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, 2013 2016. JAMA. doi:10.1001/jama.2018.7270 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 2013 2016 etable 2. Weighted prevalence of obesity and severe obesity by sex, age, and race and Hispanic origin, adults aged 20 and over, United States, 2013 2016 etable 3. Unweighted number of persons with obesity and severe obesity by sex, age and race and Hispanic origin, NHANES, 2013 2016 etable 4. Unweighted number of persons with obesity or severe obesity by sex and urbanization level, NHANES 2001 2016 efigure 1. Age adjusted prevalence of obesity (BMI 30) among men by urbanization level, United States, 2001 2016 efigure 2. Age adjusted prevalence of severe obesity (BMI 40) among men by urbanization level, United States, 2001 2016 efigure 3. Age adjusted prevalence of obesity (BMI 30) among women by urbanization level, United States, 2001 2016 efigure 4. Age adjusted prevalence of severe obesity (BMI 40) among women by urbanization level, United States, 2001 2016
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 2013 2016 a,b Unweighted No. Men Women Obesity (BMI 30) Overall 1802 2417 Age (years) 20 39 588 696 40 59 639 931 60 575 790 Race and Hispanic origin Non Hispanic white 721 832 Non Hispanic black 410 653 Non Hispanic Asian 66 86 Hispanic 528 763 Education High school diploma or less 843 1130 Some college 591 849 College graduate 366 437 Smoking status Current smoker 337 412 Former smoker 592 470 Never smoker 870 1534 Urbanization level Large MSA 908 1325 Medium or small MSA 612 717 Non MSA 282 375 Severe obesity (BMI 40) Overall 283 561 Age (years) 20 39 110 189 40 59 102 229 60 71 143 Race and Hispanic origin Non Hispanic white 115 200 Non Hispanic black 81 180 Non Hispanic Asian 2 2 Hispanic 70 160 Education High school diploma or less 121 242 Some college 109 226 College graduate 53 93
Unweighted No. Men Women Smoking status Current smoker 48 108 Former smoker 85 111 Never smoker 150 342 Urbanization level Large MSA 129 259 Medium or small MSA 99 199 Non MSA 55 103 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.
etable 2. Weighted prevalence of obesity and severe obesity by sex, age, and race and Hispanic origin, adults aged 20 and over, United States, 2013 2016 a All ages Age (years) No. partic ipants Unadjusted Obesity (BMI 30) Both Sexes All race/hispanic origins c 10792 38.9 (37.0, 40.7) Non Hispanic white 4094 37.9 (35.9, 39.9) Non Hispanic black 2241 47.6 (44.5, 50.8) Non Hispanic Asian 1260 12.7 (10.9, 14.7) Hispanic 2847 44.8 (41.7, 47.9) Men All race/hispanic 5221 36.6 (34.1, origins c 39.1) Non Hispanic white 2021 36.9 (33.9, 39.9) Non Hispanic black 1086 37.5 (33.7, 41.4) Non Hispanic Asian 621 11.7 ( 9.3, 14.5) Hispanic 1313 41.2 (37.1, 45.5) Women All race/hispanic 5571 41.0 (38.9, origins c 43.1) Non Hispanic white 2073 38.8 (36.3, 41.4) Non Hispanic black 1155 56.1 (53.1, 59.0) Ageadjusted 20 39 40 59 60 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 3590 35.0 (32.5, 37.5) 1262 32.1 (28.9, 35.5) 733 42.5 (37.7, 47.5) 467 16.0 (12.8, 19.6) 960 42.7 (39.1, 46.4) 1785 33.2 (29.6, 37.0) 649 31.3 (25.5, 37.7) 354 31.8 (25.5, 38.6) 239 19.1 (14.3, 24.6) 457 42.3 (37.6, 