Definition

Percentage of adults 18 years of age and older who are obese as defined by a body mass index (BMI) of >=30.0 as computed by the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)]. BMI is calculated as self-reported weight ("About how much do you weigh without shoes?") in kilograms divided by self-reported height ("About how tall are you without shoes?") in meters squared.

Numerator

Weighted number of adults (18+) who have a BMI of >=30.0 calculated from self-reported weight ("About how much do you weigh without shoes?") and height ("About how tall are you without shoes?") on the BRFSS, excluding women who are pregnant and biologically implausible values.

Denominator

Weighted number of adults (18+) for whom BMI can be calculated from their self-reported weight and height on the BRFSS, excluding women who are pregnant, biologically implausible values, or "Do not know/Not Sure" or "Refused" responses.

Data Interpretation Issues

Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx]. Alaska data were obtained from the Standard BRFSS from 1991-2003, and from the Standard and Supplemental BRFSS surveys combined from 2004 onward. The Supplemental BRFSS survey is conducted using identical methodology as the Standard BRFSS and allows a doubling of the BRFSS sample size for those measures included in both surveys. Questions on the height and weight of respondents have been components of the Standard BRFSS since its inception in 1991 and for the Supplemental BRFSS since it began in 2004. Alaska Native people in analyses of the BRFSS refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals who indicate multiple races including American Indian/Alaska Native are considered Alaska Native in the data. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. This definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium health care services.

Why Is This Important?

Leading health officials state that obesity is the predominant public health threat of our lifetimes. If obesity rates aren't stabilized and reversed, the medical care costs associated with treating obesity-related chronic disease will threaten the government's ability to fund Medicare and Medicaid. Obesity and overweight are determined by calculating Body Mass Index (BMI) from a person's weight and height. BMI provides a reliable indicator of body fatness for most people, and it is used to screen for weight categories that increase the risk of health problems. Obesity is expected to overtake tobacco as the leading cause of death. It already surpasses tobacco in estimates of annual medical costs in Alaska ($459 million vs. $318 million).^1^ Alaska's obesity-related Medicaid costs will be $684 million annually by 2030 if rates continue as predicted.^2^ The responsibility for this dramatic change in our state's population is both personal and societal. Government is already invested by paying the medical costs related to the chronic disease consequences associated with obesity in an ever-rising Medicaid budget. Obesity increases the risk of type 2 diabetes, heart disease, high blood pressure, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some types of cancer. It also negatively affects physical performance, life expectancy, and quality of life.^3^ Due to obesity, this generation of children is predicted to have a shorter lifespan than their parents.^4^[[br]] [[br]] ---- {{class .SmallerFont 1. Trogdon JG, Finkelstein EA, Feagan CW, Cohen JW. State- and Payer-Specific Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity 2012;20(1):214-20. 2. Alaska Department of Health and Social Services. [http://dhss.alaska.gov/dph/Chronic/Documents/Obesity/pubs/10-11ObesityStatus_web.pdf Alaska Obesity Prevention and Control Program: 2010-2011 Status Report]. Published 2011. Accessed October 12, 2016. 3. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001. [https://www.ncbi.nlm.nih.gov/books/NBK44206/pdf/Bookshelf_NBK44206.pdf]. Published 2001. Accessed October 12, 2016. 4. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. N Engl J Med 2005;352(11):1138-45. }}

Other Objectives

Healthy Alaskans 2020 Indicator 4.b: Reduce the percentage of adults (age 18 years and older) who meet criteria for obesity (body mass index of >=30 kg/(m*m)) to 27% by 2020. Related Objectives: Healthy People Objective NWS-9: Reduce the proportion of adults who are obese U.S. Target: 30.5% as measured by the National Health and Nutrition Examination Survey (NHANES) for adults 20 years of age and older. The Healthy People objective for adult obesity based upon clinical examination of height and weight cannot be matched by the self-reported measures obtained by the BRFSS. The definition of adult also differs between the two surveillance systems with NHANES using individuals who are 20 years of age and older and the BRFSS defining adults as individuals who are 18 years of age and older.

How Are We Doing?

The percentage of Alaska adults who are obese has steadily increased over the past 2 decades, more than doubling between 1991 (13%) and 2015 (30%). The prevalence of obesity has plateaued at just under 30% for the past 3 years, which may be an indicator of future declines. The prevalence of obesity is higher for Alaska Native/American Indian people (35%), Blacks (non-Hispanic) (44%), and Native Hawaiians/Other Pacific Islanders (57%) when compared to White Alaskans (28%), who are also above the goal of 27%. Those at decreased risk of obesity include those 18-24 years of age, Asians (non-Hispanic), and college graduates. Additional statistics on obesity burden are available at: [http://www.hss.state.ak.us/dph/chronic/obesity/resources.htm]. Prevalence rates for obesity from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status) are limited to 2010 and later to allow for ease in assessing recent trends. Crosstabulations of obesity by current smoking, sexual orientation, disability, and Adverse Childhood Experiences (ACEs) score were conducted for the 3-year average of 2013-2015. Only the significant differences related to disability and ACEs are presented, but the other comparisons are available upon request. The rates of obesity by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 7 Alaska Public Health Regions, 2) three-year averages by the 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) three-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regionalizes of Alaska for those desiring longer time series.

