A demographic, clinical, and behavioral typology of obesity in the United States: an analysis of National Health and Nutrition Examination Survey 2011-2012.

PURPOSE: Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States.

METHODS: We analyzed data from the 2011-2012 wave of the National Health and Nutrition Examination Survey, a nationally representative sample of adults in the United States with detailed physical examination and clinical data (n = 1380). We used cluster analysis to identify subgroups classified as obese according to demographic factors, clinical conditions, and behavioral characteristics.

RESULTS: We found significant heterogeneity among participants with obesity according to six distinct clusters (P < .001): affluent men with sleep disorders (16% of sample); older smokers with cardiovascular disease (16%); older women with high comorbidity (20%); healthy white women (13%); healthy non-white women (14%); and active men who drink higher amounts of alcohol (21%).

CONCLUSIONS: Obesity in the United States is not a homogeneous condition. Current research and treatment may fail to account for complex and interrelated factors, with implications for prevention strategies and diverse risks of obesity.