Modest Progress or a New Normal in War on Obesity?

September 02, 2016

The rate of adult obesity declined in four states in 2015, the first time any state has weighed less on the scales in the past decade, according to an analysis of government data issued yesterday by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

Obesity rates have stabilized as opposed to growing in most other states, but that's actually a problem, because they're stabilizing at alarmingly high levels, the TFAH and RWJF stated in an annual report titled The State of Obesity. In 1991, no state posted an obesity rate higher than 20%. In 2015, all states topped 20%, and half were at or above 30%.

With obesity a risk factor for disorders ranging from diabetes to cancer, complacency is not in order, said TFAH Interim President and CEO Richard Hamburg in a news conference yesterday. "There's much more left to be done."

The latest State of Obesity report gleaned its data for adults from the Behavioral Risk Factor Surveillance System (BRFSS), established by the Centers for Disease Control and Prevention (CDC). It's a state-based telephone survey in which adults self-report their weight and height, allowing for a calculation of body mass index (BMI). A person with a BMI of 30 or higher is considered obese. BRFSS altered its dataset methodology in 2011.

Accordingly, the CDC cautions that estimates of obesity prevalence in 2011 and beyond should not be compared with those before 2011. However, TFAH spokesman Albert Lang told Medscape Medical News that the numbers before 2011 are still valuable in painting broad historical trends.

How States Tip the Scale

Colorado had bragging rights to the nation's lowest obesity rate — 20.2% — in 2015. The highest belonged to Louisiana, where 36.2% of the population is obese. Alabama, Mississippi, and West Virginia tied for second place at 35.6%.

Prevalence of Self-Reported Obesity Among Adults, 2015



The four states that saw their obesity rates decline in 2015 were Minnesota (26.1%), Montana (23.6%), New York (25%), and Ohio (29.8%). Although they were the first states to experience a decrease in the past decade, Washington, DC, saw its obesity rate drop in 2010.

Obesity rates rose in Kansas (34.2%) and Kentucky (34.6%) in 2015. However, they constitute more proof of stabilization, according to The State of Obesity report, because the number of states with annual increases has been steadily falling since 2005, when 49 states experienced higher obesity rates.

As in prior years, certain geographic and demographic variations in America's obesity epidemic held sway in 2015. Of the 11 states with the highest obesity rates, nine are in the South, which posted an overall rate of 31.2%. It was followed by the Midwest (30.7%), the Northeast (26.4%), and the West (25.2%). According to BRFSS data spanning 2013 to 2015, non-Hispanic blacks had the highest prevalence of self-reported obesity (38.1%). Trailing them were Hispanics (31.9%) and non-Hispanic whites (27.6%).

Nationwide, almost 38% of adults were obese for the years 2013-2014, compared with 34.9% in 2011-2012 and 30.5% in 1999-2000, according to the CDC's National Health and Nutrition Examination Survey (NHANES), which offers a different statistical look at the issue than BRFSS.

Policies and Projects to Replicate

Although obesity rates for adults have risen steadily in recent years, those for children and youth aged 2 to 19 years have generally hovered around 17% since 2003-2004, as reported by NHANES. That intransigent statistic isn't encouraging, but others are, according to The State of Obesity report. The prevalence of obesity among children 2 to 5 years of age is declining, for example.

The State of Obesity report also identifies policies and projects that offer hope. A growing number of states — 18 as of now, plus Washington, DC — mandate a minimum amount of physical education for elementary school students. The US Food and Drug Administration has updated the Nutrition Facts panel on packaged foods and beverages to help consumers take charge of their diets. And in Los Angeles, California, farmers' markets are required to accept Supplemental Nutrition Assistance Program (SNAP) cards for payment.

The report singled out private-sector initiatives worthy of emulation as well. In the early 2000s, a nonprofit health system called CentraCare in central Minnesota spearheaded a community effort to get children moving more and eating better. The initiative invested in sidewalks, bike lanes, safe-speed signage, and crossing guard stations to make it easier for children to walk or bike to school. In one year alone, a middle school saw the number of biking and walking students increase by 40%, according to RWJF.

Local grocery stores and one school district also adopted a nutrition scoring system that lets students and their families spot the most nutritious food. The scoring system may be achieving its goal. In the first year, sales of low-scoring yogurt in the St. Cloud area fell 19%, while sales of high-scoring yogurt rose 4%.

One bottom-line number for the initiative led by CentraCare is more convincing. From 2008 to 2015, the obesity rate among 12-year-olds in St. Cloud went from 17% to 13%.

"These signs of progress are pretty exciting because they show that we can halt this epidemic," said Donald Schwarz, MD, MPH, RWJF's vice president of programs, at yesterday's news conference. "But we need to spread these efforts across the country."

The State of Obesity report is available online.

Follow Robert Lowes on Twitter @LowesRobert


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