What Economic and Cultural factors are associated

with the Differences in U.S. States Obesity Rates?

Nathaniel S. Hall
Winter 2014

1. Introduction
The United States has been recognized as a nation with an especially high increase in
obesity rates in the past two decades. This is a pressing and attention-demanding issue for
U.S. policy-makers, due not only to the emotional toll in human suffering and death but the
high economic costs of supporting an overweight nation. The American Heart Association
reports that the medical cost that can be attributed to obesity in the U.S. during 2008 reached
$147 billion. Apart from direct medical costs, lost worker productivity because of missed
time from diseases related to obesity costs employers billions of dollars in the private
industry (Lloyd-Jones 2013). As U.S. policy makers quarrel over which spending cuts will
lead the nation to a more balanced budget, addressing the factors associated with the
increasing obesity rate could return with billions in savings.
According to the Central Intelligence Agency World Fact Book, the United States ranked
18th out of 191 countries in highest obesity rates in 2008, at a rate of 33% (Central
Intelligence Agency 2013). But before looking at other countries to find solutions to the
problem of such a relatively high rate, it is worth turning attention to the differences between
U.S. own states obesity rates. They range from Colorado at 19%, which would rank 107th on
the list, to Mississippi at 35.4%, which would rank 13 th (Center of Disease Control 2009).
This is a significant disparity (16.4%) that can be attributed to economic and cultural
differences found in the United States.
Examining the economic and cultural differences that associate with obesity between
states is a more feasible task than attempting to account for all the factors that make up the
differences between the U.S. and other countries. Factors included in analysis will contain

and go beyond the more extensively studied demographic factors such as gender, race, and
income. The aim of this paper will be to capture obesity association with less traditional
factors, such as religion, political affiliation, and leisure activities. As the underlying
foundation of obesity is further understood, researchers will be able to help policy-makers
reduce the epidemic of obesity, potentially resulting in large public savings. Using the above
2008 American Medical Association statistic, a 1.75% decrease in the obesity rate obesity
would save $7.35 billion in cut medical costs and increased worker productivity.

2. Literature Review
Past literature on factors that associate with obesity in the U.S. has primarily been
concerned with demographic factors such as race, gender and income. Race, Ethnicity, and
Obesity, published in the book The Oxford Handbook of the Social Science of Obesity in 2011,
addresses the issues of American obesity and overweight through a cross-section analysis of race
and income. Through this analysis authors Renee E. Walker and Ichiro Kawachi aim to describe
the difference in obesity rates between racial and ethnic groups in the U.S. population, and
summarize their findings on the possible causes of these differences. The article begins by
defining the difference between overweight (Body Mass Index 25 to 29.9 Kg/M 2) and obese
(BMI greater than 29.9 Kg/M2), and states that it will examine patterns in both.
Walker and Kawachi (2011) first approach the data by stratifying race and ethnic
overweight and obesity rates by income and gender to test the theory that income disparities can
account for the differences in obesity rates between genders. By examining the graphs of women
of each race across low, medium, and high income levels, Walker and Kawachi (2011) claim that
lower family incomes are associated with higher prevalence of overweight. However, the pattern
observed cannot be found in the same graphs for men. Instead, white and Hispanic men exhibit
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an inverted U-shape, with highest obesity among the near poor and lowest among the
impoverished and wealthy. Walker and Kawachi (2011) conclude that these complexities
suggest that income differences are unlikely to completely account for race/ethnic differences in
overweight at least for males. This is a logical and expected conclusion to come to from a
visual analysis of the data. The conclusion could be improved by a regression analysis which
estimates the associations of the gender and income stratifications with overweightness, and then
reporting the strength of the associations.
Both a cross-sectional analysis and regression model are utilized by authors Lisa M.
Powell and Euna Han in the article Adult Obesity and the Price and Availability of Food in the
United States, published in 2011. The study obtains its data from the Panel Study of Income
Dynamics, a longitudinal study of U.S. individuals which began in 1968, as well as American
Chamber of Commerce Researchers Association (ACCRA) Cost of Living Index reports.
Powell and Han (2011) employ a similar cross sectional analysis as the previously
mentioned study, examining the relationship between income and Body Mass Index by gender
but without controlling by race. The overall results for men found a statistically significant
positive U-shaped trend between income and BMI, consistent with the previous cited works
findings. It also noted an inverse relationship between income and BMI for women, though the
trend was not found to be significant statistically. Though not stratified by race, this analysis
provides more details into the strength of associations compared to the cross-sectional model
provided by Walker and Kawachi (2011).
Powell and Hans (2011) empirical regression model aims to examine the importance of
the direct monetary prices of fruits and vegetables, as well as fast food prices. Parameters include
measures of these price levels by zip code and date, as well as vectors that measure the