How Do We Compare With the U.S.?

The Alaska adult obesity rate has paralleled the increase seen in adult obesity prevalence nationwide. In 2015, the median for obesity in the U.S. was 29.8% compared to the 29.5% among Alaska adults.

What Is Being Done?

The mission of the Obesity Prevention and Control Program is to prevent and reduce obesity among Alaskans though the promotion of physical activity and good nutrition. The program: [[br]]a) manages the Play Every Day campaign, Community Nutrition efforts, Early Care and Education (ECE) Obesity Prevention Partnerships, the Obesity Prevention School Partnerships and supports Healthy Futures; [[br]]b) serves as a credible source of information on the causes, health and economic consequences of obesity; [[br]]c) provides information to the public, health professionals, and the media; [[br]]d) maintains systematic collection, analysis, evaluation and reporting of obesity prevalence and related physical activity and nutrition behaviors; [[br]]e) identifies population groups at greatest risk for the health threats of obesity; [[br]]f) develops partnerships with and provides leadership to a wide variety of private and public agencies; [[br]]g) provides technical advice and support to partners in implementing obesity prevention strategies; [[br]]h) facilitates the Alaska Alliance for Healthy Kids that works to prevent childhood obesity; and [[br]]i) facilitates the Alaska Food Policy Council that works to strengthen Alaska's food systems to spur local economic development, increase food security, and improve nutrition and health.

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. '''Strategy 1:''' [[br]]Implement a comprehensive social marketing campaign promoting nutrition and physical activity. Choose campaign topics strategically; examples include limiting sugary drinks and the importance of family meals. '''Evidence Base:''' [[br]]Citing The Community Guide and other reviews, the CDC recommends community-wide campaigns as effective in increasing physical activity, a contributing factor to maintaining a healthy weight. '''Sources:''' [[br]]Centers for Disease Control and Prevention. Increasing physical activity: A report on recommendations of the Task Force on Community Preventive Services. MMWR 2001;50(RR-18):1-16. The Community Guide. [http://www.thecommunityguide.org/pa/index.html]. Kahn EB, Ramsey LT, Brownson RC, Heath GW, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(4S):73-107. A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_4_Overweight_Adult.pdf].

Data Notes

U.S. values are based upon the median value of the states, District of Columbia, and territories.

Data Notes

The sex of the respondent is only asked if necessary.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Respondents are asked, "What is your age?", which is coded in years. Responses of Refused are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Race/ethnicity is determined by responses to three questions: [[br]] 1) "Are you Hispanic, Latino/a, or Spanish origin?" "If yes, are you...?" One or more categories may be selected from categories of (1) "Mexican, Mexican American, Chicano/a"; (2) "Puerto Rican"; (3) "Cuban"; (4) "Another Hispanic, Latino/a, or Spanish origin".[[br]] 2) "Which one or more of the following would you say is your race?" Response categories consist of "White", "Black or African American", "American Indian or Alaska Native", "Asian" (with subcategories of Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian), "Pacific Islander" (with subcategories of Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islander), Other, or No additional choices. [[br]] 3) If more than one response to race, then "Which one of these groups would you say best represents your race?" with choices from the list enumerated above. Responses of Don't Know/Not Sure or Refused are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Ethnicity is defined independent of race. It is based upon responses to the question, "Are you Hispanic, Latino/a, or Spanish origin?" Responses of "Don't Know/Not Sure" or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Marital status is determined by the question, "Are you ...?" with responses of "Married", 'Divorced", "Widowed", "Separated", "Never married," or "A member of an unmarried couple". Responses of "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Education is based upon education completed by or after 25 years of age. Individuals less than 25 years of age are excluded. Education is assessed by responses to the question: "What is the highest grade or year of school you completed?" Responses are "Never attended school or only attended kindergarten", "Grades 1 through 8 (Elementary)", "Grades 9 through 11 (Some high school)", "Grade 12 (High School Graduate)", "College 1 year to 3 years (Some college or technical school)", "College 4 years or more (College graduate)", or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Employment status is assessed by the question: "Are you currently ...?" with responses of "Employed for wages", "Self-employed", "Out of work for 1 year or more", "Out of work for less than 1 year", "A Homemaker", "A Student", "Retired", "Unable to work" or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Income is measure by the question: "Is your annual household income from all sources ---" with categories of "Less than $10,000", "Less than $15,000", "less than $20,000", "less than $25,000", "less than $35,000", "less than $50,000", "less than $75,000", "$75,000 or more", and "Don't know / Not sure" or "Refused". Responses of "Don't know / Not sure" or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Poverty thresholds are intended for use as a statistical yardstick, not as a complete description of what people and families need to live. Poverty thresholds are the dollar amounts assigned by the U.S. Census Bureau to determine poverty status. Poverty thresholds are assigned based upon the size of the family and the ages of the members (i.e., adults versus children). The same thresholds are used throughout the United States. Poverty thresholds were originally derived in the 1963-1964 using U.S. Department of Agriculture food budgets designed for families under economic stress and data about what proportion of their income families spent on food. The thresholds are updated annually for inflation using the Consumer Price Index for All Urban Consumers (CPI-U). How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Notes

