Most US Adults with Obesity, Hypertension, or Diabetes Rate Their Own Health as Good or Better: A Cross-Sectional Analysis of Two National Surveys
DOI:
https://doi.org/10.22230/ijdrp.2026v8n2a667Keywords:
self-rated heath, obesity, hypertension, type 2 diabetes, health perception, lifestyle medicine, BRFSS, NHISAbstract
Background: Obesity, hypertension, and type 2 diabetes are highly prevalent and, in contrast to many chronic conditions, are substantially modifiable through dietary and lifestyle interventions. Although perceived need is widely considered a prerequisite for behavior change, the national prevalence of adults with these conditions who still rate their health as good has not been quantified.
Methods: A cross-sectional analysis was performed using the 2023 Behavioral Risk Factor Surveillance System (BRFSS; n = 389,862), with an independent replication in the 2024 National Health Interview Survey (NHIS; n = 31,736). Self-rated health was dichotomized as good, very good, or excellent versus fair or poor. Obesity was defined as a body mass index of 30 kg/m. or greater based on self-reported height and weight; hypertension and diabetes were defined by self-reported prior diagnosis. Weighted prevalences were estimated using Taylor-series linearization, and survey-weighted modified Poisson models were fitted to obtain adjusted prevalence ratios (aPRs).
Results: Among adults with at least one of the three conditions, 73.3% (95% CI, 72.9–73.7) rated their health as good, very good, or excellent, representing 89.0 million US adults. The proportion decreased as the number of conditions increased: 89.7% with none, 79.4% with one, 67.9% with two, and 50.3% (95% CI, 48.8–51.8) among those with all three. Favorable ratings were most common at younger ages and increased substantially with income, from 44.8% among adults with household income below $15,000 to 90.6% at $200,000 or more. Under a stricter threshold, 35.5% rated their health as very good or excellent, and 8.6% as excellent. Favorable ratings declined with disease severity but persisted, reaching 59.3% among adults with class III obesity, 51.8% among those with diabetes of 20 years or longer, and 39.9% among those with all three conditions and class III obesity. In fully adjusted models, each condition was associated with only a modest reduction in the prevalence of favorable self-rated health (obesity aPR 0.95; hypertension aPR 0.94; diabetes aPR 0.81). The National Health Interview Survey (NHIS) replicated both the magnitude and gradient. Unexpectedly, adults with these conditions who rated their health favorably reported more physical activity and less smoking than those rating it unfavorably.
Conclusions: The majority of US adults living with obesity, hypertension, or diabetes consider their general health to be good or better. These data establish favorable general health perception; they do not establish that these adults are unaware of their diagnoses or that they underestimate their future risk. As these conditions are often asymptomatic and substantially reversible, favorable self-assessment may represent an under-recognized context for lifestyle intervention. The impact of modifying self-perception on intervention uptake or health outcomes is unclear and should not be presumed.
