美国哈佛公共卫生学院Zachary J. Ward团队宣布他们预测了美国各州成人肥胖和严重肥胖率。这一研究成果于2019年12月19日发表在国际顶尖学术期刊《新英格兰医学杂志》上。

尽管美国全国性的肥胖流行已被很好记录，但在各州层面，人们对肥胖的了解却不多。目前的估计基于人们自己汇报的量体结果，而这些测量低估了肥胖，特别是重度肥胖的患病率。

研究组开发了纠正自我汇报偏差的方法，并对特定州和特定人口亚组的趋势按体重指数（BMI）分类进行预测。研究组收集了1993-1994和1999-2016年间行为风险因素监测系统调查中6264226名成人参与者的BMI数据，采用全国健康和营养调查的57131名参与者的数据进行校正。

研究组对各州和亚组的多项回归进行拟合，来估计1990-2030年4个BMI类别的趋势：体重不足或正常体重（BMI<25），超重（25至<30），中度肥胖（30至<35），和重度肥胖（>35）。采用1990-2010年间的数据来评估方法的准确性，并来预测2016年的结果。

研究结果表明，到2030年，美国将有近半的成年人肥胖（48.9%），其中29个州的肥胖率将高于50%，所有州的肥胖率都不低于35%，将近四分之一的成年人重度肥胖（24.2%），25个州的重度肥胖率将高于25%。研究组预测，在全国范围内，女性（27.6%）、非西班牙裔黑人成人（31.7%）、低收入成人（31.7%）更容易发生重度肥胖。

总之，在美国的国家范围内，成人肥胖和重度肥胖率将继续增加，且各州与人口亚组之间的差距较大。

附：英文原文

Title: Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity

Author: Zachary J. Ward, M.P.H.,, Sara N. Bleich, Ph.D.,, Angie L. Cradock, Sc.D.,, Jessica L. Barrett, M.P.H.,, Catherine M. Giles, M.P.H.,, Chasmine Flax, M.P.H.,, Michael W. Long, Sc.D.,, and Steven L. Gortmaker, Ph.D.

Issue&Volume: 2019-12-18

Abstract: 

BACKGROUND
Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.

METHODS
We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup–specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993–1994 and 1999–2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.

RESULTS
The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).

CONCLUSIONS
Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. 

DOI: 10.1056/NEJMsa1909301

Source: https://www.nejm.org/doi/full/10.1056/NEJMsa1909301