Poverty thresholds computed using the BRFSS assume that householders are less than 65 years of age as the ages of the household heads are not recorded. The maximum of the income range provided for the household is used to evaluate the proportion of the poverty threshold. This is a conservative approach as there are no errors of misclassification into the lowest poverty group. The category of Poor represents less than 100% of the poverty threshold. Near Poor is 100% through 199% of the poverty threshold. Middle/High income families are 200% or higher of the poverty threshold. How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Disability is assessed using responses from 5 questions: 1) "Are you blind or do you have serious difficulty seeing, even when wearing glasses?"; 2) Because of physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?"; 3) "Do you have a serious difficulty walking or climbing stairs?"; 4) "Do you have difficulty dressing or bathing?"; and 5) "Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?" A "Yes" response to one or more of the questions when all questions have valid answers is used to classify the respondent as having a disability. Responses of "No" to all 5 questions denotes the absence of a disability. Responses of "Don't know / Not sure" or "Refused" to one or more questions result in the survey being excluded from analysis on disability status.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

The presence of one or more Adverse Childhood Experiences (ACEs) is assessed using either the 10 domains that are grouped into: [[br]] '''Abuse:'''[[br]] 1) Verbal Abuse[[br]] 2) Physical Abuse[[br]] 3) Sexual Abuse][[br]] '''Dysfunctional Households:'''[[br]] 4) Substance Abuse[[br]] 5) Mental Illness[[br]] 6) Domestic Violence[[br]] 7) Separation/Divorce[[br]] 8) Incarceration among household members[[br]] '''Neglect:'''[[br]] 9) Emotional Neglect[[br]] 10) Physical Neglect[[br]] The presence of an Adverse Childhood Experience have grouped into scores of 0 (no exposure), 1 (single exposure to an ACE), 2-3 (exposure to 2 or 3 ACEs), and 4+ (exposure to 4 or more different ACEs) The questions associated with each type of ACEs is described in the [http://ibis.dhss.alaska.gov/indicator/index/Alphabetical.html respective reports]. A summary ACEs score is computed for those with valid responses to all domains. Respondents with refusals to one or more of the ACEs questions are excluded.

Data Notes

Geographic descriptions of the public health regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_phr.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Geographic descriptions of the metropolitan and micropolitan statistical areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_mmsa.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Geographic descriptions of the behavioral health systems assessment reporting regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bhs.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

** = Data not available due to less than 50 respondents in the denominator. Geographic descriptions of boroughs and census areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bca.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Geographic descriptions of the tribal health organization regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_thr.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

References and Community Resources

'''References:''' 1. Trogdon JG, Finkelstein EA, Feagan CW, Cohen JW. State- and Payer-Specific Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity 2012;20(1):214-20. 2. Alaska Department of Health and Social Services. [http://dhss.alaska.gov/dph/Chronic/Documents/Obesity/pubs/10-11ObesityStatus_web.pdf Alaska Obesity Prevention and Control Program: 2010-2011 Status Report]. Published 2011. Accessed October 12, 2016. 3. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001. [https://www.ncbi.nlm.nih.gov/books/NBK44206/pdf/Bookshelf_NBK44206.pdf]. Published 2001. Accessed October 12, 2016. 4. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. N Engl J Med 2005;352(11):1138-45. '''Resources:''' The National Center for Chronic Disease Prevention and Health Promotion provides consumer information. [http://www.cdc.gov/nccdphp/dnpa/obesity/] NHLBI Obesity Education Initiative at [http://www.nhlbi.nih.gov/about/oei/] The Surgeon General's Call to Action to Prevent and Decrease Overweight & Obesity. [http://www.surgeongeneral.gov/topics/obesity] Let's Move, America's Move to Raise a Healthier Generation of Kids. [http://www.letsmove.gov] More information on the Behavioral Risk Factor Surveillance System may be found on the website of the Centers for Disease Control and Prevention at [http://www.cdc.gov/brfss/].