Regional disparities in obesity prevalence in the United States: A spatial regime analysis

Myers, Candice A.; Slack, Tim; Martin, Corby K.; Broyles, Stephanie T.; Heymsfield, Steven B.

doi:10.1002/oby.20963

Cited by 80 publications

(86 citation statements)

References 30 publications

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“…The large-scale and national scope of this work is particularly valuable, given known geographic variability in obesity prevalence. 46 Furthermore, since the bulk of prior weight management research has focused on women (especially white women 32,33 ), our ability to examine obesity in several populations that previously received little attention adds to the general scientific literature in this field. An additional strength is that obesity case-finding in this paper relied on BMI values calculated using height and weight from the VHA national electronic health record rather than ICD-9 diagnoses.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

et al. 2017

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BACKGROUND: Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services. OBJECTIVES: To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients. DESIGN: Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant. PARTICIPANTS: Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients). MAIN MEASURES: We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic-and comorbidity-based subpopulations. KEY RESULTS: Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%). CONCLUSIONS: Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. Highrisk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/ Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.

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Section: Discussionmentioning

confidence: 99%

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

et al. 2017

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“…Six factors were included1: percentage of county residents that was non-Hispanic white (2008),2 percentage of county residents that was non-Hispanic black (2008),3 county median household income (2008),4 county poverty rate (2008),5 census-tract population size (2000) and6 Rural–Urban Commuting Area Code (RUCA) (2000). RUCA codes were categorised and coded as 1=urban, 2=large rural city/town, 3=small rural town and 4=isolated small rural town, according to Categorization A by the University of Washington Rural Health Research Center 29…”

Section: Methodsmentioning

confidence: 99%

Association of community food environment and obesity among US adults: a geographical information system analysis

Chen

Creger

Howard

et al. 2018

J Epidemiol Community Health

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BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant exposure as food environment indicator, and (2) not accounting for non-stationarity assumption. This study aimed to describe the spatial distribution of obesity and examine the association between community food environment and obesity, and the variation of magnitude and direction of this association across the USA.MethodsData from 20 897 adults who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment between January 2003 and October 2007 were eligible in analysis. Hot Spot analysis was used to assess the spatial distribution of obesity. The association between community food environment and obesity and the variation of this association across the USA were examined using global ordinary least squares regression and local geographically weighted regression.ResultsHigher body mass index (BMI) clusters were more likely to locate in socioeconomically disadvantaged, rural, minority neighbourhoods with a smaller population size, while lower BMI clusters were more likely to appear in more affluent, urban neighbourhoods with a higher percentage of non-Hispanic white residences. There was an overall significant, inverse association between community food environment and obesity (β=−0.0210; p<0.0001). Moreover, the magnitude and direction of this association varied significantly across the US regions.ConclusionsThe findings underscored the need for geographically tailored public health interventions and policies to address unique local food environment issues to achieve maximum effects on obesity prevention.

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“…Recently, deprived residential environments have been found to contribute to the gender inequality (14). Little work has been done to further explore the distribution of gender inequality using spatial units larger than neighborhoods, though geographic inequalities in overall obesity prevalence have been well documented at larger geographies (4, 15). Together this evidence indicates that spatially influenced processes (e.g.…”

Section: Introductionmentioning

confidence: 99%

The spatial distribution of gender differences in obesity prevalence differs from overall obesity prevalence among US adults

Gartner

Taber

Hirsch

et al. 2016

Annals of Epidemiology

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Purpose While obesity disparities between racial and socioeconomic groups have been well characterized, those based on gender and geography have not been as thoroughly documented. This study describes obesity prevalence by state, gender, and race/ethnicity to (1) characterize obesity gender inequality, (2) determine if the geographic distribution of inequality is spatially clustered and (3) contrast the spatial clustering patterns of obesity gender inequality with overall obesity prevalence. Methods Data from the Centers for Disease Control and Prevention’s 2013 Behavioral Risk Factor Surveillance System (BRFSS) were used to calculate state-specific obesity prevalence and gender inequality measures. Global and Local Moran’s Indices were calculated to determine spatial autocorrelation. Results Age-adjusted, state-specific obesity prevalence difference and ratio measures show spatial autocorrelation (z-score=4.89, p-value <0.001). Local Moran’s Indices indicate the spatial distributions of obesity prevalence and obesity gender inequalities are not the same. High and low values of obesity prevalence and gender inequalities cluster in different areas of the U.S. Conclusion Clustering of gender inequality suggests that spatial processes operating at the state level, such as occupational or physical activity policies or social norms, are involved in the etiology of the inequality and necessitate further attention to the determinates of obesity gender inequality.

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Regional disparities in obesity prevalence in the United States: A spatial regime analysis

Cited by 80 publications

References 30 publications

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

Association of community food environment and obesity among US adults: a geographical information system analysis

The spatial distribution of gender differences in obesity prevalence differs from overall obesity prevalence among US adults

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