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

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.