title: The geographic concentration of US adult obesity prevalence and associated social, economic, and environmental factors.
abstract: OBJECTIVE
  This study used spatial statistical methods to test the hypotheses that county-level adult obesity prevalence in the United States is (1) regionally concentrated at significant levels, and (2) linked to local-level factors, after controlling for state-level effects.
  
  
  METHODS
  Data were obtained from the Centers for Disease Control and Prevention and other secondary sources. The units of analysis were counties. The dependent variable was the age-adjusted percentage of adults who were obese in 2009 (body mass index >30 kg/m2).
  
  
  RESULTS
  The prevalence of county-level obesity varied from 13.5% to 47.9% with a mean of 30.3%. Obesity prevalence across counties was not spatially random: 15.8% belonged to high-obesity regions and 13.5% belonged to low-obesity regions. Obesity was positively associated with unemployment, outpatient healthcare visits, physical inactivity, female-headed families, black populations, and less education. Obesity was negatively correlated with physician numbers, natural amenities, percent ≥65 years, Hispanic populations, and larger population size. A number of variables were notable for not reaching significance after controlling for other factors, including poverty and food environment measures.
  
  
  CONCLUSIONS
  The findings demonstrate the importance of local-level factors in explaining geographic variation in obesity prevalence, and thus hold implications for geographically targeted interventions to combat the obesity epidemic.
authors: Louisiana State University, Baton Rouge, Louisiana, USA.
authors: Tim
authors: T
authors: Slack
authors: Candice A
authors: CA
authors: Myers
authors: Corby K
authors: CK
authors: Martin
authors: Steven B
authors: SB
authors: Heymsfield
mesh_terms: D000328:Adult; D001741:Black or African American; D015992:Body Mass Index; D002487:Centers for Disease Control and Prevention, U.S.; D016208:Databases, Factual; D004777:Environment; D005260:Female; D005843:Geography; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult