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1 Supplementary Online Content Hales CM, Fryar CD, Carroll MD, Freedman DS, Aoki Y, Ogden CL. Differences in obesity prevalence by demographic characteristics and urbanization level among adults in the United States, JAMA. doi: /jama etable 1. Unweighted number of persons with obesity or severe obesity by sex, age, race and Hispanic origin, education, smoking status, and urbanization level, NHANES etable 2. Weighted prevalence of obesity and severe obesity by sex, age, and race and Hispanic origin, adults aged 20 and over, United States, etable 3. Unweighted number of persons with obesity and severe obesity by sex, age and race and Hispanic origin, NHANES, etable 4. Unweighted number of persons with obesity or severe obesity by sex and urbanization level, NHANES efigure 1. Age adjusted prevalence of obesity (BMI 30) among men by urbanization level, United States, efigure 2. Age adjusted prevalence of severe obesity (BMI 40) among men by urbanization level, United States, efigure 3. Age adjusted prevalence of obesity (BMI 30) among women by urbanization level, United States, efigure 4. Age adjusted prevalence of severe obesity (BMI 40) among women by urbanization level, United States,

2 etable 1. Unweighted number or persons with obesity or severe obesity by sex, age, race and Hispanic origin, education, smoking status, and urbanization level, NHANES a,b Unweighted No. Men Women Obesity (BMI 30) Overall Age (years) Race and Hispanic origin Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Education High school diploma or less Some college College graduate Smoking status Current smoker Former smoker Never smoker Urbanization level Large MSA Medium or small MSA Non MSA Severe obesity (BMI 40) Overall Age (years) Race and Hispanic origin Non Hispanic white Non Hispanic black Non Hispanic Asian 2 2 Hispanic Education High school diploma or less Some college College graduate 53 93

3 Unweighted No. Men Women Smoking status Current smoker Former smoker Never smoker Urbanization level Large MSA Medium or small MSA Non MSA Abbreviation: NHANES, National Health and Nutrition Examination Surveys a. Includes race and Hispanic origin groups not shown separately b. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA.

4 etable 2. Weighted prevalence of obesity and severe obesity by sex, age, and race and Hispanic origin, adults aged 20 and over, United States, a All ages Age (years) No. partic ipants Unadjusted Obesity (BMI 30) Both Sexes All race/hispanic origins c (37.0, 40.7) Non Hispanic white (35.9, 39.9) Non Hispanic black (44.5, 50.8) Non Hispanic Asian (10.9, 14.7) Hispanic (41.7, 47.9) Men All race/hispanic (34.1, origins c 39.1) Non Hispanic white (33.9, 39.9) Non Hispanic black (33.7, 41.4) Non Hispanic Asian ( 9.3, 14.5) Hispanic (37.1, 45.5) Women All race/hispanic (38.9, origins c 43.1) Non Hispanic white (36.3, 41.4) Non Hispanic black (53.1, 59.0) Ageadjusted b %, (95% CI) %, (95% CI) No. partic ipants 38.7 (36.8, 40.6) 37.2 (35.1, 39.3) 47.6 (44.4, 50.7) 12.6 (10.9, 14.6) 44.9 (41.8, 48.0) 36.5 (34.0, 39.0) 36.2 (33.1, 39.5) 37.4 (33.8, 41.2) 11.2 ( 8.8, 13.9) 40.6 (36.5, 44.7) 40.8 (38.7, 42.9) 38.1 (35.6, 40.6) 55.9 (53.0, 58.9) %, (95% CI) No. parti cipants (32.5, 37.5) (28.9, 35.5) (37.7, 47.5) (12.8, 19.6) (39.1, 46.4) (29.6, 37.0) (25.5, 37.7) (25.5, 38.6) (14.3, 24.6) (37.6, 47.0) (34.5, 39.0) (29.2, 36.8) (46.4, 58.6) %, (95% CI) No. parti cipants (38.5, 45.3) (36.6, 44.9) (48.4, 58.5) ( 7.7, 13.9) (44.4, 52.2) (35.1, 42.9) (34.2, 44.1) (39.8, 52.0) ( 3.5, 10.0) (35.8, 48.2) (40.5, 48.9) (37.1, 47.7) (53.6, 65.7) %, (95% CI) (37.2, 42.5) (36.8, 43.5) (42.6, 50.7) ( 7.1, 14.4) (38.7, 47.9) (34.5, 41.7) (35.9, 44.5) (28.0, 39.6) ( 2.4, 11.3) d (30.3, 41.0) (37.8, 44.9) (35.6, 44.8) (49.6, 61.7)

