Abstract
Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.
Highlights
Obesity is known to drastically increase the risk of chronic diseases and is associated with excess morbidity and mortality [1]
By demonstrating the variability of obesity by race throughout the country, we demonstrate the necessity of targeted interventions
Obesity prevalence rates were calculated by race for each county
Summary
Obesity is known to drastically increase the risk of chronic diseases and is associated with excess morbidity and mortality [1]. The prevalence rates of obesity in the United States remain higher than in most developed countries [2,3]. In 2009–2010, over 35% of adults were considered obese [4]. The rate of obesity is greater than 25% in 41 states, and 13 of these states have rates over 30%. There is no state with a prevalence rate of obesity lower than 20% [2]. These statistics, do not fully capture the obesity epidemic. We hypothesize that state and nation-wide obesity prevalence rates mask the variability of outcomes across smaller geographic areas and the existence of racial disparities within these areas [5]
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