You’ve probably seen various versions of an “obesity map” like the one above. Most of them show higher obesity rates in the South, which has led to a lot of tsk-tsking and speculation about possible reasons for the regional differences. TIME magazine ran an article in 2009 titled Why Are Southerners So Fat? that offered the usual explanations: It could be all that southern-fried food with gravy. Or perhaps obesity is just a marker for poverty, since more Southerners are poor. Or maybe it’s that people living in the South don’t spend as much time outdoors in the summer because it’s too hot and humid. The problem might even be a lack of public transportation, according to the TIME reporter:
That’s another problem, by the way: the South doesn’t have many bus stops. Public transportation is paltry, and for most people, the best way to get around is by car. “You don’t really think of riding the train as exercise, but at least you have to walk a few blocks to get to the stop,” says Bassett. States like Mississippi and Tennessee also have a surprising lack of sidewalks, discouraging even the most eager pedestrians. Many roads are narrower than those in the North — where streets have wider shoulders to accommodate winter snow — and people who want to bike or jog find themselves uncomfortably close to traffic.
Poverty, fried food, humid weather, not enough sidewalks, too much sweet tea … take your pick. But there’s another possible explanation that most of the obesity experts haven’t considered:
Those damned Yankees might just be a bunch of big fat liars.
Obesity rates are calculated by the Centers for Disease Control based on phone surveys. According to a new study, people who answer those surveys might not be (surprise!) completely honest:
The South often gets tagged with having the most obese population.
But it doesn’t appear to be true, a University of Alabama at Birmingham study suggests.
The study recently published in the journal Obesity found that there’s a significantly higher percentage of obese people in a region of central and northwest states including Minnesota, Kansas and North and South Dakota.
“What we found is the West North Central region has about 41 percent obesity compared to 31 percent obesity in the southern region that includes Alabama and Mississippi,” said George Howard, professor in the Department of Biostatics at UAB. “By the way, 31 percent is not a good thing — but it’s not at the bottom.”
How did Southerners get such a fat reputation? Apparently because they are more truthful.
Yup. The researchers found when they compared what people say they weigh versus what they actually weigh, the Northerners were more likely to … uh … underestimate their weight. Men in the North were also more likely to overestimate their height, which reduces their calculated BMI.
Thanks to the inability of Northerners to accurately estimate their heights and weights, the regional data on obesity may not be relevant after all:
The study analyzed the weights in the nine geographic regions used by the U.S. Census Bureau.
It found that the West North Central region, which includes Iowa, Kansas, Minnesota, Missouri, Nebraska and North and South Dakota, ranked fourth in obesity by the telephone survey results. But when actually weighed in the REGARDS study, people from that region ranked first in the nation for obesity.
In the telephone survey results, the East South Central region, which includes Alabama, Mississippi, Tennessee and Kentucky, ranked highest. But when weighed, that southern region ranked fifth.
That’s fifth out of nine national regions, mind you. As I wrote after we moved to Tennessee, I was surprised at how few obese people I saw in our immediate area. I see a higher proportion of obese people in my hometown in Illinois than I do here, but I figured perhaps that’s because Franklin is in a prosperous part of Tennessee.
“It is hard to know exactly what is going on, but my speculation is that people in the South are telling the truth more,” Howard said. “Perhaps there is not as much stigma connected to obesity as say someone in California, or in this case, Minnesota.”
Oh, I don’t think it’s because Southerners are less ashamed of being fat, Dr. Howard. I think it’s because more Northerners are less ashamed of being big fat liars. There are a lot more religious people in the South; perhaps they consider lying to the CDC to be a sin. (I’m not religious, so I consider lying to government officials to be a patriotic duty.) Sure, we grow some big fat liars in the South, but they tend to run for office, serve out their terms in Washington, then move to New York or California and write fictional autobiographies or make scary documentaries.
Anyway, since I’m sure the folks at TIME magazine wouldn’t want us to think they secretly enjoyed portraying the conservative South as a region populated by a bunch of fat Bubbas, I’m looking forward to their upcoming article, Why Northerners Are So Fat – And Why They Can’t Read A Scale.
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Well, whatever else is true, the Northeast is still the least obese section of the country, so suck it, fatties 😉
Seriously, I would like to see the methodology details of the REGARDS study. Clearly they didn’t weigh & measure each person who responded to a CDC phone survey about weight and height – so how did they get their random representative sample?
Phone surveys are a good way to randomize, but they definitely introduce a selection bias – you’re only getting data from people willing to tell a stranger how much they weigh, so both skinny people AND liars might be over-represented, due to truthful lipido-Americans declining to answer.
I’m guessing they compared phone-survey data for each region to actual weigh-in data for each region. But you’d have to weigh a LOT of people to have a good sample, and as you noted, it would have to be a random sample.
I don’t have any PubMed-type subscriptions, but one thing that jumps out at me from the summary of the REGARDS study is that one of its selection criteria for participants is “age >= 45.” (http://stroke.ahajournals.org/content/37/5/1171.full)
The CDC phone surveys, on the other hand, are of adults, 18+.
So if (and I have no idea if this is true or likely) obesity happens to skew younger in the South than in the Midwest, the REGARDS study would under-represent it.
