Perspectives in Disease Promotion and Health Promotion Prevalence of Overweight -- Behavioral Risk Factor Surveillance System, 1987

An estimated 34 million adults in the United States are overweight (1), placing them at increased risk for chronic diseases such as diabetes, hypertension, and some types of cancer (2,3). Thus, reducing the prevalence of overweight is an important public health objective.

To examine patterns of overweight adults by geographic location, data from the 1987 Behavioral Risk Factor Surveillance System (BRFSS) (4) were used to obtain prevalence estimates for 32 states and the District of Columbia. Participating states were divided into four regions (West, Northeast, South, and Midwest) based on the 1984 census divisions (5).

In the BRFSS, state health departments collect data on behavioral risk factors using random-digit-dialed telephone interviews of adults greater than or equal to 18 years of age. Prevalence estimates, obtained from self-reported weights and heights in BRFSS interviews, are adjusted to the age, sex, and race distribution of each state's population.

Overweight was defined as a body mass index (BMI=weight(kg)/height(m)2) greater than or equal to 27.8 for men and greater than or equal to 27.3 for women. These values represent the sex-specific 85th percentile of BMI for U.S. adults aged 20-29 years, estimated from the Second National Health and Nutrition Examination Survey (NHANES II) (1).

Overall, the prevalence of overweight ranged from a high of 25.7% in Wisconsin and Indiana to a low of 15.2% in New Mexico (Table 1). Among men, the prevalence of overweight ranged from 26.9% in Wisconsin to 15.1% in Arizona. For women, the prevalence ranged from 25.8% in the District of Columbia to 13.7% in Hawaii. The median prevalence of overweight was 21.8% for men and 21.1% for women.

The median prevalence of overweight by region was lowest in the West (17.0%), followed by the Northeast (19.8%), the South (22.0%), and the Midwest (23.1%). Adjusting for regional population distribution by age, sex, and race did not change this pattern. Compared with the median prevalence of overweight for all 33 participating units (21.1%), the median prevalence by region is lower in the West and Northeast and higher in the South and Midwest. Reported by: The state BRFSS coordinators: R Strickland, Alabama; T Hughes, Arizona; L Parker, California; M Rivo, District of Columbia; S Hoecherl, Florida; JD Smith, Georgia;E Tash, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; K Bramblett, Kentucky; R Schwartz, Maine; A Weinstein, Maryland; L Koumijian Yandel, Massachusetts; N Salem, Minnesota; N Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; C Chakley, Utah; K Tollestrup, Washington; R Anderson, West Virginia; R Miller, Wisconsin. Div of Nutrition and Office of Surveillance and Analysis, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The prevalence of overweight in this report may be underestimated because the data are based on self-reported responses. When measured weights and heights from NHANES II were used, an estimated 24.2% of men and 27.1% of women in the United States were overweight (1), compared with 21.8% of men and 21.1% of women from BRFSS. Assuming that the underestimation of overweight does not differ by state or region, findings of this report can be used to make relative comparisons of the prevalence of overweight between states and regions.

State and regional variations in the prevalence of overweight may result from differences in eating habits and exercise practices (6,7). A number of states have reached low prevalence levels of overweight. Public health agencies should encourage moderate but regular physical activity and caloric restriction through decreased dietary fat consumption in weight-loss programs. These efforts are of special importance in states with the highest prevalences of overweight.

References

1. NCHS. Anthropometric reference data and prevalence of overweight, United States 1976-1980. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1987; DHHS publication no. (PHS)87-1688. (Data from the National Health Survey; series 11, no. 238).

2. National Institutes of Health Consensus Development Panel on the Health Implications of Obesity. Health implications of obesity: National Institutes of Health consensus development conference statement. Ann Intern Med 1985;103(6 pt 2):1073-7.

3. Office on Smoking and Health. The Surgeon General's report on nutrition and health. Washington, DC: US Department of Health and Human Services; DHHS publication no. (PHS)88-50210:275-309.

4. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry, EM. Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-1987. Public Health Rep 1988;103:366-75.

5. US Department of Commerce. Factfinder for the nation. Census geography

• concepts and products. Washington, DC: Bureau of the Census, 1985. (CFF No. 8 Rev.). 6. Council on Scientific Affairs. Treatment of obesity in adults. JAMA 1988;260:2547-51. 7. Black W, James WPT, Besser GM, et al. Obesity: a report of the Royal College of Physicians. J R Coll Physicians Lond 1983;17:5-65.

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