Epi Corner: 2004 review

Several months ago Houston was in the news as the fattest city in the nation as measured by Men’s Fitness magazine. The rankings were based on a variety of factors including the percent of people who are obese and how physically active the citizens are. Where did the magazine get those numbers? For some of the information, the magazine looked to the Behavioral Risk Factor Surveillance System, or BRFSS. The BRFSS is a nationwide telephone survey about chronic disease and health-related behaviors in the U.S. population. Every year about 250,000 people nationally, and 6,000 people in Texas participate in the survey. National, state and local governments use the data to plan, conduct and evaluate public health programs.

The survey was initiated in 1984 as public health officials recognized that health-related behaviors, such as food choices, seat belt use and smoking, affected the rates of morbidity (injury and illness) and mortality (death). Texas first participated in the BRFSS in 1987, and by 1994 all fifty states, three territories and the District of Columbia were participating. The Centers for Disease Control and Prevention (CDC) directs and coordinates the BRFSS, but each state is responsible for carrying out its own program. The survey includes mandatory questions that every state must ask, optional questions that states may include and questions that are being tested for future use. Mandatory topics include demographic information, such as age, gender, education level and questions on diabetes, smoking, asthma and women’s health. Optional questions cover topics such as childhood asthma, oral health, fruit and vegetable consumption and secondhand smoke practices.

States also have the opportunity to design their own state-specific questions to address local health needs. For example, after the Oklahoma City bombing, state health officials wanted to assess the impact of the bombing. They included questions in the Oklahoma BRFSS about the bombing and learned that 62 percent of residents in the Oklahoma City region knew someone who was killed or injured in the blast. That information was used to estimate mental health services needed to assist residents in recovering from the event.

Wait, you might say. What about the BRFSS and Men’s Fitness magazine? The magazine used several different sources when it ranked the cities. The BRFSS data was only part of that decision process. Two of the BRFSS variables were used: (1) the percent of people with no physical activity in the past month and (2) the percent of people who were obese (body mass index of 30.0 or more). The chart below shows the results for two cities on the ‘fat’ list, Houston and Dallas, two cities on the ‘fit’ list, Albuquerque, NM, and Tucson, AZ, and the national average. You can see that the ‘fit’ cities had less than 20 percent of their population reporting no physical activity and less than 20 percent of their populations were obese. In contrast, the ‘fat’ cities had more of their populations reporting no physical activity and more considered obese than the national average.