The geographic distribution of obesity in the US and the potential regional differences in misreporting of obesity


  • Disclosure: The authors declared no conflict of interest. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data. The findings and conclusions in this articles are those of the authors and do not necessarily represent the views of the Research Data Center, the National Institutes of Health, the National Center for Health Statistics, the Centers for Disease Control and Prevention, or any other organization.

  • Funding agencies: The REGARDS research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. Dr. Allison received additional support for this manuscript through NIH grant P30DK056336.


Objective: State-level estimates of obesity based on self-reported height and weight suggest a geographic pattern of greater obesity in the Southeastern US; however, the reliability of the ranking among these estimates assumes errors in self-reporting of height and weight are unrelated to geographic region.

Design and Methods: Regional and state-level prevalence of obesity (body mass index ≥ 30 kg m−2) for non-Hispanic black and white participants aged 45 and over were estimated from multiple sources: [1] self-reported from the behavioral risk factor surveillance system (BRFSS 2003-2006) (n = 677,425), [2] self-reported and direct measures from the National Health and Nutrition Examination Study (NHANES 2003-2008) (n = 6,615 and 6,138, respectively), and [3] direct measures from the REasons for Geographic and Racial Differences in Stroke (REGARDS 2003-2007) study (n = 30,239).

Results: Data from BRFSS suggest that the highest prevalence of obesity is in the East South Central Census division; however, direct measures suggest higher prevalence in the West North Central and East North Central Census divisions. The regions relative ranking of obesity prevalence differs substantially between self-reported and directly measured height and weight.

Conclusions: Geographic patterns in the prevalence of obesity based on self-reported height and weight may be misleading, and have implications for current policy proposals.