Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity

作者：Zachary J. Ward, Sara N. Bleich, Angie L.I. Cradock, Jessica L. Barrett, Catherine M. Giles, Chasmine N. Flax, Michael William Long, Steven L. Gortmaker · 发表于：New England Journal of Medicine · 年份：2019 · DOI：10.1056/nejmsa1909301 · 被引用次数：2051 · 研究领域：Obesity, Physical Activity, Diet、Bariatric Surgery and Outcomes、Obesity and Health Practices

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than...