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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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