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

Objective
To examine change in county-level adult obesity prevalence between 2004 and 2009 and identify associated community characteristics.
Methods
Change 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 (p<0.01) with change in adult obesity prevalence.
Results
Mean±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.
Conclusions
Most 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：分析2004至2009年县级成年人群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：针对2004至2009年这5年的县级成年（年满20周岁）人群肥胖患病率变化进行测算；同时测算经济、医疗、休闲、食品环境、人口结构及教育背景维度的社区特征指标。采用回归分析评估与成年肥胖患病率变化存在显著关联（p<0.01）的社区特征。
研究结果：肥胖患病率的变化均值±标准差为5.1±2.4%。2004至2009年间，全美1.4%的县（n=44）肥胖患病率有所下降，98%的县（n=3060）则出现上升。结果显示，成年人群身体活动不足的基线水平及其增幅均与肥胖患病率的更大增幅显著相关；而医师密度、杂货店/超级购物中心密度的基线水平及其增幅则与肥胖率增幅较小相关。西班牙裔人口占比的基线水平与肥胖水平变化呈负相关，而西班牙裔人口增长更快的地区，肥胖患病率增幅也更大。
研究结论：2004至2009年，美国多数县级区域的成年肥胖患病率均呈上升趋势。本研究结果表明，针对成年肥胖的社区干预措施需纳入多维度社区影响因素，包括身体活动不足水平、医师可及性、食品门店供给情况以及种族/民族人口构成。