Geographic Variation in Obesity at the State Level in the All of Us Research Program

Introduction National obesity prevention strategies may benefit from precisionhealth approaches involving diverse participants in populationhealth studies. We used cohort data from the National Institutes of Health All of Us Research Program (All of Us) Researcher Workbenchto estimate population-level obesity prevalence.MethodsTo estimate state-level obesity prevalence we used data fromphysical measurements made during All of Us enrollment visitsand data from participant electronic health records (EHRs) whereavailable. Prevalence estimates were calculated and mapped bystate for 2 categories of body mass index (BMI) (kg/m2): obesity(BMI >30) and severe obesity (BMI >35). We calculated andmapped prevalence by state, excluding states with fewer than 100All of Us participants.ResultsData on height and weight were available for 244,504 All of Usparticipants from 33 states, and corresponding EHR data wereavailable for 88,840 of these participants. The median and IQR ofBMI taken from physical measurements data was 28.4 (24.4–33.7) and 28.5 (24.5–33.6) from EHR data, where available. Overallobesity prevalence based on physical measurements data was41.5% (95% CI, 41.3%–41.7%); prevalence of severe obesity was20.7% (95% CI, 20.6–20.9), with large geographic variations observedacross states. Prevalence estimates from states with greaternumbers of All of Us participants were more similar to nationalpopulation-based estimates than states with fewer participants.ConclusionAll of Us participants had a high prevalence of obesity, with statelevelgeographic variation mirroring national trends.