47.0) 1805 36.8 (34.5, 39.0) 613 32.9 (29.2, 36.8) 379 52.6 (46.4, 58.6) %, (95% CI) No. parti cipants 3681 41.9 (38.5, 45.3) 1292 40.7 (36.6, 44.9) 797 53.5 (48.4, 58.5) 498 10.5 ( 7.7, 13.9) 980 48.3 (44.4, 52.2) 1732 39.0 (35.1, 42.9) 628 39.1 (34.2, 44.1) 363 45.9 (39.8, 52.0) 246 6.2 ( 3.5, 10.0) 434 41.9 (35.8, 48.2) 1949 44.7 (40.5, 48.9) 664 42.3 (37.1, 47.7) 434 59.7 (53.6, 65.7) %, (95% CI) 3521 39.8 (37.2, 42.5) 1540 40.1 (36.8, 43.5) 711 46.6 (42.6, 50.7) 295 10.4 ( 7.1, 14.4) 907 43.3 (38.7, 47.9) 1704 38.0 (34.5, 41.7) 744 40.1 (35.9, 44.5) 369 33.6 (28.0, 39.6) 136 5.7 ( 2.4, 11.3) d 422 35.5 (30.3, 41.0) 1817 41.3 (37.8, 44.9) 796 40.1 (35.6, 44.8) 342 55.7 (49.6, 61.7)
All ages Age (years) No. partic ipants Non Hispanic Asian 639 13.6 (11.1, 20 39 40 59 60 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, 228 13.0 ( 8.9, 252 14.2 (10.0, 159 13.8 ( 8.9, 16.5) 16.5) 18.1) 19.3) 20.2) Hispanic 1534 48.4 (44.6, 52.1) 48.9 (45.3, 52.4) 503 43.2 (37.5, 49.0) 546 54.6 (50.2, 58.9) 485 49.4 (44.2, 54.6) Class 3 Obesity (BMI 40) Both All race/hispanic 3681 8.6 (7.1, 3521 6.0 (4.9, 7.4) Sexes origins c 9.2) 10.3) Non Hispanic white 4094 7.4 ( 6.3, 8.6) 7.5 ( 6.4, 8.8) 1262 7.6 ( 5.7, 9.8) 1292 8.4 ( 6.6, 10.6) 1540 6.0 ( 4.6, 7.7) Non Hispanic black 2241 11.8 (10.0, 13.9) 11.8 (10.0, 13.8) 733 11.6 ( 9.1, 14.5) 797 13.8 (10.5, 17.7) 711 8.8 ( 6.5, 11.7) Non Hispanic Asian 1260 0.4 ( 0.1, 1.1) 0.4 ( 0.1, 1.1) 467 0.3 ( 0.0, 1.5) 498 0.5 ( 0.0, 2.0) 295 0.4 ( 0.0, 2.6) Hispanic 2847 8.2 ( 6.6, 10.1) 8.0 ( 6.6, 9.7) 960 8.8 ( 6.4, 11.7) 980 8.4 ( 6.7, 10.3) 907 6.2 ( 4.6, 8.1) Men All race/hispanic 5.5 (4.6, 1785 6.1 (4.5, 1732 5.5 (4.1, 1704 4.7 (3.3, 6.4) origins c 6.5) 6.6) 8.0) 7.3) Non Hispanic white 2021 5.5 ( 4.4, 6.8) 5.6 ( 4.4, 7.0) 649 6.1 ( 3.8, 9.2) 628 5.5 ( 3.7, 7.8) 744 5.0 ( 3.3, 7.3) Non Hispanic black 1086 7.4 ( 5.8, 9.3) 7.3 ( 5.8, 9.2) 354 7.7 ( 5.1, 11.0) 363 8.2 ( 5.3, 11.9) 369 5.3 ( 3.2, 8.2) Non Hispanic Asian 621 0.4 ( 0.0, 1.6) 0.4 ( 0.0, 1.6) 239 0.5 ( 0.0, 3.1) 246 0.0 ( e, 1.6) 136 1.0 ( 0.0, 6.0) d Hispanic 1313 5.9 ( 3.9, 8.6) 5.6 ( 3.9, 7.8) 457 6.4 ( 3.3, 11.1) 434 6.1 ( 4.0, 8.7) 422 3.7 ( 2.1, 5.9) Women All race/hispanic 9.8 (8.7, 1805 9.8 (8.3, 1949 11.5 (9.4, 1817 7.2 (5.4, 9.2) origins c 10.9) 11.0) 11.5) 14.0) Non Hispanic white 2073 9.2 ( 7.7, 10.8) 9.4 ( 8.0, 11.0) 613 9.1 ( 6.7, 12.0) 664 11.4 ( 8.6, 14.6) 796 6.9 ( 4.7, 9.7) Non Hispanic black 1155 15.5 (12.9, 15.5 (12.9, 379 15.2 (10.7, 434 18.4 (14.4, 342 11.3 ( 7.2,
All ages Age (years) No. partic ipants Unadjusted Ageadjusted 20 39 40 59 60 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 639 0.3 ( 0.0, 0.3 ( 0.0, 228 0.0 ( e, 1.8) 252 0.8 ( 0.1, 159 0.0 ( e, 2.7) 1.4) 1.4) 3.6) Hispanic 1534 10.6 ( 8.9, 12.4) 10.3 ( 8.8, 12.1) 503 11.4 ( 8.6, 14.6) 546 10.6 ( 8.2, 13.5) 485 8.1 ( 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
