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Prevalence of physical activity and obesity in US counties, 2001--2011: a road map for action

Prevalence of physical activity and obesity in US counties, 2001--2011: a road map for action

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Published by ABC News Online
This study was published in the open-access, peer-reviewed journal Population Health Metrics.
This study was published in the open-access, peer-reviewed journal Population Health Metrics.

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Categories:Types, Research
Published by: ABC News Online on Jul 11, 2013
Copyright:Attribution Non-commercial


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This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formattedPDF and full text (HTML) versions will be made available soon.
Prevalence of physical activity and obesity in US counties, 2001--2011: a roadmap for action
Population Health Metrics 
:7 doi:10.1186/1478-7954-11-7Laura Dwyer-Lindgren (ladwyer@uw.edu)Greg Freedman (gregdf@uw.edu)Rebecca E Engell (engellr@uw.edu)Thomas D Fleming (tfleming@uw.edu)Stephen S Lim (stevelim@uw.edu)Christopher JL Murray (cjlm@uw.edu)Ali H Mokdad (mokdaa@uw.edu)
Article type
Submission date
10 June 2013
Acceptance date
30 June 2013
Publication date
10 July 2013
Article URL
http://www.pophealthmetrics.com/content/11/1/7This peer-reviewed article can be downloaded, printed and distributed freely for any purposes (seecopyright notice below).Articles in
are listed in PubMed and archived at PubMed Central.For information about publishing your research in
or any BioMed Central journal, go tohttp://www.pophealthmetrics.com/authors/instructions/ For information about other BioMed Central publications go tohttp://www.biomedcentral.com/ 
Population Health Metrics
 © 2013 Dwyer-Lindgren
et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prevalence of physical activity and obesity in UScounties, 2001–2011: a road map for action
Laura Dwyer-Lindgren
 Email: ladwyer@uw.eduGreg Freedman
 Email: gregdf@uw.eduRebecca E Engell
 Email: engellr@uw.eduThomas D Fleming
 Email: tfleming@uw.eduStephen S Lim
 Email: stevelim@uw.eduChristopher JL Murray
 Email: cjlm@uw.eduAli H Mokdad
Corresponding authorEmail: mokdaa@uw.edu
Institute for Health Metrics and Evaluation, University of Washington, 2301 5thAvenue, Suite 600, Seattle, WA, USA
Obesity and physical inactivity are associated with several chronic conditions, increasedmedical care costs, and premature death.
We used the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the NationalHealth and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. About 3.7 million adults aged 20 years orolder participated in the BRFSS from 2000 to 2011, and 30,000 adults aged 20 or olderparticipated in NHANES from 1999 to 2010. We calculated body mass index (BMI) fromself-reported weight and height in the BRFSS and adjusted for self-reporting bias usingNHANES. We calculated self-reported physical activity—both any physical activity andphysical activity meeting recommended levels—from self-reported data in the BRFSS. Weused validated small area estimation methods to generate estimates of obesity and physicalactivity prevalence for each county annually for 2001 to 2011.
Our results showed an increase in the prevalence of sufficient physical activity from 2001 to2009. Levels were generally higher in men than in women, but increases were greater inwomen than men. Counties in Kentucky, Florida, Georgia, and California reported the largestgains. This increase in level of activity was matched by an increase in obesity in almost allcounties during the same time period. There was a low correlation between level of physicalactivity and obesity in US counties. From 2001 to 2009, controlling for changes in poverty,unemployment, number of doctors per 100,000 population, percent rural, and baseline levelsof obesity, for every 1 percentage point increase in physical activity prevalence, obesityprevalence was 0.11 percentage points lower.
Our study showed that increased physical activity alone has a small impact on obesityprevalence at the county level in the US. Indeed, the rise in physical activity levels will havea positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes. Other changes such as reduction in caloric intake arelikely needed to curb the obesity epidemic and its burden.
Physical activity, Obesity, Small area measurement, US Counties
Obesity and lack of physical activity are associated with several chronic conditions such asheart disease and diabetes, increased medical care costs, and premature death [1-3]. Obesityhas increased rapidly during the past years; however, recent studies reported a decline in therate of increase [4,5]. Recent studies reported a small increase in physical activity [6-8].Levels of obesity and physical activity are likely to vary substantially across states andcounties; different local governments have pursued a variety of approaches to address bothrisks. Understanding local trends in physical activity and obesity are important inputs toidentifying successful and less successful strategies. Public health is local, and only local datawill drive policy and action.To examine the county-level changes in physical activity and obesity, we used data from theBehavioral Risk Factor Surveillance System (BRFSS) in the United States. We used datafrom the National Health and Nutrition Examination Survey (NHANES) to adjust BRFSSdata for self-reporting bias in height and weight.
The BRFSS is a state-based surveillance system that is operated by state health departmentsin collaboration with the Centers for Disease Control and Prevention. A detailed descriptionof the survey methods is available elsewhere [9]. Briefly, the BRFSS collects data on manyof the behaviors and conditions that place adults (aged
18 years) at risk for chronic disease.Trained interviewers collect data monthly, using an independent probability sample of 

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