There are many problems with how Americans talk about weight, specifically about obesity and overweightness.

Behind people’s veiled concerns that excess weight may hasten worsening health or an earlier death is often times an unabashed spite towards the obese and overweight. And though obesity experts have come to view the process of weight gain as a complex interplay of genetic and environmental factors that few individuals have full control over, the cries of "not enough willpower!" still ring loud and hollow from the peanut gallery.

Doctors themselves aren’t off the hook either, with a 2001 review in Obesity Research finding a persistent pattern of weight discrimination from those supposedly equipped to provide their patients the best possible care. "Physicians associated obesity and other negatively perceived conditions with poor hygiene, noncompliance, hostility, and dishonesty," the authors wrote. "Similarly, a study of 318 family physicians using anonymous questionnaires found that two-thirds reported that their obese patients lacked self-control, and 39 percent stated that their obese patients were lazy."

And yet, despite these large gaps of knowledge in understanding the complexities of weight; or that Body Mass Index (BMI) is an imprecise tool for weight measurement; or that excess weight doesn’t necessarily predict poor health, obesity remains a looming public health crisis.

Obesity is associated with a number of chronic health conditions, particularly type 2 diabetes. Over time, without adequate physical activity, it lowers our health-related quality of life and may very well send us to the grave sooner. And according to a new analysis published in JAMA Internal Medicine today, it’s a crisis that’s only getting worse.

In a research letter, the authors of the analysis concluded that more than two-thirds of Americans are currently either overweight or obese, percentages that are significantly higher than a similar head count taken around two decades ago. Far from only focusing on the overweight and obese though, they advocate wide-sweeping societal changes to address these growing trends.

The authors examined the most recent data (2007 to 2012) from the National Health and Nutrition Examination Survey (NHNES). With over 15,208 men and women 25 or older included in their analysis, their sample was representative of more than 188 million people. "39.96 percent of men and 29.74 percent of women were overweight,” the authors concluded. "[A]nd 35.04 percent of men and 36.84 percent of women were obese."

These numbers are a noticeable jump from those estimated by the authors’ analysis of the NHNES data from 1988 to 1994, when 63 percent of men and 55 percent of women were overweight or obese. "It’s been a steady dramatic increase," lead author Dr. Lin Yang of the Washington University School of Medicine in St. Louis told Medical Daily.

More specifically, it’s black women who bear the largest burden, as while they were less likely to be overweight when compared to other ethnic groups, they were also more than three times more likely to be in the highest risk category of obesity (BMI ≥ 40), at about 17 percent. And only about 15 percent of black women were in the normal weight category, compared to over 30 percent of white women. The reasons that surround this disparity are complicated, but Yang says that there is research showing higher levels of physical inactivity among black women, which may partially explain it.

It’s tempting to conflate obesity and overweightness as one broad health issue, but the difference between the two groups isn’t window dressing. "It’s like talking about prediabetes and diabetes," said Yang. She notes that just because someone is overweight doesn’t mean that they’re destined to become obese, nor is obesity a specialized problem. "The increase is being seen across all population groups."

In fact, there’s been research showing that those overweight may outlast everyone else, with a 2013 review of the evidence in JAMA finding that overweight individuals had the lowest all-cause mortality compared to any other weight group. Other studies have shown that sedentary behavior is the bigger risk factor if you’re worried about an early death, with even those obese but fit not any more likely to die early than fit individuals at a lower BMI.

Still, these fit and fat people don’t describe the majority of obese individuals, and sedentary behavior is closely linked to the emergence of obesity. As Yang’s numbers show, that percentage is only getting higher.

It will require a dramatic overhaul in how we have these conversations about weight to fix any of that. "We need to reshape social norms," said Yang. The range of solutions include training medical professionals to effectively communicate with their overweight patients to creating neighborhoods that are safe and attractive enough to walk around in, but will especially center on reaching out to people at greatest risk of becoming overweight or obese, since weight loss success is notoriously difficult to maintain. "It’s always easier to prevent obesity than it is to treat it," said Yang.

For that reason, Yang hopes to pursue research that will evaluate and fine-tweak population-level approaches towards increasing physical activity. "We kind of know what works already. The challenge is how to make it sustainable," said Yang.

Source: Yang L, Colditz G. Prevalence of Overweight and Obesity In the United States, 2007 to 2012. JAMA Internal Medicine. 2015