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Prevalence of Overweight in Selected States -- Behavioral
Risk Factor Surveillance, 1986
Since 1984, 26 states* have been gathering data on health
practices and behaviors from adults (greater than or equal to18
years
of age) as part of the Behavioral Risk Factor Surveillance System
(BRFSS) (1). These data are collected monthly by telephone
interview
and include information on height and body weight. State-specific
estimates of the prevalence of overweight for 1986 have been
derived
from analysis of this information. The definition of overweight
used
for this study** was based on the Body Mass Index (BMI = Weight
(kg)/
Height (m)2), which is derived from height and weight data from the
Second National Health and Nutrition Examination Survey
(NHANES-NII)
carried out by the National Center for Health Statistics (NCHS)
between
1976 and 1980. The BMI was used because it has a high correlation
with
body weight and virtually no correlation with height (3). For the
BRFSS
study, overweight for men was defined as a BMI greater than or
equal
to27.8, and overweight for women, as a BMI greater than or equal
to27.3.
These values represent the sex-specific 85th percentile of BMI for
U.S.
adults 20 to 29 years of age. The highest prevalence of
overweight
for a total population (24%) was observed in West Virginia; the
lowest
(14%) was observed in both Utah and Hawaii (Table 1). For men, the
highest prevalence of overweight (24%) was reported from North
Dakota;
and the lowest (14%) was reported from Hawaii. For women, the
highest
prevalence (26%) was observed in West Virginia and the District of
Columbia; and the lowest (12%), in Arizona and Utah. No clear trend
in
prevalence of overweight was observed among those states that had
participated in the BRFSS for the full period 1984-1986. Reported
by:
The 1986 State Behavioral Risk Factor Surveillance System
Coordinators.
Div of Nutrition, Center for Health Promotion and Education, CDC. Editorial Note
Editorial Note: state to state may be due to several factors that
are
known to be related to overweight and that may differ among state
populations. These factors include age, race, socioeconomic status,
diet, and exercise practices. Sampling error may also explain some
of
the observed differences. The lack of a perceptible trend between
1984
and 1986 in the prevalence of overweight in these states was
expected
since other studies of trends in overweight have yielded similar
results (4,5). The criteria currently used to define overweight
in
the BRFSS have been adopted for several reasons. First, they have
been
developed from observed differences. The lack of a perceptible
trend
between 1984 and 1986 in the prevalence of overweight in these
states
was expected since other studies of trends in overweight have
yielded
similar results (4,5). The criteria currently used to define
overweight in the BRFSS have been adopted for several reasons.
First,
they have been developed from a representative sample of the U.S.
population. Second, the criteria use persons 20 to 29 years of age,
the
leanest age group among adults, as the referent group (3).
Virtually
all of the age-related increase in body weight that occurs among
adults
is attributable to body fat. Third, these criteria are being used
by
NCHS and are also used to monitor progress toward the 1990
Objectives
for the Nation regarding overweight (6). The estimates of
overweight
from the BRFSS are generally lower than those obtained in other
surveys.
During 1986, the median prevalence for overweight among the
participating states was 20% for men and 19% for women. National
data
on the prevalence of overweight, based on actual measurement rather
than on self-reported data from telephone interviews, are available
from the 1976-1980 NHANES-NII. When the NCHS reference was used,
24.2%
of adult men and 27.1% of adult women were overweight (3). Self-
reported data from face-to-face interviews in the 1985 Health
Interview
Survey indicated that 23.5% of adult men and 24.2% of adult women
were
overweight (7). The BRFSS and the NHANES-NII results may differ
because
the BRFSS does not include all states, or the discrepancy may
indicate
greater underreporting of body weight over the telephone than in
face-
to-face interviews (8). The 1990 objective regarding the
prevalence
of overweight was recently revised to state: "By 1990, the
prevalence
of overweight (BMI of 27.8 or higher for men and 27.3 for women)
among
the U.S. adult population should be reduced, without impairment of
nutritional status, to approximately 18% of men and 21% of women"
(6).
Because this objective is based on the prevalence of overweight
derived
from actual measurements, data from the upcoming NHANES-NIII will
be
required to assess progress. State health departments participating
in
the BRFSS can set similar objectives and can monitor their progress
through telephone surveys. However, when interpreting their
results,
states must bear in mind the potential effects of telephone survey
methodology on estimates of prevalence. The second 1990
objective
related to overweight states, "By 1990, 50% of the overweight
population should have adopted weight loss regimens combining an
appropriate balance of diet and physical activity" (6). This
objective
is supported by several studies that have found diet and exercise
together to be more effective for weight loss than diet alone (9).
Forty percent of overweight persons who reported trying to lose
weight
in the 1986 BRFSS were following this objective. References 1.
Centers
for Disease Control. Behavioral risk factor
surveillance--selected
states, 1986. MMWR 1987;36:252-4. 2. The Society of Actuaries.
Build
and blood pressure study 1959. Vol I and II. Chicago: The
Society of
Actuaries, 1959. 3. Najjar MF, Rowland M. Anthropometric reference
data and prevalence of overweight--United States, 1976-80.
Hyattsville, Maryland: US Department of Health and Human
Services,
Public Health Service, surveillance--selected states, 1986. MMWR
1987;36:252-4. 2. The Society of Actuaries. Build and blood
pressure
study 1959. Vol I and II. Chicago: The Society of Actuaries,
1959. 3.
Najjar MF, Rowland M. Anthropometric reference data and
prevalence
of overweight--United States, 1976-80. Hyattsville, Maryland:
US
Department of Health and Human Services, Public Health Service,
1987. DHHS publication no. (PHS)87-1688. (Vital and health
statistics; series 11, no. 238). 4. Forman MR, Trowbridge FL,
Gentry EM, Marks JS, Hogelin GC. Overweight adults in the United
States: the behavioral risk factor surveys. Am J Clin Nutr
1986;44:
410-6. 5. Van Itallie TB. Health implications of overweight and
obesity in the United States. Ann Intern Med 1985;103(suppl 6,
pt 2):
983-8. 6. Public Health Service. The 1990 health objectives for
the
nation: a midcourse review. Washington, DC: US Department of
Health
and Human Services, Public Health Service, 1986. 7. Stephenson
MG,
Levy AS, Sass NL, McGarvey WE. 1985 NHIS findings: nutrition
knowledge and baseline data for the weight-loss objectives.
Public
Health Rep 1987;102:61-7. 8. Millar WJ. Distribution of body
weight
and height: comparison of estimates based on self-reported and
observed measures. J Epidemiol Community Health 1986;40:319-23.
9.
Bjorntorp P. Interrelation of physical activity and nutrition on
obesity. In: White PL, Mondeika T, eds. Diet and exercise:
synergism in health maintenance. Chicago: American Medical
Association, 1982:91-8. *Includes the District of Columbia.
**Previous BRFSS estimates of the prevalence of overweight were
derived
from the Metropolitan Life Insurance Company's "Desirable Weight
Tables" (greater than or equal to120% of desirable weight)
synergism
in health maintenance. Chicago: American Medical Association,
1982:
91-8. *Includes the District of Columbia. **Previous BRFSS
estimates of
the prevalence of overweight were derived from the Metropolitan
Life
Insurance Company's "Desirable Weight Tables" (greater than or
equal
to120% of desirable weight) (2). 20 to 29 years of airtually all of
the
age-related increase in bod
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