availability of food stores (supermarkets, grocery stores, and convenience stores) and restaurants
(full-service and fast-food). Models are estimated separately for men and women, and controlled
for income level. Model results showed that none of the food price or availability contextual
factors were significant in association with mens BMI. However in the womens model, the
price of fruits and vegetables was found to be positively correlated with BMI, with statistical
significance. Specifically, a one dollar increase in price is associated with a .62 unit BMI
increase in females. The model effectively captures the factors that the authors aim to examine in
their initial question, and is conscious of the possible differences observed in different income
environments. Overall, the study concludes that food price and availability measures play a
limited role in the weight outcomes of U.S. adult men and women.
Past literature such as these two studies has relied primarily on U.S. individual-level data
to determine the underlying factors of obesity. Models have repeatedly focused on gender,
income, race, and education to account for the differences in BMI or obesity in individuals. The
model used in this paper differs from past literature by regressing data at the state level on the
dependent factors of state BMI, with the intention of capturing the economic and cultural U.S.
state population differences that associate with the 16.4% variation in states obesity rates
mentioned previously.

3. Data
Data used in the regression analysis comes primarily from the Behavioral Risk Factor
Surveillance System (BRFSS), a United States health survey run by the Center of Disease
Control and Prevention (2009). It is conducted by individual state health departments through
telephone interviews. It includes questions about health history, exercise and eating habits, and
tobacco and alcohol use, as well as other demographic information. Other data on Christian

affiliation and urban classification comes from the U.S. Census Bureau (2012, 2010).
Presidential election result data was provided by the National Archives and Records
Administration (2012).
The BRFSS is considered the largest health telephone survey in the world, but results by
telephone interviews could have some limitations. Individuals who refuse to respond or answer
calls are not considered in the survey and thus the survey may not be representative of the
general population. Also, individuals can answer questions untruthfully (eating and exercise
habits, for example), which could affect important statistics. Nonetheless, we move forward with
the assumption that the data is accurate and acknowledge that these issues could potentially
affect the results presented below.

4. Analysis
This study employs an Ordinary Least Squares regression model which includes the
dependent variable State Obesity Rate. An obese person is defined by having a Body Mass
Index of 30.0 Kg/M2 or above. Independent variables taken from the responses to the 2009
BRFSS are defined as follows: Percent of the state population that consumed vegetables 5 or
more times per day, percent of the state population that has engaged in physical activity in the
past month, percent of the state population that is 18-24 years old,

percent of the state

population that is white, percent of the state population that is black, percent of the state
population that is Hispanic, percent of the state population with a high school degree or G.E.D.,
percent of the state population with some post-high school education, percent of the state
population with a college degree or more education, and percent of the state population of adults
who are current tobacco smokers, percent of the population who voted for Barack Obama in the

2008 presidential election from the National Archives and Records Administration (2012), and
percent of the state population living in urban areas which was provided by the U.S. Census
Bureau (2010).
Also included as an explanatory variable is the number of McDonalds per capita in 2006
in each state, multiplied by 100,000 so the values are easier to work with. This dataset was
provided by International Business Machines Research (2008). Descriptive statistics for all of
the variables are presented in the table below.

There is variation in the spread of the distributions of the variables, evident in the
different standard deviations. Explanatory variables such as the percent of a states population
living in urban areas vary greatly between states. Others, such as the percent of a states
population aged 18-24 years old, do not vary as much between states.
Coefficients of variables from the resulting analysis are presented in the table labeled
Coefficient Estimates.

