Abstract
Background: Self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) survey show higher prevalence of obesity in the south, particularly for the East South Central(ESC) states of LA, MS, and AL. Because obesity is associated with hypertension and diabetes, higher prevalence of obesity has been hypothesized as a primary contributor to the stroke belt, an area of high stroke mortality in the southeast. We assessed measured obesity from the National Health and Nutrition Examination Survey (NHANES) and REasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort from 48 states, and compared geographic prevalence patterns across studies. Methods: Weighted obesity prevalence estimates (with 95% CIs) were calculated from NHANES (2003-2008; n = 6138), REGARDS (2003-2007; n = 30,183), and BRFSS (2003-2007; n = 67,742) in non-Hispanic black and white adults over 45 years of age in the census divisions. Obesity was defined as BMI >= 30 kg/m 2 . Results: There is a lack of concordance in the obesity prevalence (see Figure) between BRFSS and both REGARDS (top left) and NHANES (bottom right). In contrast, the comparison of REGARDS and NHANES (top right) shows good agreement in the estimated obesity prevalence for all divisions (including those containing the stroke belt states, shown in red). Conclusion: Our results indicate discordance in measured and self-reported obesity prevalence especially in the ESC division. The objectively measured obesity prevalence for both NHANES and REGARDS was high in the West North Central division including ND, SD, NE, KS, MN, IA, and MO. Factors other than obesity may contribute to the high prevalence of hypertension and diabetes, and high stroke mortality rates, in the stroke belt. Additionally, these data suggest that errors in self-reporting height and/or weight differ by region and may have distorted past estimates of obesity rates by region.
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