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Independent Annual Policy Report
The State of Metabolic Health in America
2026 Baseline Edition
The State of Metabolic Health in America is an independent annual policy report documenting the prevalence, economic burden, financing, prevention, treatment, innovation, and measurement of metabolic health across the United States.
The 2026 Baseline Edition establishes the initial benchmark against which future annual editions will measure change.
Annual Policy Report
The State of Metabolic Health
in America
2026 Baseline Edition
James M. Knox
Eagles Benefits by Design, Inc.
Published annually each August.
- Edition
- 2026 Baseline Edition
- Publication date
- August 2026
- Report type
- Annual Policy Report
- Prepared by
- James M. Knox
- Publisher
- Eagles Benefits by Design, Inc.
- Primary location
- Tampa, Florida
- Version
- Version 1.0
- Data freeze date
- TBD
- ISSN (Online)
- 3144-8178 (Online)
About
About the Report
The State of Metabolic Health in America was created to provide policymakers, employers, healthcare organizations, researchers, journalists, and the public with a consistent, evidence-based account of the nation's metabolic health.
The report examines metabolic health as an interconnected national issue rather than as a collection of unrelated diagnoses. It brings together data on obesity, diabetes, hypertension, chronic kidney disease, cardiovascular disease, metabolic syndrome, metabolic liver disease, sleep apnea, and other related conditions while examining how those conditions affect employers, Medicare, Medicaid, public health infrastructure, and the broader economy.
The report is published annually in August. Each edition uses the most current validated data available during the production cycle. Because federal agencies, state agencies, employer surveys, and peer-reviewed research operate on different reporting schedules, each material statistic identifies its source period and data vintage.
Purpose
Mission
The mission of The State of Metabolic Health in America is to become the authoritative annual reference on metabolic health in the United States.
The report measures rather than advocates. It documents what is known, identifies what remains uncertain, and establishes a transparent baseline for evaluating whether the metabolic health of the American population is improving, remaining stable, or declining over time.
Measure
Document the prevalence, burden, financing, and outcomes associated with metabolic health.
Compare
Preserve stable metrics and transparent methodology so that changes can be evaluated across annual editions.
Inform
Provide policymakers, employers, researchers, healthcare organizations, and the public with reliable evidence for decision-making.
Data
2026 National Findings
Final figures will be published in August 2026. Placeholders reflect the most recently available validated data.
40.3%
U.S. adult obesity prevalence
NHANES
August 2021–August 2023
9.4%
Severe obesity prevalence (BMI ≥40)
NHANES
2021–2023
38.4M
Americans with diagnosed diabetes
CDC National Diabetes Statistics Report
2021
97.6M
Americans with prediabetes
CDC National Diabetes Statistics Report
2021
48.1%
U.S. adults with hypertension
CDC / NHANES
2017–2020
14%
U.S. adults with chronic kidney disease
CDC Chronic Kidney Disease Surveillance
2021
34.7%
U.S. adults meeting metabolic syndrome criteria
NHANES
2011–2016
$4.9T
U.S. national health expenditures
CMS Office of the Actuary
2023
$25,572
Average employer-sponsored family premium
KFF Employer Health Benefits Survey
2024
67.3M
Medicare enrollees
CMS Medicare Enrollment Dashboard
2024
92.3M
Medicaid and CHIP enrollees
CMS Medicaid Enrollment Data
2024
~50%
Large employers offering GLP-1 coverage for obesity
KFF Employer Health Benefits Survey
2024
Contents
Inside the 2026 Baseline Edition
Chapter 1
America's Metabolic Health
Establishes the national baseline for obesity, diabetes, prediabetes, hypertension, chronic kidney disease, metabolic liver disease, obstructive sleep apnea, cardiovascular disease, metabolic syndrome, testosterone deficiency, and menopause-related symptom burden.
Chapter 2
Economic Impact
Examines national health expenditures, condition-specific costs, employer premiums, lost productivity, workers' compensation, disability, and early workforce exit.
Chapter 3
Employer Healthcare
Evaluates the financing, cost, pharmacy strategy, GLP-1 coverage, benefit design, and measurement practices within employer-sponsored health plans.
Chapter 4
Medicare and the Concentration of Metabolic Disease
Examines how metabolic disease becomes concentrated within Medicare, including Medicare Advantage, prevention, pharmaceuticals, supplemental benefits, and cost pressures.