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, 2013 2016 Unweighted No. Age (years) All adults 20 39 40 59 60 Obesity (BMI 30) Both Sexes All race/hispanic origins a 4219 1284 1570 1365 Non Hispanic white 1553 410 551 592 Non Hispanic black 1063 316 429 318 Non Hispanic Asian 152 72 51 29 Hispanic 1291 414 483 394 Men All race/hispanic origins a 1802 588 639 575 Non Hispanic white 721 199 245 277 Non Hispanic black 410 117 168 125 Non Hispanic Asian 66 44 15 7 Hispanic 528 194 181 153 Women All race/hispanic origins a 2417 696 931 790 Non Hispanic white 832 211 306 315 Non Hispanic black 653 199 261 193 Non Hispanic Asian 86 28 36 22 Hispanic 763 220 302 241 Severe obesity (BMI 40) Both Sexes All race/hispanic origins a 844 299 331 214 Non Hispanic white 315 105 120 90 Non Hispanic black 261 88 114 59 Non Hispanic Asian 4 1 2 1 Hispanic 230 88 84 58 Men All race/hispanic origins a 283 110 102 71 Non Hispanic white 115 41 41 33 Non Hispanic black 81 30 31 20 Non Hispanic Asian 2 1 0 1
Unweighted No. Age (years) All 20 39 40 59 60 adults Hispanic 70 29 25 16 Women All race/hispanic origins a 561 189 229 143 Non Hispanic white 200 64 79 57 Non Hispanic black 180 58 83 39 Non Hispanic Asian 2 0 2 0 Hispanic 160 59 59 42 Abbreviations: NHANES, National Health and Nutrition Examination Surveys; BMI, body mass index a. Includes race/hispanic origin groups not shown separately.
etable 4. Unweighted number of persons with obesity or severe obesity by sex and urbanization level, NHANES 2001 2016 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) 2001 2004 1288 991 544 575 453 234 713 538 310 2005 2008 1965 947 672 871 448 319 1094 499 353 2009 2012 2257 1037 826 999 459 393 1258 578 433 2013 2016 2233 1329 657 908 612 282 1325 717 375 Severe obesity (BMI 40) 2001 2004 180 183 79 56 57 23 124 126 56 2005 2008 337 159 114 117 61 36 220 98 78 2009 2012 382 217 167 118 61 70 264 156 97 2013 2016 388 298 158 129 99 55 259 199 103 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
efigure 1. Age adjusted prevalence of obesity (BMI 30) among men by urbanization level: United States, 2001 2016 Obesity prevalnece (%) 50 45 40 35 30 25 20 15 10 5 0 42.4 38.5 36.9 39.2 38.9 32.6 35.7 31.8 28.7 30.8 29.5 27.4 2001 2004 2005 2008 2009 2012 2013 2016 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, 40 49 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.
efigure 2. Age adjusted prevalence of severe obesity (BMI 40) among men by urbanization level: United States, 2001 2016 Obesity prevalence (%) 50 45 40 35 30 25 20 15 10 5 0 9.9 5.0 6.5 4.5 4.7 5.0 6.1 2.8 2.5 3.6 3.1 4.1 2001 2004 2005 2008 2009 2012 2013 2016 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, 40 49 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)
efigure 3. Age adjusted prevalence of obesity (BMI 30) among women by urbanization level: United States, 2001 2016 Obesity prevalence (%) 50 45 40 35 30 25 20 15 10 5 0 47.2 40.4 39.4 42.5 35.0 37.9 38.8 38.1 34.9 31.3 32.4 33.1 2001 2004 2005 2008 2009 2012 2013 2016 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, 40 49 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.
efigure 4. Age adjusted prevalence of severe obesity (BMI 40) among women by urbanization level: United States, 2001 2016 COI180049 50 Obesity prevalence (%) 45 40 35 30 25 20 15 10 5 0 13.5 11.0 11.1 8.0 9.3 8.7 7.3 8.1 6.4 6.6 5.7 6.8 2001 2004 2005 2008 2009 2012 2013 2016 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, 40 49 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.