Reason for Ranking
Obesity is often the result of an overall energy imbalance due to poor diet and limited physical activity. Obesity increases the risk for health conditions such as coronary heart disease, type 2 diabetes, cancer, hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, and poor health status.[1,2]
Measurement Strengths and Limitations
When comparing estimates of obesity, physical inactivity and diabetes included in this year's release with prior releases, caution should be used due to changes in the BRFSS methodology. More information can be found here: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html.
Caution should be used when comparing these estimates across state lines, particularly when comparing bordering states. The model used to create these estimates includes a state-level factor that limits comparability between neighboring counties of adjacent states.
The BRFSS measures of weight and BMI have very high reliability (repeatability) scores. The self-reported weight and BMI measure data are also representative across different subsets of the population. Although the reliability and validity of the BRFSS measures of weight and BMI are high, an analysis found that BRFSS data generally underestimate the obese population compared with studies that directly measure height and weight.
Another limitation is that the Rankings use obesity rates as a proxy measure for healthiness of food consumption and exercise participation. Obesity is a complex measure that is affected through several different pathways: genetics, metabolic processes, education, built environment, behavioral choices, socioeconomic status and education. The final limitation of the data is that they do not include data on childhood obesity. These additional data would provide a more comprehensive measure of the current and future health risks of a county.