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Report: Hawaii ranks 5th lowest in adult obesity


Adult obesity rates increased in 16 states in the past year and did not decline in any state, according to “F as in Fat: How Obesity Threatens America’s Future 2011,” a report from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

Hawaii has the fifth lowest rate in the latest report, with 23.1 percent of its adult population considered obese. However, the state has doubled its numbers in 15 years, when it ranked the least obese in the nation.

Twelve states now have obesity rates above 30 percent. Four years ago, only one state was above 30 percent.

The obesity epidemic continues to be most dramatic in the South, which includes nine of the 10 states with the highest adult obesity rates. States in the Northeast and West tend to have lower rates.

Mississippi maintained the highest adult obesity rate for the seventh year in a row, and Colorado has the lowest obesity rate and is the only state with a rate under 20 percent.

This year, for the first time, the report examined how the obesity epidemic has grown over the past two decades.

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 exceeding 25 percent, and just one has a rate lower than 20 percent.

Since 1995, when data was available for every state, obesity rates have doubled in seven states and increased by at least 90 percent in 10 others.

Obesity rates have grown fastest in Oklahoma, Alabama, and Tennessee, and slowest in Washington, D.C., Colorado, and Connecticut.

“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.

Twenty years ago, 37 states had hypertension rates over 20 percent. Now, every state is over 20 percent, with nine over 30 percent.

Racial and ethnic minority adults, and those with less education or who make less money, continue to have the highest overall obesity rates:

* Adult obesity rates for blacks topped 40 percent in 15 states, 35 percent in 35 states, and 30 percent in 42 states and D.C.

* Rates of adult obesity among Latinos were above 35 percent in four states (Mississippi, North Dakota, South Carolina, and Texas) and at least 30 percent in 23 states.

* Meanwhile, rates of adult obesity for whites topped 30 percent in just four states (Kentucky, Mississippi, Tennessee, and West Virginia) and no state had a rate higher than 32.1 percent.

* Nearly 33 percent of adults who did not graduate high school are obese, compared with 21.5 percent of those who graduated from college or technical college.

* More than 33 percent of adults who earn less than $15,000 per year were obese, compared with 24.6 percent of those who earn at least $50,000 per year.

“The information in this report should spur us all — individuals and policymakers alike — to redouble our efforts to reverse this debilitating and costly epidemic,” said Risa Lavizzo-Mourey, M.D., M.B.A, RWJF president and CEO. “Changing policies is an important way to provide children and families with vital resources and opportunities to make healthier choices easier in their day-to-day lives.”

This year’s report also includes a series of recommendations from TFAH and RWJF on how policymakers and the food and beverage industry can help reverse the obesity epidemic.

The recommendations for policymakers include:

* Protecting the Prevention and Public Health Fund: TFAH and RWJF recommend that the fund not be cut, that a significant portion be used for obesity prevention, and that it not be used to offset or justify cuts to other Center for Disease Control and Prevention (CDC) programs.

* Implementing the Healthy, Hunger-Free Kids Act: TFAH and RWJF recommend that the U.S. Department of Agriculture (USDA) issue a final rule as swiftly as possible regarding school meal regulations and issue strong standards for so-called “competitive” food and beverages — those sold outside of school meal programs, through a la carte lines, vending machines and school stores.

* Implementing the National Physical Activity Plan: TFAH and RWJF recommend full implementation of the policies, programs, and initiatives outlined in the National Physical Activity Plan. This includes a grassroots advocacy effort; a public education program; a national resource center; a policy development and research center; and dissemination of best practices.

* Restoring Cuts to Vital Programs: TFAH and RWJF recommend that the $833 million in cuts made in the fiscal year 2011 continuing resolution be restored and that programs to improve nutrition in child care settings and nutrition assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children be fully funded and carried out. If fully funded these programs could have a major impact on reducing obesity.

“Creating healthy environments is key to reversing the obesity epidemic, particularly for children,” said Lavizzo-Mourey. “When children have safe places to walk, bike and play in their communities, they’re more likely to be active and less likely to be obese. It’s the same with healthy food: when communities have access to healthy affordable foods, families eat better.”

Additionally, for the food and beverage industry, TFAH and RWJF recommend that industry should adopt strong, consistent standards for food marketing similar to those proposed in April 2011 by the Interagency Working Group, composed of representatives from four federal agencies — the Federal Trade Commission, CDC, Food and Drug Administration and the USDA — and work to implement the other recommendations set forth in the 2005 Institute of Medicine report on food marketing to children and youth.


Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity. Rankings are based on combining three years of data (2007-2009) from the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to “stabilize” data for comparison purposes. This methodology, recommended by the CDC, compensates for any potential anomalies or usual changes due to the specific sample in any given year in any given state. States with statistically significant (p<0.05) increases for one year are noted with an asterisk (*), states with statistically significant increases for two years in a row are noted with two asterisks (**), states with statistically significant increases for three years in a row are noted with three asterisks (***). Additional information about methodologies and confidence intervals is available in the report. Individuals with a body mass index (BMI) (a calculation based on weight and height ratios) of 30 or higher are considered obese. 1. Mississippi (34.4%); 2. Alabama (32.3%); 3. West Virginia* (32.2%); 4. Tennessee (31.9%); 5. Louisiana (31.6%); 6. Kentucky** (31.5%); 7. Oklahoma** (31.4%); 8. South Carolina* (30.9%); 9. Arkansas (30.6%); 10. Michigan* (30.5%); 11. Missouri* (30.3%); 12. Texas** (30.1%); 13. Ohio (29.6%); 14. North Carolina (29.4%); 15. Indiana* (29.1%); 16. Kansas** (29.0%); 17. (tie) Georgia (28.7%); and South Dakota (28.7%); 19. Pennsylvania (28.5%); 20. Iowa (28.1%); 21. (tie) Delaware (28.0%); and North Dakota (28.0%); 23. Illinois** (27.7%); 24. Nebraska (27.6%); 25. Wisconsin (27.4%); 26. Maryland (27.1%); 27. Maine** (26.5%); 28. Washington (26.4%); 29. Florida** (26.1%); 30. (tie) Alaska (25.9%); and Virginia (25.9%); 32. Idaho (25.7%); 33. (tie) New Hampshire (25.6%); and New Mexico (25.6%); 35. (tie) Arizona (25.4%); Oregon (25.4%); and Wyoming (25.4%); 38. Minnesota (25.3%); 39. Nevada (25.0%); 40. California (24.8%); 41. New York (24.7%); 42. Rhode Island** (24.3%); 43. New Jersey (24.1%); 44. Montana (23.8%); 45. Vermont** (23.5%); 46. Utah (23.4%); 47. Hawaii (23.1%); 48. Massachusetts** (22.3%); 49. Connecticut (21.8%); 50. District of Columbia (21.7%); 51. Colorado* (19.8%). STATE-BY-STATE ADULT OBESITY RANKINGS IN 1995

Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity. Data for this analysis was obtained from the Behavioral Risk Factor Surveillance System (BRFSS) dataset (publicly available on the web at States that have increased their obesity rate by at least 80 percent since 1995 are noted with an asterisk (*), states that have increased their obesity rate by at least 90 percent are noted with two asterisks (**), states that have doubled their obesity rate over the past 15 years are noted with three asterisks (***). Additional information about methodologies and confidence intervals is available in the report. Individuals with a body mass index (BMI) (a calculation based on weight and height ratios) of 30 or higher are considered obese.

1. Mississippi (19.4%); 2. Indiana (18.3%); 3. West Virginia* (17.7%); 4. Michigan (17.2%); 5. (tie) Arkansas* (17.0%); and Louisiana* (17.0%); 7. Missouri (16.9%); 8. (tie) Kentucky** (16.6%); and South Carolina* (16.6%); 10. (tie) Tennessee** (16.4%); and Wisconsin (16.4%); 12. North Carolina* (16.3%); 13. (tie) Iowa (16.2%); and Pennsylvania (16.2%); 15. Ohio* (16.1%); 16. Texas* (16.0%); 17. (tie) Alabama*** (15.7%); and Alaska (15.7%); 19. Illinois* (15.3%); 20 (tie) Delaware* (15.2%); Nebraska* (15.2%); and North Dakota* (15.2%); 23. Maryland* (15.0%); 24. Minnesota (14.6%); 25. South Dakota** (14.5%); 26. (tie) Florida* (14.3%); Maine* (14.3%); and New York (14.3%); 29. Virginia* (14.2%); 30. Idaho* (14.1%); 31. Wyoming* (14.0%); 32. (tie) California (13.9%); and Washington** (13.9%); 34. Georgia*** (13.8%); 35. Oregon* (13.6%); 36. Kansas*** (13.5%); 37. Vermont (13.4%); 38. Nevada** (13.1%); 39. Montana* (13.0%); 40. (tie) New Hampshire (12.9%); and Oklahoma*** (12.9%); 42. (tie) District of Columbia (12.8%); and Rhode Island** (12.8%); 44. Arizona*** (12.6%); 45. New Jersey** (12.3%); 46. Utah** (12.0%); 47. Connecticut* (11.8%); 48 (tie) Massachusetts** (11.6%); and New Mexico*** (11.6%); 50. Colorado* (10.7%); 51. Hawaii*** (10.6%).


Note: 1 = Fastest rate of growth in adult obesity, 51 = lowest rate of growth in adult obesity. Data for this analysis was obtained from the Behavioral Risk Factor Surveillance System (BRFSS) dataset (publicly available on the web at

1. Oklahoma; 2. Alabama; 3. Tennessee; 4. Kansas; 5. Mississippi; 6. (tie) Georgia; and Kentucky; 8. (tie) Louisiana; and West Virginia; 10. South Carolina; 11. South Dakota; 12. (tie) New Mexico; and Texas; 14. Arkansas; 15. Ohio; 16. Missouri; 17. Michigan; 18. North Carolina; 19. (tie) Arizona; Delaware; and North Dakota; 22. New Hampshire; 23. (tie) Hawaii; and Washington; 25. (tie) Illinois and Nebraska; 27. Pennsylvania; 28. Maine; 29. Maryland; 30. Nevada; 31. Iowa; 32. (tie) Florida; New Jersey; and Oregon; 35. Virginia; 36. (tie) Idaho; and Rhode Island; 38. Wyoming; 39. Utah; 40. Wisconsin; 41. California 42. (tie) Indiana; and Montana; 44. (tie) Massachusetts; and Minnesota; 46. New York; 47. Alaska; 48. Vermont; 49. Connecticut; 50. Colorado; 51. District of Columbia.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. In 2007, the Foundation committed $500 million toward its goal of reversing the childhood obesity epidemic by 2015. This is the largest commitment any foundation has made to the issue.

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