5 All ages Age (years) No. partic ipants Non Hispanic Asian (11.1, Unadjusted Ageadjusted b %, (95% CI) %, (95% CI) No. %, (95% CI) No. %, (95% CI) No. %, (95% CI) partic parti parti ipants cipants cipants 13.6 (11.1, ( 8.9, (10.0, ( 8.9, 16.5) 16.5) 18.1) 19.3) 20.2) Hispanic (44.6, 52.1) 48.9 (45.3, 52.4) (37.5, 49.0) (50.2, 58.9) (44.2, 54.6) Class 3 Obesity (BMI 40) Both All race/hispanic (7.1, (4.9, 7.4) Sexes origins c 9.2) 10.3) Non Hispanic white ( 6.3, 8.6) 7.5 ( 6.4, 8.8) ( 5.7, 9.8) ( 6.6, 10.6) ( 4.6, 7.7) Non Hispanic black (10.0, 13.9) 11.8 (10.0, 13.8) ( 9.1, 14.5) (10.5, 17.7) ( 6.5, 11.7) Non Hispanic Asian ( 0.1, 1.1) 0.4 ( 0.1, 1.1) ( 0.0, 1.5) ( 0.0, 2.0) ( 0.0, 2.6) Hispanic ( 6.6, 10.1) 8.0 ( 6.6, 9.7) ( 6.4, 11.7) ( 6.7, 10.3) ( 4.6, 8.1) Men All race/hispanic 5.5 (4.6, (4.5, (4.1, (3.3, 6.4) origins c 6.5) 6.6) 8.0) 7.3) Non Hispanic white ( 4.4, 6.8) 5.6 ( 4.4, 7.0) ( 3.8, 9.2) ( 3.7, 7.8) ( 3.3, 7.3) Non Hispanic black ( 5.8, 9.3) 7.3 ( 5.8, 9.2) ( 5.1, 11.0) ( 5.3, 11.9) ( 3.2, 8.2) Non Hispanic Asian ( 0.0, 1.6) 0.4 ( 0.0, 1.6) ( 0.0, 3.1) ( e, 1.6) ( 0.0, 6.0) d Hispanic ( 3.9, 8.6) 5.6 ( 3.9, 7.8) ( 3.3, 11.1) ( 4.0, 8.7) ( 2.1, 5.9) Women All race/hispanic 9.8 (8.7, (8.3, (9.4, (5.4, 9.2) origins c 10.9) 11.0) 11.5) 14.0) Non Hispanic white ( 7.7, 10.8) 9.4 ( 8.0, 11.0) ( 6.7, 12.0) ( 8.6, 14.6) ( 4.7, 9.7) Non Hispanic black (12.9, 15.5 (12.9, (10.7, (14.4, ( 7.2,

