Obesity is associated with poor health, although it is little understood whether this association differs geographically. We examined whether the associations of obesity with poor general, physical and mental health vary across 50 US states and DC.


We analyzed the Behavior Risk Factor Surveillance System (BRFSS) year 2016 data (N=486,303). Responses of fair or poor to the general health questionnaire item were classified as poor general health (PGH). Poor physical (PPH) and mental (PMH) health are defined as 14+ days in a month with poor physical and mental health, respectively; BMI > 30 was classified as obesity. Multivariable survey logistic regressions were applied to test the significance of obesity effects on the three poor health conditions compared to non-obesity (BMI<30) after adjusting for socio-economic and lifestyle factors: sex, age, race, marital status, employment, health insurance, income, education, smoking, binge drinking, and leisure time physical activities.


The ranges of prevalence across the US states and DC are: obesity (22.3% -37.7%), PGH (11.6%-26.3%), PPH (8.2%-18.2%), and PMH (8.3%-16.5%). The linear association in terms of absolute prevalence at the state level between obesity and the three poor health conditions were significantly stronger for states with obesity prevalence > 32% compared to those with < 32%. The adjusted odds-ratio (AOR) of experiencing the three poor health conditions between obesity and non-obesity ranged: 1.7-2.8 (PGH), 1.3-2.3 (PPH), and 1.1-2.2 (PMH). Obese residents in states with higher obesity prevalence had smaller AOR’s for all three poor health conditions compared to their counterparts in states with lower obesity prevalence.


The findings call for a deeper understanding of why obesity-health associations differ geographically. A goal of future study should be to identify state-level macro environmental, cultural, social and health care system characteristics that differentiate the obesity-health associations.