The most obese countries in the world are small Pacific Island nations, where rates far exceed anything seen in larger, wealthier countries. American Samoa tops the list at 70.3% of adults living with obesity, followed closely by Nauru at 69.7%. The United States, often assumed to lead globally, ranks tenth at 41.6%.
The Top 10 Most Obese Countries
According to the World Obesity Federation’s Global Obesity Observatory, the countries with the highest percentage of adults with obesity (a BMI of 30 or above) are:
- American Samoa: 70.3%
- Nauru: 69.7%
- Tokelau: 67.1%
- Cook Islands: 66.1%
- Niue: 63.7%
- Tonga: 63.4%
- Tuvalu: 57.7%
- Samoa: 52.8%
- French Polynesia: 47.0%
- United States: 41.6%
Eight of the top ten are Pacific Island nations or territories. The dominance of this region isn’t a statistical quirk of small populations. It reflects decades of dramatic dietary and economic change that reshaped how entire societies eat.
Why Pacific Island Nations Lead the World
Between 1980 and 2008, Nauru and the Cook Islands experienced the fastest-rising BMI of any countries on Earth. Their average BMI climbed by more than 2.0 points per decade for both men and women, over four times the global average increase of 0.4 to 0.5 points per decade.
The roots of this crisis trace back to colonization. European missionaries and colonial administrators systematically changed how Pacific Islanders grew, prepared, and thought about food. Traditional preservation and cooking methods, which had sustained island populations for centuries, were discouraged or replaced. Colonial education systems and the introduction of cash economies shifted communities away from subsistence farming and fishing toward imported, processed foods. On Nauru, for example, pandanus fruit products were once stored for up to six years using complex traditional drying techniques. Those food systems were gradually abandoned.
Today, the cheapest and most accessible foods on many Pacific islands are imported, calorie-dense, and nutrient-poor. In cash-based island economies, these foods serve a social function too: they’re affordable in bulk, require little preparation time, and fit the logic of a wage-based lifestyle where cooking from scratch is a luxury. The result is that eating processed food has become intertwined with modern social belonging, making dietary change deeply difficult even when health consequences are severe.
The Middle East’s Rising Crisis
Outside the Pacific, the highest obesity rates cluster in the Gulf states. Kuwait leads the Middle East at 38%, followed by Qatar and Saudi Arabia at 35% each, and the United Arab Emirates at 32%. All of these rates more than double the global average.
Gulf governments are responding with aggressive policy measures. Saudi Arabia taxes energy drinks at 100% and soft drinks at 50%, runs nutrition clinics in hospitals, and restricts food marketing to children. The UAE has adopted the same tax structure on sugary beverages and regulates what gets sold in school canteens. Oman has cut salt and sugar in processed foods and banned partially hydrogenated oils, the primary industrial source of trans fats. These are some of the most assertive dietary policies anywhere in the world, a signal of how seriously the region treats the problem.
Where the United States Stands
The U.S. obesity rate among adults is 40.3%, based on CDC data collected between August 2021 and August 2023. That figure has remained statistically flat since 2013-2014, hovering above the national Healthy People 2030 target of 36%. The plateau is somewhat misleading: rates aren’t improving, and severe obesity continues to be a significant component of the overall number.
While the U.S. gets outsized attention for its obesity rates, it falls behind all eight Pacific Island nations and French Polynesia in percentage terms. What makes the American situation globally significant is scale. At 40.3% of roughly 260 million adults, the U.S. has far more people living with obesity in absolute numbers than any small island nation.
Women Are Disproportionately Affected
Globally, women have a median obesity prevalence about 6 percentage points higher than men. The gap is largest in the Americas, the Eastern Mediterranean, and Africa. In the Americas, female obesity prevalence rose by 20.4 percentage points between 1976 and 2016, compared to 19.0 points for men. In the Eastern Mediterranean, the disparity was even wider: a 16.1-point increase for women versus 12.3 for men.
In South and Southeast Asia and the Western Pacific, the gap between men and women is much smaller. The reasons for these regional differences involve a mix of physical activity patterns, cultural norms around body size, economic roles, and differences in how men and women access food in lower-income settings.
Urbanization Is Accelerating the Trend
Across developing nations, living in a city raises the probability of being overweight by 7 to 12 percentage points compared to rural areas, even after accounting for differences in education. In Sub-Saharan Africa, urban women are about 11 percentage points more likely to be above normal weight than rural women. In South Asia, the gap is about 9 points.
Unlike education, where the link to obesity eventually reverses as countries grow richer (wealthier, more educated populations tend to have lower obesity), the urban effect never flips. At every level of national income, city residents are more likely to carry excess weight than rural residents. As the world continues urbanizing, particularly in Africa and South Asia, this pattern is expected to push obesity rates higher in regions that have historically had low prevalence.
The Global Trajectory
Projections from the World Obesity Federation estimate that by 2035, more than 1.77 billion people will be overweight and 1.53 billion will be living with obesity. Combined, that represents 54% of all adults worldwide. The economic toll is projected to reach $4.32 trillion annually by 2035, nearly 3% of global GDP. That figure accounts for healthcare costs, lost productivity, and the broader drag on economic output.
The countries at the top of today’s rankings are small, but the forces driving their obesity rates, including the replacement of traditional diets with cheap processed food, rapid urbanization, and economic systems that make unhealthy eating the default, are now operating everywhere. The Pacific islands are not outliers so much as early arrivals at a destination the rest of the world is heading toward.