Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 33

Data on measured weight and height of adults from the nationally representative National Health and Nutrition Examination Survey (NHANES) indicate that the most recent estimate (2017–2018) is that 42.4% of adults in the United States have obesity [4] – far surpassing the 2020 target of 30.5% [8]. This finding represented a significant increase compared to the prevalence in 1999–2000 of 30.5%, but, notably, it was a nonsignificant increase compared to the previous cycle (2015–2016) of 39.6% [4]. The earliest national estimates of obesity prevalence in the United States, from 1959 to 1962, indicated that just 10% of men and 16% of women had obesity at that time [26]. Several studies have demonstrated that there has been an overall shift in the US population distribution for BMI toward the upper end of the BMI distribution [26–28].

There are no notable differences between men and women or according to age group in the overall prevalence of obesity [4]. However, the prevalence of severe obesity (BMI ≥40 kg/m²) is higher among women. In terms of differences by race and Hispanic origin, the prevalence of obesity in the United States is highest among non‐Hispanic black women (56.9%) and lowest among non‐Hispanic Asian women (17.2%). Generally speaking, there is greater variability in the prevalence of obesity among women than among men in the United States and globally. Among US men, there are no significant differences between non‐Hispanic Whites, non‐Hispanic Blacks, and Hispanics – although the prevalence among non‐Hispanic Asian men is significantly lower than these three other population subgroups [4]. This may relate to the fact that US analyses of Asian populations do not use Asian cut‐offs to define obesity. Therefore, the prevalence of obesity appears to be markedly lower.

State‐level obesity levels in the United States are based on the Behavior and Risk Factor Surveillance Survey (BRFSS), which uses self‐reported weight and height collected during telephone surveys to determine BMI. The response rate for BRFSS is also notably lower than that for NHANES, which may result in greater selection bias [17]. Nonetheless, the data are useful for providing insights into the geographical distribution of obesity in the United States. The most recent round of BRFSS (2018) found that no state or territory had a prevalence of obesity less than 20% (Fig. 2.1) [29]. Nine states (Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, and West Virginia) had a prevalence of obesity of 35% or greater [29]. In general, the South (33.6%) and the Midwest (33.1%) had the highest prevalence of obesity, consistent with earlier BRFSS surveys [29].