Chapter 5
Medicaid
Reviews Medicaid enrollment, financing, managed care, cardiometabolic disease burden, obesity treatment coverage, and major federal and state policy developments.
Governance
Built for Long-Term Comparability
The report is governed by permanent editorial, methodological, and operational standards designed to preserve objectivity, transparency, reproducibility, and year-over-year comparability.
No metric will be silently added, removed, renumbered, or redefined.
Editorial & Production Standards Manual
Defines how the report is written, structured, reviewed, and presented.
Methodology Manual
Defines how sources, metrics, formulas, confidence classifications, and analytical methods are selected and applied.
Data Operations Manual
Internal governance document covering data acquisition, storage, validation, security, version control, and archiving. The complete internal manual is not published.
Annual Change Log
Beginning with the 2027 edition, documents all metrics added, retired, revised, renamed, or replaced and explains the reason for every material change.
Research
Employer Research Partner Program
The Employer Research Partner Program allows qualified employers to contribute standardized, longitudinal information to the development of the annual report and the broader evidence base on employer metabolic health.
The program is designed to collect primary-source employer information — not broker-, consultant-, or vendor-curated submissions.
Minimum qualifications
- Preferred minimum of 10,000 benefit-eligible employees; minimum consideration of 5,000
- At least 24 months of historical data; 36–60 months preferred
- Willingness to participate annually
- Ability to provide benefit, utilization, financial, governance, and population-health information
- Submission must be completed and submitted directly by an employer executive holding the title of Vice President or higher
Critical submission requirement
Employer submissions must be made directly by the employer. Every submission must be reviewed, approved, certified, and submitted by a Vice President or higher using the executive's official employer email address. Brokers, consultants, pharmacy benefit managers, third-party administrators, carriers, vendors, manufacturers, and other intermediaries may not prepare, certify, submit, or transmit an application on behalf of an employer.
State Cooperation
Cooperative State Editions
State-specific editions may be developed for states interested in cooperating with the report's research and editorial team. The preferred model is to work directly with official state medical, public health, Medicaid, employee-benefit, actuarial, and data personnel to obtain the most current, accurate, and nonpolitical information available.
State cooperation improves factual accuracy and state-specific context but does not grant editorial control or constitute endorsement of every analysis or conclusion.
State edition scope
Downloads
Reports and Supporting Materials
The State of Metabolic Health in America — 2026 Baseline Edition
Full report · PDF · Version 1.0 · September 2026
Additional supporting materials — executive brief, chapter PDFs, data tables, and figures — will be added as they are finalized.
Archive
Annual Report Archive
2026 Baseline Edition
Published: September 2026
Version 1.0
Annual Edition
Annual Edition
Citation
How to Cite the Report
Knox, James M. The State of Metabolic Health in America — 2026 Baseline Edition. Tampa, Florida: Eagles Benefits by Design, Inc.; 2026. ISSN: 3144-8178 (Online). DOI: 10.5281/zenodo.22772957
ISSN: 3144-8178 (Online) · DOI: 10.5281/zenodo.22772957 · Permanent record: https://zenodo.org/records/22772957
https://zenodo.org/records/22772957Contact
Media, Policy, and Research Inquiries
Journalists, policymakers, researchers, employers, health plans, and public agencies may request interviews, briefings, source clarification, data interpretation, or permission to reproduce report figures.
James M. Knox
Author and Editor, The State of Metabolic Health in America
Inquiry types accepted
Send an inquiry
Transparency
Corrections and Version History
The report is committed to transparent correction of material errors. Published editions will not be silently overwritten.
- Current version
- Version 1.0
- Publication date
- September 2026
- Revision date
- None
Schedule
Annual Publication Cycle
September–December
Review the prior edition, identify corrections, update the source registry, and recruit research partners.
January–March
Collect national, state, employer, and peer-reviewed data.
April–May
Validate data, update metrics, and begin drafting.
June
Complete chapter drafts, figures, tables, and internal review.
July
Finalize the data freeze, complete external review, and prepare publication files.
August
Publish the annual report, executive brief, supporting materials, and approved state editions.
The edition year identifies the report edition. The underlying data period may vary by metric because national surveillance systems and research sources operate on different release schedules.
Stay informed
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The State of Metabolic Health in America is an independent annual policy report prepared by James M. Knox and published by Eagles Benefits by Design, Inc. · 238 E Davis Blvd Ste 206, Tampa, FL 33606