预计美国各州成年人肥胖和重度肥胖的流行率。

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

机构信息

From the Center for Health Decision Science (Z.J.W.) and the Departments of Health Policy and Management (S.N.B.) and Social and Behavioral Sciences (A.L.C., J.L.B., C.M.G., C.F., S.L.G.), Harvard T.H. Chan School of Public Health, Boston; and the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C. (M.W.L.).

出版信息

N Engl J Med. 2019 Dec 19;381(25):2440-2450. doi: 10.1056/NEJMsa1909301.

DOI:10.1056/NEJMsa1909301

PMID:31851800

Abstract

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 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).

CONCLUSIONS

Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).

摘要

背景

尽管美国的全国性肥胖症流行情况已得到充分记录，但对于州一级的肥胖情况了解甚少。目前的估计数是基于人们自身报告的身体测量值得出的，这些估计数低估了肥胖症的流行程度，尤其是严重肥胖症。

方法

我们开发了纠正自我报告偏差的方法，并估算了特定州和特定人口亚组的肥胖症流行率类别（体重指数）的趋势和预测值。我们获得了参加行为风险因素监测系统调查（1993-1994 年和 1999-2016 年）的 6264226 名成年人（18 岁或以上）报告的 BMI 数据，并使用参加全国健康和营养检查调查的 57131 名成年人的测量数据对其进行了按分位数特异性自我报告偏差的纠正。我们为每个州和亚组拟合了多项回归，以估算 1990 年至 2030 年期间四个 BMI 类别（体重不足或正常体重（体重以千克为单位除以身高以米为单位，<25）、超重（25 至 <30）、中度肥胖（30 至 <35）和严重肥胖（≥35）的流行率。我们使用 1990 年至 2010 年的数据评估了我们方法的准确性，以预测 2016 年的结果。

结果

我们的方法表明，预测精度很高，到 2030 年，近 1/2 的成年人将肥胖（48.9%；95%置信区间 [CI]，47.7 至 50.1），29 个州的患病率将超过 50%，任何州的患病率都不会低于 35%。预计到 2030 年，将有近 1/4 的成年人患有严重肥胖症（24.2%；95% CI，22.9 至 25.5），25 个州的患病率将超过 25%。我们预测，全国范围内，严重肥胖症可能成为女性（27.6%；95% CI，26.1 至 29.2）、非西班牙裔黑人成年人（31.7%；95% CI，29.9 至 33.4）和低收入成年人（31.7%；95% CI，30.2 至 33.2）中最常见的 BMI 类别。