From the Coefficient Estimates table six explanatory variables have statistically
significant coefficients. Percentage of state population that consumes vegetables more than times
vegetables a day appears to be inversely associated with obesity. Specifically, a 1% increase in
percentage of a states population who eats vegetables more than five times per day is associated
with a .29% decrease in a states obesity rate. This is a seemingly expected relationship as
calories coming from vegetables are less dense in fats and sugars than other foods that make up
the American diet. Similarly, higher percentages of populations that have exercised in the past
month are inversely correlated with obesity rates. A 1% increase in the percent of a states
population who participated in physical activity in the past month is associated with a .26%
decrease in its obesity rate.
White and black populations were found to have significant positive correlations with
obesity rates, though Hispanic populations were not found to have significant association. A 1%
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increase in the proportion of the white population in a state is associated with a .06% higher
obesity rate. A 1% increase in the black population proportion associates with an 11% higher
obesity rate. This might partly be the result of cultural diets among blacks and whites, or be a
mix of factors like income and location that are not captured in the model.
Also noteworthy is the negative association of the percentage of a states population who
has a college education or higher with obesity rate. Specifically, a 1% increase percentage of
college educated state residents associates with a .32% decrease in that states rate of obesity. This
is consistent with past research on the relationship between education and obesity, including the
findings in a study by Devaux, Sassi, and Church (2011). The analysis showed a broadly linear
relationship between the number of years spent in full-time education and the probability of
obesity. It is interesting to note however that the other population proportions with different
levels of education did not significantly associate with any change in obesity rate in our
regression model.
Finally, the number of McDonalds restaurants per capita, multiplied by 100,000, was
found to be significantly positively correlated with state obesity rates. The model associates a .
0001 increase in the number of McDonalds per capita with a 1.01% increase in a states obesity
rate. This raises the question whether high densities of McDonalds restaurants (or fast food in
general) have caused populations to gain a taste for fatty foods, or whether restaurant locations
have targeted states with higher obesity rates.

5. Conclusion and Policy Implications

Through analysis of a multitude of demographic, economic, and cultural factors six differences
in state populations were found to be significantly associated with obesity rates in individual
states. The findings in this study have value in addressing the overall increasing obesity rate of
the United States as a nation. First, vegetable intake and even minor exercise (one or more times
in the past month) have strong negative associations with obesity rates. This continues to be an
important narrative for policy makers to address and attack in hopes of seeing the obesity rate
decay.
The positive associations of black and white populations with obesity do not provide
answers on their own, but should stimulate further research into what differentiates prevalence of
these populations from others (Asian, Hispanic, etc.) and how this affects the obesity rate.
The positive association of percentage of a states population with a college education or
higher and a states obesity rate confirm past literature on the relationship between the two
factors. This can be useful in arguing the importance of higher education and the benefits it
potentially provides to the U.S.
Finally, the number of McDonalds restaurants per capita strong association with obesity
gives restaurant policy-makers insight into the relationship between fast-food chain density and
obesity. The increasing availability of cheap, unhealthy food is a factor that has been theorized to
be a cause in the rise of obesity, and must continue to be researched and addressed by policymakers.
Equally as important as addressing the significant associations is looking at the
explanatory variables that were found to not be associated with a states obesity rate. Past
literature on the relationships between obesity and religion and political affiliations are scarce,

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and the insignificance of the political and religious measures as explanatory factors in this
analysis affirms that the relationship is low or negligible. Also, insignificance of the association
of the percentage of a states population that lives in urban areas with obesity rate presents a
contradiction with past literature. Patterson, Moore, and Probst (2004) found that Rural persons
were 15% more likely to be obese than urban residents in 1998, based on self-reported height
and weight. This relationship did not translate into an association between state urban
populations and obesity rates in our regression. Tobacco use also is presented at an issue not
associated with obesity.
Policymakers can consider avoiding these insignificant explanatory variables when
addressing the epidemic of obesity, as they are not found to be associated with the difference in
states obesity rates in the U.S.
Overall this study helped to discover some of the factors which associate with the
difference in obesity rates between states. Percent of a states population who ate vegetables five
or more times a day, exercised at least once in the past month, have a college or higher education
all were significantly associated with changes in a states obesity rate. The proportion of a states
population that is white and black both were found to be positively associated with obesity rates.
And lastly, the number of McDonalds per capita in a state was found to positively associate with
rates of obesity. These explain a portion of the variation between states obesity rates, but more
research can certainly be performed to determine these differences in the fight against the
epidemic of U.S. obesity.

References

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Center of Disease Control, 2009. Behavioral Risk Fact Surveillance System. Office of
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http://apps.nccd.cdc.gov/BRFSS/page.asp?yr=2009&state=All&cat=DE#DE.
Central Intelligence Agency. 2013. Country Comparison: Obesity Adult Prevalence Rate.
The World Factbook, Feb 20. https://www.cia.gov/library/publications/the-worldfactbook/rankorder/2228rank.html.
Devaux, Marion, Sassi, Franco, and Church, Jody, 2011. Exploring the Relationship between
Education and Obesity. OECD Journal: Economic Studies, Feb 18. 112-121.
International Business Machines Research, 2008. Data Sets: Obesity and Number of
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