A new report by the Trust for America’s Health and the Robert Wood Johnson Foundation finds that about 28 percent of Iowan adults are obese, an increase of 73 percent since 1995. Because the obesity rate has grown even more quickly in many other states, however, Iowa fell from the 13th most obese state in 1995 to the 20th most obese now. In some health categories correlated with obesity, Iowa scored relatively well compared to the rest of the country, but in others Iowa was near the bottom.
Follow me after the jump for key findings and excerpts from F as in Fat: How Obesity Threatens America’s Future 2011.
The full F as in Fat report is here (pdf). Some depressing reading from the summary findings:
Twenty years ago, no state had an obesity rate above 15 percent. Today, more than two out of three states, 38 total, have obesity rates over 25 percent, and just one has a rate lower than 20 percent. […]
“Today, the state with the lowest obesity rate would have had the highest rate in 1995,” said Jeff Levi, Ph.D., executive director of TFAH. “There was a clear tipping point in our national weight gain over the last twenty years, and we can’t afford to ignore the impact obesity has on our health and corresponding health care spending.” […]
Obesity has long been associated with other severe health problems, including diabetes and high blood pressure. New data in the report show how rates of both also have risen dramatically over the last two decades. Since 1995, diabetes rates have doubled in eight states. Then, only four states had diabetes rates above 6 percent. Now, 43 states have diabetes rates over 7 percent, and 32 have rates above 8 percent. […]
Racial and ethnic minority adults, and those with less education or who make less money, continue to have the highest overall obesity rates […].
Explanation of the methodology, from page 17:
The analysis in F as in Fat compares data from the Behavioral Risk Factor Surveillance System (BRFSS), the largest phone survey in the world. Researchers compared data from three-year periods 2007 to 2009 and 2008 to 2010 which ensures that the sample sizes are large enough to compare states over time. For a state rate to increase, the change must reach the level of statistical significance (p<0.05) for that state’s particular sample size. […]
The data are based on telephone surveys by state health departments, with assistance from the CDC [Centers for Disease Control]. Surveys ask people to report their weight and height, which is used to calculate BMI. Experts say rates of overweight and obesity are probably slightly higher than shown by the data because people tend to underreport their weight and exaggerate their height.
Another note on methodology: for F as in Fat, “overweight” adults are those with a body mass index (BMI) of 25 to 29.9. “Obese” adults are those with a BMI of 30 or more. There are known problems with using BMI as a marker of obesity; for one thing, very fit people with lots of muscle can have high BMIs. But I doubt many Iowans walking around with BMIs over 30 are bodybuilders or professional athletes.
Page 12 of the report includes a chart showing how Iowa ranks on several indicators. The obesity rate for Iowa adults is 28.1 percent, plus or minus 0.9 (with a 95 percent confidence interval). An estimated 65.9 percent of Iowans are either overweight or obese. No state had less than 50 percent of adults estimated to be either overweight or obese.
The fact page on Iowa notes that obesity has increased by 73 percent here since 1995, when an estimated 16.2 percent of Iowa adults were obese. Iowa’s obesity ranking has fallen only because obesity rates have doubled or nearly doubled in 17 other states.
Approximately 7.4 percent of Iowa adults are estimated to be diabetic, putting us in 38th place nationwide. About 24.7 percent of Iowa adults lead sedentary lives, putting us in 22nd place for physical inactivity. The hypertension (high blood pressure) rate for Iowa adults is about 26.5 percent, 31st in the country.
Charts showing obesity rates by gender and ethnicity for each state are on pages 18 and 19 of the full report. In Iowa, as in most states, the obesity rate for men (30.0 percent) was higher than that for women (26.1 percent). The obesity rate for whites (28.1 percent) was lower than that for African-Americans (33.0 percent) and Latinos (29.5 percent).
I was shocked to see that Iowa has the 9th lowest rate of fruit and vegetable consumption for adults (page 27 of the report). Only 19.3 percent of Iowans are estimated to be eating the recommended five or more servings of fruits and vegetables daily.
Another surprise was that Iowa has the seventh-highest rate of exclusive breastfeeding at six months of age (21.2 percent). In the lowest-scoring states, fewer than 10 percent of infants were receiving exclusively breast milk at six months (page 30 of the report). The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life. A White House task force on obesity endorsed several policies to increase breastfeeding rates as a way to reduce the number of overweight children.
F as in Fat also looked at state policies or laws that have the potential to prevent obesity. Iowa doesn’t do as well as some states on nutritional standards or physical activity requirements in schools (page 42). Iowa is one of 26 states with a Farm to School program, but it hasn’t accomplished much in terms of getting locally-grown produce into school lunches. Iowa taxes soda or sweetened beverages, but doesn’t have other laws in place that promote healthy lifestyles (such as “complete streets” or menu labeling requirements). Democratic State Representative Chuck Isenhart of Dubuque has introduced a complete streets bill in the Iowa House, but it hasn’t advanced. That’s too bad, because research has repeatedly shown that people tend to be less overweight if they live in neighborhoods where it’s safe to walk or ride a bike.
Research on menu labeling is inconclusive on whether it steers consumers toward lower-calorie options. I know it has affected my choices the few times I’ve eaten at restaurants that provide calorie counts, but according to this report, I’m not a typical customer.
“Combating the obesity epidemic” is one of the top ten priorities for preventing illness and chronic disease, according to the Trust for America’s Health. We have long known that obesity and the illnesses with which it is correlated contribute to high health care costs. F as in Fat identified other problems related to the growing prevalence of overweight children and adults. For instance, page 16 of the report describes how obesity “has the potential to undermine national security and public safety” because the epidemic reduces “the number of recruits eligible to join the military or become firefighters and police officers.”
F as in Fat makes various federal policy recommendations. None of them are likely to happen when cuts in domestic spending are all the rage for President Barack Obama and Republican leaders in Congress. If you want to read the good advice Washington politicians will ignore, scroll to the bottom of the summary page or read pages 71 through 79 of the full report.
Share any relevant thoughts in this thread.