title: The geographic distribution of obesity in the US and the potential regional differences in misreporting of obesity.
abstract: OBJECTIVE
  State-level estimates of obesity based on self-reported height and weight suggest a geographic pattern of greater obesity in the Southeastern US; however, the reliability of the ranking among these estimates assumes errors in self-reporting of height and weight are unrelated to geographic region.
  
  
  METHODS
  Regional and state-level prevalence of obesity (body mass index ≥ 30 kg m(-2) ) for non-Hispanic black and white participants aged 45 and over were estimated from multiple sources: self-reported from the behavioral risk factor surveillance system (BRFSS 2003-2006) (n = 677,425), self-reported and direct measures from the National Health and Nutrition Examination Study (NHANES 2003-2008) (n = 6,615 and 6,138, respectively), and direct measures from the REasons for Geographic and Racial Differences in Stroke (REGARDS 2003-2007) study (n = 30,239).
  
  
  RESULTS
  Data from BRFSS suggest that the highest prevalence of obesity is in the East South Central Census division; however, direct measures suggest higher prevalence in the West North Central and East North Central Census divisions. The regions relative ranking of obesity prevalence differs substantially between self-reported and directly measured height and weight.
  
  
  CONCLUSIONS
  Geographic patterns in the prevalence of obesity based on self-reported height and weight may be misleading, and have implications for current policy proposals.
authors.affiliation: Department of Biostatistics, UAB School of Public Health, Birmingham, Alabama, USA.
authors.forename: Anh
authors.initials: A
authors.lastname: Le
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.forename: David B
authors.initials: DB
authors.lastname: Allison
authors.forename: Reena
authors.initials: R
authors.lastname: Oza-Frank
authors.forename: Olivia
authors.initials: O
authors.lastname: Affuso
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D040343:Behavioral Risk Factor Surveillance System; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D005006:Ethnicity; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D057566:Self Report; D014481:United States / Q000453:epidemiology