6 All ages Age (years) No. partic ipants Unadjusted Ageadjusted b %, (95% CI) %, (95% CI) No. partic ipants %, (95% CI) No. parti cipants %, (95% CI) No. parti cipants %, (95% CI) 18.4) 18.4) 20.7) 23.0) 16.6) Non Hispanic Asian ( 0.0, 0.3 ( 0.0, ( e, 1.8) ( 0.1, ( e, 2.7) 1.4) 1.4) 3.6) Hispanic ( 8.9, 12.4) 10.3 ( 8.8, 12.1) ( 8.6, 14.6) ( 8.2, 13.5) ( 5.5, 11.4) Abbreviations: BMI, body mass index; CI, confidence interval a. Data from the National Health and Nutrition Examination Survey; estimates are weighted; see etable 3 for unweighted number of persons with obesity and severe obesity by sex, age group and race/hispanic origin b. Age adjusted by the direct method to the projected 2000 U.S. census population using the age groups 20 39, 40 59, and 60 and over c. Includes race/hispanic origin groups not shown separately. d. Estimate potentially unreliable due to absolute CI width > 5% and relative CI width > 130% e. The lower confidence limit cannot be calculate

7 etable 3. Unweighted number of persons with obesity and severe obesity by sex, age and race and Hispanic origin, adults aged 20 and over, NHANES, Unweighted No. Age (years) All adults Obesity (BMI 30) Both Sexes All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Men All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Women All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Severe obesity (BMI 40) Both Sexes All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Men All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian

8 Unweighted No. Age (years) All adults Hispanic Women All race/hispanic origins a Non Hispanic white Non Hispanic black Non Hispanic Asian Hispanic Abbreviations: NHANES, National Health and Nutrition Examination Surveys; BMI, body mass index a. Includes race/hispanic origin groups not shown separately.

9 etable 4. Unweighted number of persons with obesity or severe obesity by sex and urbanization level, NHANES a Unweighted No. Both sexes Men Women Large metro Medium or small metro Large metro Medium or small metro Large metro Medium or small metro Obesity (BMI 30) Severe obesity (BMI 40) Abbreviation: NHANES, National Health and Nutrition Examination Surveys; BMI, body mass index a. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA. Nonmetro Nonmetro Nonmetro

10 efigure 1. Age adjusted prevalence of obesity (BMI 30) among men by urbanization level: United States, Obesity prevalnece (%) Large metro Medium or Small metro Non metro Abbreviation: BMI, Body Mass Index Data from National Health and Nutrition Examination Survey (NHANES). Estimates are weighted and age adjusted using the direct method to the projected 2000 U.S. census population using age groups 20 39, and 60 and over. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA. See etable 4 for unweighted number of persons with obesity or severe obesity by sex and urbanization.

11 efigure 2. Age adjusted prevalence of severe obesity (BMI 40) among men by urbanization level: United States, Obesity prevalence (%) Large metro Medium or Small metro Non metro Abbreviation: BMI, Body Mass Index Data from National Health and Nutrition Examination Survey (NHANES). Estimates are weighted and age adjusted using the direct method to the projected 2000 U.S. census population using age groups 20 39, and 60 and over. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA. See etable 4 for unweighted number of persons with obesity or severe obesity by sex and urbanization. Fully adjusted percentage point change (i.e., linear trend) varied by urbanization level (p=0.02 for interaction)

12 efigure 3. Age adjusted prevalence of obesity (BMI 30) among women by urbanization level: United States, Obesity prevalence (%) Large metro Medium or Small metro Non metro Abbreviation: BMI, Body Mass Index Data from National Health and Nutrition Examination Survey (NHANES). Estimates are weighted and age adjusted using the direct method to the projected 2000 U.S. census population using age groups 20 39, and 60 and over. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA. See etable 4 for unweighted number of persons with obesity or severe obesity by sex and urbanization.

13 efigure 4. Age adjusted prevalence of severe obesity (BMI 40) among women by urbanization level: United States, COI Obesity prevalence (%) Large metro Medium or Small metro Non metro Abbreviation: BMI, Body Mass Index Data from National Health and Nutrition Examination Survey (NHANES). Estimates are weighted and age adjusted using the direct method to the projected 2000 U.S. census population using age groups 20 39, and 60 and over. Large MSAs indicate MSAs with a population of 1 million or more; medium or small MSAs are those with a population of less than 1 million; non MSAs indicate counties not in a MSA. See etable 4 for unweighted number of persons with obesity or severe obesity by sex and urbanization.