The prevalence of moderate-to-severe (Class 2 and 3) obesity in US nursing homes rose from 26.5% in 2011 to 30.5% in 2023 (a 15% relative increase), with higher prevalence concentrated in facilities serving more Medicaid residents, with lower direct care staffing, and in rural areas.
ABSTRACT
Background
Residents with obesity in US nursing homes (NHs) present challenges for facilities, as these individuals often require specialized assistance and resources. However, recent trends, geographic variation, and NH characteristics related to the prevalence of obesity in NHs are understudied. We examined national trends in prevalence of Class 2–3 (moderate-to-severe) obesity in NHs over a 13-year period, geographic variation in trends, and facility characteristics associated with high prevalence.
Methods
Prevalence of moderate-to-severe obesity in NHs was defined as the proportion of residents with body mass index (BMI) ≥ 35 kg/m2. Annual average prevalences were calculated across NHs between 2011 and 2023 and changes in state-level prevalence were analyzed over the study period. Lastly, resident and facility characteristics associated with NHs in the top quartile of prevalence in 2023 were examined.
Results
The sample included 16,886 NHs in 49 states. Mean prevalence increased from 26.5% in 2011 to 30.5% in 2023, a 15% relative increase, with substantial state variation. All states experienced increases in prevalence with Idaho exhibiting the largest increase of 34% (9.9 percentage points (pp); from 29.1% to 39.0%) and New York experiencing the smallest of 5.8% (1.4 pp; from 24.0% to 25.4%). Compared to NHs in the lowest quartile of prevalence, those in the highest quartile had younger residents on average (75.2 vs. 78.3; p < 0.001), lower proportions of non-White residents (18.1% vs. 30.6%; p < 0.001), and higher shares covered by Medicaid (65.7% vs. 61.2%; p < 0.001). NHs in the highest quartile also had lower occupancy rates (73.1% vs. 79.4%; p < 0.001), and were more likely to be part of a multi-facility chain (64.6% vs. 52.8%; p < 0.001) and in a rural area (39.2% vs. 13.8%: p < 0.001).
Conclusions
Our findings indicate continued increases in the prevalence of moderate-to-severe obesity in NHs with large variation across states and potential disparities associated with income and rurality.