing factor to the development of obesity cardiovascular disease, and type II diabetes.11 A healthy, nutritious diet is one that includes vegetables, fruits, whole grains, fat free or low-fat dairy, and a variety of proteins while limiting saturated and trans fats, added sugars, and salt.12 However, food insecurity effects approximately 15% of Missourians and consequentially, their dietary patterns.13 Differential access to nutritious foods such as fruits and vegetables is related to poor diet quality for individuals of socio-economic disparities; this is due to cost and neighborhood food environments. As such, more readily available sugar-sweetened beverages and high-fat foods are eaten, increasing the risk for developing obesity and chronic diseases when compared to high income households.14 Family eating habits and the school environment can help shape the dietary patterns of children and lead to lifelong, healthy eating habits. In a study conducted in Missouri schools, modification to the school cafeteria environment (foods provided and signage) with educational nutrition letters sent home to parents to promote adequate nutrition resulted in children eating more nutritious foods and reducing intake of added sugars.15 Therefore, education and accessibility need to be considered when developing obesity prevention initiatives related to nutrition.

Missouri Obesity Prevention Initiatives

Missouri has several obesity initiatives including statewide, community, childcare, and school- based programs to reduce the prevalence of obesity in children and families (Table 1). These programs encourage physical activity participation, increase fruit and vegetable consumption, and decrease consumption of sugar-sweetened beverages. Missouri requires physical education in schools; however, this is not a daily requirement. Missouri received federal funds from the US Department of Agriculture (USDA) to improve nutrition quality of the Child and Adult Care Food Program. The Missouri Council on Physical Activity and Nutrition (MoCAN) developed a five-year strategy (2016-2020) to reduce obesity. The report should be available at the conclusion of the year; dependent upon the evaluation of this strategy, a new strategy may be needed. While these programs seemed to have improved knowledge about physical activity and nutrition, it is unknown whether the implementation of these programs has curbed the obesity epidemic in Missouri, particularly those of low socio-economic status and across ethnicities.


  1. Centers for Disease Control and Prevention (2020). Overweight & obesity. Retrieved fromhttps://www.cdc.gov/obesity/index.html
  2. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018.
  3. Centers for Disease Control and Prevention (2019). Childhood obesity facts. Retrieved fromhttps://www.cdc.gov/obesity/data/childhood.html
  4. Robert Wood Johnson Foundation (2020). State of childhood obesity. Retrieved from https://stateofchildhoodobesity.org/
  5. United Health Foundation. (2019). Obesity in Missouri. Retrieved fromhttps://www.americashealthrankings.org/explore/annual/measure/Obesity/state/MO
  6. Wilfley, D. E., Hayes, J. F., Balantekin, K. N., Van Buren, D. J., & Epstein, L. H. (2018). Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice. The American Psychologist, 73(8), 981–993. DOI: 10.1037/amp0000293
  7. Hasnie, U., Lindquist, M., Sweeney, B., Hampl, S., & Drees, B. M. (2019). Childhood Obesity in the State of Missouri: A Review for Providers to Counsel and Treat Patients. Missouri Medicine, 116(5), 409-413.
  8. Trust for America's Health. (2020). The State of Obesty: Better Policies for a Healthy America 2020. Retrieved from https://www.tfah.org/report-details/state-of-obesity-2020/
  9. Rovio, S.P., Yang, X, Kankaanpää, A., Aalto, V., Hirvensalo, M., Telama, R., Pahkala, K., Hutri- Kähönen, N., Viikari, J.S.A., Raitakari, O.T., & Tammelin, T.H. et al. (2018). Longitudinal physical activity trajectories from childhood to adulthood and their determinants: the young Finns study. Scandinavian Journal of Medicine & Science in Sports. 28(3), 1073-1083. DOI: 10.1111/sms.12988
  10. Willbond, S. M., Laviolette, M. A., Duval, K., & Doucet, E. (2010). Normal weight men and women overestimate exercise energy expenditure. The Journal of Sports Medicine and Physical Fitness, 50(4), 377–384.

  11. Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., Chung, S.T., Costa, E., Courville, A., Darcey, V., Fletcher, L. A., Forde, C.G., Gharib, A.M., Guo, J., Howard, R., Joseph, P.V., McGehee, S., Ouwerkerk, R., Raisinger, K., Rozga, I., ... Zhou, M., (2019). Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metabolism, 30(1), 67-77. DOI: 10.1016/j.cmet.2019.05.008
  12. Bushman, B. A. (2017). Complete guide to fitness and health. Champaign, IL: Human Kinetics.
  13. Bass, M., Carlos Chavez, F. L., Chapman, D., Freeman, K., Mangoni, G. N., McKelvey, B., Miller,E., & Rikoon, S. (2019). Missouri Hunger Atlas 2019. University of Missouri, Interdisciplinary Center for Food Security. Retrieved from https://foodsecurity.missouri.edu/missouri-hunger- atlas/
  14. Alkerwi, A., Vernier, C., Sauvageot, N., Crichton, G. E., & Elias, M. F. (2015). Demographic and socioeconomic disparity in nutrition: Application of a novel correlated component regression approach. British Medical Journal, 5(5), 1-10. DOI: 10.1136/bmjopen-2014-006814
  15. Ball, S., Kovarik, J., & Leidy, H. (2015). Active and healthy schools. Physical Educator, 72(2), 224- 235.
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