Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
J Community Health. 2012 Feb;37(1):242-52. doi: 10.1007/s10900-011-9442-y.
Evidence is conflicting as to whether youth obesity prevalence has reached a plateau in the United States overall. Trends vary by state, and experts recommend exploring whether trends in weight-related behaviors are associated with changes in weight status trends. Thus, our objective was to estimate between-state variation in time trends of adolescent body mass index (BMI) percentile and weight-related behaviors from 2001 to 2007. A time series design combined cross-sectional Youth Risk Behavior Survey data from 272,044 adolescents in 29 states from 2001 to 2007. Self-reported height, weight, sports participation, physical education, television viewing, and daily consumption of 100% fruit juice, milk, and fruits and vegetables were collected. Linear mixed models estimated state variance in time trends of behaviors and BMI percentile. Across states, BMI percentile trends were consistent despite differences in behavioral trends. Boys experienced a modest linear increase in BMI percentile (ß = 0.18, 95% CI: 0.07, 0.30); girls experienced a non-linear increase, as the rate of increase declined over time from 1.02 units in 2001-2002 (95% CI: 0.68, 1.36) to 0.23 units in 2006-2007 (95% CI: -0.09, 0.56). States in which BMI percentile decreased experienced a greater decrease in TV viewing than states where BMI percentile increased. Otherwise, states with disparate BMI percentile trends did not differ with respect to behaviors. Future research should explore the role of other behaviors (e.g., soda consumption), measurement units (e.g., portion size), and societal trends (e.g., urban sprawl) on state and national adiposity trends.
关于美国整体青少年肥胖流行率是否已达到高峰，证据相互矛盾。各州的趋势各不相同，专家建议探讨与体重相关的行为趋势是否与体重状况趋势的变化有关。因此，我们的目的是估计 2001 年至 2007 年期间各州青少年体重指数（BMI）百分位数和与体重相关行为的时间趋势的差异。采用时间序列设计，结合了 2001 年至 2007 年来自 29 个州的 272,044 名青少年的横断面青少年风险行为调查数据。收集了自我报告的身高、体重、运动参与、体育教育、看电视和每天饮用 100%果汁、牛奶和水果和蔬菜的情况。线性混合模型估计了各州行为和 BMI 百分位数时间趋势的差异。尽管行为趋势存在差异，但各州的 BMI 百分位数趋势是一致的。男孩的 BMI 百分位数呈适度线性增加（β=0.18，95%置信区间：0.07，0.30）；女孩的 BMI 百分位数呈非线性增加，随着时间的推移，增加率从 2001-2002 年的 1.02 个单位（95%置信区间：0.68，1.36）下降到 2006-2007 年的 0.23 个单位（95%置信区间：-0.09，0.56）。BMI 百分位数下降的州比 BMI 百分位数增加的州，看电视的时间减少得更多。否则，BMI 百分位数趋势不同的州在行为方面没有差异。未来的研究应该探讨其他行为（例如，苏打水的消费）、测量单位（例如，份量大小）和社会趋势（例如，城市扩张）对州和国家肥胖趋势的作用。
