Abstract
BackgroundObesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death.MethodsWe used the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. About 3.7 million adults aged 20 years or older participated in the BRFSS from 2000 to 2011, and 30,000 adults aged 20 or older participated in NHANES from 1999 to 2010. We calculated body mass index (BMI) from self-reported weight and height in the BRFSS and adjusted for self-reporting bias using NHANES. We calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in the BRFSS. We used validated small area estimation methods to generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011.ResultsOur results showed an increase in the prevalence of sufficient physical activity from 2001 to 2009. Levels were generally higher in men than in women, but increases were greater in women than men. Counties in Kentucky, Florida, Georgia, and California reported the largest gains. This increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. There was a low correlation between level of physical activity and obesity in US counties. From 2001 to 2009, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower.ConclusionsOur study showed that increased physical activity alone has a small impact on obesity prevalence at the county level in the US. Indeed, the rise in physical activity levels will have a positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes. Other changes such as reduction in caloric intake are likely needed to curb the obesity epidemic and its burden.
Highlights
Obesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death
Our study revealed a wide variation in obesity and physical activity levels among counties in the US
This is the first study to combine data from National Health and Nutrition Examination Survey (NHANES) and Behavioral Risk Factor Surveillance System (BRFSS) in order to adjust for selfreporting bias of weight and height to measure obesity at the county level
Summary
Obesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death. Obesity and lack of physical activity are associated with several chronic conditions such as heart disease and diabetes, increased medical care costs, and premature death [1,2,3]. Obesity has increased rapidly during the past years; recent studies reported a decline in the rate of increase [4,5]. Recent studies reported a small increase in physical activity [6,7,8]. Levels of obesity and physical activity are likely to vary substantially across states and counties; different local governments have pursued a variety of approaches to address both risks. Understanding local trends in physical activity and obesity are important inputs to identifying successful and less successful strategies. Only local data will drive policy and action
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