It’d definitely be interesting to see a breakdown of the CDC’s numbers by region AND by age – compare apples to apples (or McDonald’s Hot Apple Pies to McDonald’s Hot Apple Pies…)
My guess is that all this data is iffy. They could have, however, compared CDC data for over people over 45 to REGARDS data to determine how phone-survey data compared to weigh-in data.
I just have to bring up my visit with a hospital dietician for gestational diabetes. I took out the calculator after my visit. The dietician wanted me to eat 200 grams of carbs a day. Up to 60 grams per meal with at least 3 snacks of 15 grams each. I told her straight out I had no intention of following her diet, that I thought a sugar based diet for a diabetic was insane. Even my obgyn encouraged me to stay with my usual low carb diet. My diabetic parents recently visited to see our new little boy and my dad was really impressed that his morning blood sugar was routinely below 100. I don’t get my hopes up in reforming their diet though. My mom, who buys the groceries and cooks the meals, knows the benefits of a low carb diet and talks a good game but she would much rather make excuses and take a pill. Unfortunately not eating nutritional crap requires a lot of work.
Well, if people know what they should do but don’t, that’s their business. My sympathies are for those who try to do the right thing but are given lousy advice.
Well, whatever else is true, the Northeast is still the least obese section of the country, so suck it, fatties 😉
Seriously, I would like to see the methodology details of the REGARDS study. Clearly they didn’t weigh & measure each person who responded to a CDC phone survey about weight and height – so how did they get their random representative sample?
Phone surveys are a good way to randomize, but they definitely introduce a selection bias – you’re only getting data from people willing to tell a stranger how much they weigh, so both skinny people AND liars might be over-represented, due to truthful lipido-Americans declining to answer.
I’m guessing they compared phone-survey data for each region to actual weigh-in data for each region. But you’d have to weigh a LOT of people to have a good sample, and as you noted, it would have to be a random sample.
I don’t have any PubMed-type subscriptions, but one thing that jumps out at me from the summary of the REGARDS study is that one of its selection criteria for participants is “age >= 45.” (http://stroke.ahajournals.org/content/37/5/1171.full)
The CDC phone surveys, on the other hand, are of adults, 18+.
So if (and I have no idea if this is true or likely) obesity happens to skew younger in the South than in the Midwest, the REGARDS study would under-represent it.
It’d definitely be interesting to see a breakdown of the CDC’s numbers by region AND by age – compare apples to apples (or McDonald’s Hot Apple Pies to McDonald’s Hot Apple Pies…)
My guess is that all this data is iffy. They could have, however, compared CDC data for over people over 45 to REGARDS data to determine how phone-survey data compared to weigh-in data.
@hausfrau: Having hovered for quite some time around 75 grams of carbs/day, I look at your hospital dietitian’s diet and all I can think of is how much WORK it would be to eat like THAT!
I just have to bring up my visit with a hospital dietician for gestational diabetes. I took out the calculator after my visit. The dietician wanted me to eat 200 grams of carbs a day. Up to 60 grams per meal with at least 3 snacks of 15 grams each. I told her straight out I had no intention of following her diet, that I thought a sugar based diet for a diabetic was insane. Even my obgyn encouraged me to stay with my usual low carb diet. My diabetic parents recently visited to see our new little boy and my dad was really impressed that his morning blood sugar was routinely below 100. I don’t get my hopes up in reforming their diet though. My mom, who buys the groceries and cooks the meals, knows the benefits of a low carb diet and talks a good game but she would much rather make excuses and take a pill. Unfortunately not eating nutritional crap requires a lot of work.
Well, if people know what they should do but don’t, that’s their business. My sympathies are for those who try to do the right thing but are given lousy advice.
@hausfrau: Having hovered for quite some time around 75 grams of carbs/day, I look at your hospital dietitian’s diet and all I can think of is how much WORK it would be to eat like THAT!
I have never lied in my life. Oops first time.
Oops second time.
I have never lied in my life. Oops first time.
Oops second time.
I’ve seen that map before, but they were associating weight with altitude with lower altitudes being heavier. You lay one map on top of the other and you can’t help but think they are on to something that is a contributing factor.
I’ve seen that map before, but they were associating weight with altitude with lower altitudes being heavier. You lay one map on top of the other and you can’t help but think they are on to something that is a contributing factor.
The south also, for the most part, includes far greater populations of blacks and Latinos(specifically, from Mexico, whose inhabitants tend to be shorter and plumper than average).
I will say that urban populations probably are thinner, and that may be because they are in close contact with other people almost continuously, and may be more conscious of their appearance. They also may walk more, though their activity levels beyond getting to/from places is nil. (not many wood choppin’ chore-doin’ NYC’ers).
The south also, for the most part, includes far greater populations of blacks and Latinos(specifically, from Mexico, whose inhabitants tend to be shorter and plumper than average).
I will say that urban populations probably are thinner, and that may be because they are in close contact with other people almost continuously, and may be more conscious of their appearance. They also may walk more, though their activity levels beyond getting to/from places is nil. (not many wood choppin’ chore-doin’ NYC’ers).