Change in Obesity Prevalence across the United States Is Influenced by Recreational and Healthcare Contexts, Food Environments, and Hispanic Populations

ObjectiveTo examine change in county-level adult obesity prevalence between 2004 and 2009 and identify associated community characteristics.MethodsChange in county-level adult (≥20 years) obesity prevalence was calculated for a 5-year period (2004–2009). Community measures of economic, healthcare, recreational, food environment, population structure, and education contexts were also calculated. Regression analysis was used to assess community characteristics associated (pResultsMean±SD change in obesity prevalence was 5.1±2.4%. Obesity prevalence decreased in 1.4% (n = 44) and increased in 98% (n = 3,060) of counties from 2004–2009. Results showed that both baseline levels and increases in physically inactive adults were associated with greater increases in obesity prevalence, while baseline levels of and increases in physician density and grocery store/supercenter density were related to smaller increases in obesity rates. Baseline levels of the Hispanic population share were negatively linked to changing obesity levels, while places with greater Hispanic population growth saw greater increases in obesity.ConclusionsMost counties in the U.S. experienced increases in adult obesity prevalence from 2004 to 2009. Findings suggest that community-based interventions targeting adult obesity need to incorporate a range of community factors, such as levels of physical inactivity, access to physicians, availability of food outlets, and ethnic/racial population composition.研究目标：考察2004至2009年间县级层面成人肥胖患病率的变化情况，并识别与之相关的社区特征。研究方法：本研究测算2004-2009这5年间县级≥20岁成人的肥胖患病率变化，同时测算社区层面的经济、医疗保健、休闲环境、食品环境、人口结构及教育背景相关指标。采用回归分析评估与肥胖患病率变化存在统计学关联（p<0.05）的社区特征。研究结果：肥胖患病率的平均变化值±标准差为5.1±2.4%。2004至2009年间，1.4%的县级行政区（n=44）肥胖患病率出现下降，98%的县级行政区（n=3060）肥胖患病率呈上升趋势。结果显示，成人身体活动不足的基线水平及其增幅均与肥胖患病率更大幅度的上升显著相关；而医师密度、食品杂货店/超级购物中心密度的基线水平及其增幅则与肥胖患病率较小幅度的上升相关。西班牙裔人口占比的基线水平与肥胖患病率变化呈负相关，而西班牙裔人口增长更快的地区，其肥胖患病率上升幅度也更大。研究结论：2004至2009年间，美国绝大多数县级行政区的成人肥胖患病率均呈上升态势。本研究结果表明，针对成人肥胖的社区干预措施需纳入多维度社区影响因素，包括成人身体活动不足水平、医师可及性、食品零售网点可获得性以及种族/民族人口构成等。