The spread of the obesity epidemic in the United States, 1991-1998

Context The increasing prevalence of obesity is a major public health conce rn, since obesity is associated with several chronic diseases. Objective To monitor trends in state-specific data and to examine changes i n the prevalence of obesity among adults. Design Cross-sectional random-digit telephone survey (Behavioral Risk Facto r Surveillance System) of noninstitutionalized adults aged 18 years or olde r conducted by the Centers for Disease Control and Prevention and state hea lth departments from 1991 to 1998. Setting States that participated in the Behavioral Risk Factor Surveillance System. Main Outcome Measures Body mass index calculated from self-reported weight and height. Results The prevalence of obesity (defined as a body mass index greater tha n or equal to 30 kg/m(2)) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age group s, races, educational levels; and occurred regardless of smoking status. Th e greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 1 7.8%), and those of Hispanic ethnicity (11.6% to 20.8%), The magnitude of t he increased prevalence varied by region (ranging from 31.9% for mid Atlant ic to 67.2% for South Atlantic, the area with the greatest increases) and b y state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state w ith the greatest increases). Conclusions Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.