Prevalence of Physical Inactivity During Leisure Time Among Overweight Persons -- Behavioral Risk Factor Surveillance System, 1994

During 1988-1991, approximately one third of adults in the United States were overweight * (2) -- an important risk factor for heart disease, diabetes, and some cancers (3). In addition to diet modification, initiating and maintaining regular physical activity is an important component of an effective weight-control strategy (4). To determine the prevalence of physical inactivity during leisure time among adults who are overweight, CDC analyzed data from the 1994 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that more than one third (37%) of overweight persons report no physical activity during their leisure time.

The BRFSS is a population-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged greater than or equal to 18 years. During 1994, a total of 103,690 persons were surveyed in 50 states and the District of Columbia; 11% were not eligible for this analysis because of pregnancy (1%) or missing information (10%). Of those remaining, 28% of men and 27% of women were overweight and were included in this analysis (n=25,164). Overweight persons were classified as attempting to control their weight if they reported trying to lose or maintain weight. Participants were asked about the type, duration, and frequency of the two leisure-time physical activities they had participated in most frequently during the preceding month. Those participating in no leisure-time physical activity during the preceding month were classified as inactive. Prevalence estimates and confidence intervals were calculated by using SUDAAN.

Overall, 33% of overweight men and 41% of overweight women were inactive during their leisure time (Table_1). The proportion of overweight persons reporting no physical activity during leisure time increased with age and level of overweight and decreased with level of educational achievement. Among overweight persons, 85% were attempting to control their weight (82% of men and 88% of women). Among men and women, overweight persons not attempting to control their weight were approximately 1.7 times more likely to be inactive during leisure time than those attempting to control their weight (49% and 29%, respectively and 66% and 37%, respectively). Among persons attempting to control their weight, those trying to only maintain weight were more likely to be inactive than those trying to lose weight (34% and 27% for men and 49% and 34% for women).

Reported by: State Behavioral Risk Factor Surveillance System Coordinators. Office of Surveillance and Analysis, and Div of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Based on the BRFSS findings, physical inactivity during leisure time was reported among a substantial proportion of overweight men (33%) and women (41%) in the United States. Demographic characteristics of persons who are less likely to be active -- both among overweight persons and the total population -- are similar. Factors related to differences in levels of physical activity may include knowledge and attitudes about physical activity, access to equipment and facilities, time, safety, and illness or disability (5). In this report, persons attempting to control their weight were more likely to be active during leisure time than those who were not. However, one third of those attempting to control their weight were inactive, indicating that some overweight persons either do not recognize the importance of physical activity in controlling weight or do not act on this knowledge.

The findings in this report may overestimate inactivity because of at least two limitations. First, because weight was self-reported and overweight persons tend to underreport their weight (6), those classified as overweight in this analysis probably represent a heavier subset of all overweight persons. Because leisure-time physical activity declines with increasing levels of weight, these prevalences of inactivity among overweight persons probably are overestimated. Second, prevalences of physical inactivity were estimated only for leisure time. The exclusion of other types of physical activity also could result in overestimates of inactivity because persons who reported inactivity during leisure time may have been physically active at other times (e.g., during work or household chores).

CDC and the American College of Sports Medicine have recommended that every U.S. adult should accumulate greater than or equal to 30 minutes of moderate-to-intense physical activity on most, preferably all, days (7). Most persons should be able to engage in moderately intense activities such as walking. Before engaging in strenuous activity, persons with chronic diseases or risk factors for chronic diseases should consult their health-care provider.

Regular physical activity provides health benefits for most persons. Because of the increased risk for chronic diseases among overweight persons (3), regular physical activity is especially important for overweight persons. Physical activity facilitates weight control by increasing energy expenditure and by preventing the loss of lean body mass that occurs with dieting (8). In addition, participation in physical activity by overweight persons can positively influence metabolic status through improved insulin sensitivity and decreased levels of blood lipids (9).

In the United States, the prevalence of overweight is increasing (2). Because of the increased health risks among overweight persons, health-care providers should routinely assess physical activity levels in their overweight patients and should counsel them to initiate or maintain regular physical activity to assist with weight control and to improve overall health (10). Although activities appropriate for overweight persons vary based on health status and other factors, walking is encouraged for most overweight persons -- particularly those who are initiating an activity program.

References

1. Najjar MF, Rowland M. Anthropometric reference data and prevalence of overweight, United States, 1976-1980. Washington, DC: US Department of Health and Human Services, Public Health Services, National Center for Health Statistics, 1987; DHHS publication no. (PHS)87-1688. (Vital and health statistics; series 11, no. 238).

2. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among U.S. adults: the National Health and Nutrition Examination Surveys, 1960-1991. JAMA 1994;272:205-11.

3. Pi-Sunyer FX. Health implications of obesity. Am J Clin Nutr 1991;53 (suppl):1595S-603S.

4. Council on Scientific Affairs. Treatment of obesity in adults. JAMA 1988;260:2547-51.

5. Dishman RK. Determinants of participation in physical activity. In: Bouchard C, Shepard RJ, Stephens T, Sutton JR, McPherson BD, eds. Exercise, fitness, and health: a consensus of current knowledge. Champaign, Illinois: Human Kinetics Publishers, Inc., 1990:75-101.

6. Rowland ML. Self-reported weight and height. Am J Clin Nutr 1990;52: 1125-33.

7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health

• a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273: 402-7.

8. Garfinkel PE, Coscina DV. Discussion: exercise and obesity. In: Bouchard C, Shepard RJ, Stephens T, Sutton JR, McPherson BD, eds. Exercise, fitness, and health: a consensus of current knowledge. Champaign, Illinois: Human Kinetics Publishers, Inc., 1990:511-5.

9. Bjorntorp P. Physical exercise in the treatment of obesity. In: Bjorntorp P, Brodoff BN, eds. Obesity. Philadelphia: J.B. Lippincott Company, 1992:708-11.

10. Patrick K, Sallis JF, Long B, et al. A new tool for encouraging activity: Project PACE. The Physician and Sportsmedicine 1994;22: 45-55.

Overweight is defined as a body mass index (BMI=weight {kg}/height {m}2) greater than or equal to 27.8 for men and greater than or equal to 27.3 for women. This classification was based on the 85th percentile value for BMI among persons aged 20-29 years in the Second National Health and Nutrition Examination Survey (1).

TABLE 1. Weighted prevalence of inactivity * during leisure time among overweight persons +, by sex and weight-control status -- United States,
Behavioral Risk Factor Surveillance System, 1994 &
=================================================================================================================================================
                                         Men                                                        Women
                 --------------------------------------------------------------  ----------------------------------------------------------------
                                               Not attempting                                              Not attempting
                         Attempting to           to control                              Attempting to       to control
                         control weight            weight          Total                 control weight         weight          Total
Category         Sample  ----------------    -----------------  ---------------  Sample  --------------   ----------------   --------------------
Age (yrs)         Size    %    (95% CI +)     %     (95% CI)    %   (95% CI)      Size     %  (95% CI)    %    (95% CI)       %  (95% CI)
-------------------------------------------------------------------------------------------------------------------------------------------------
 18-29            1586   21%   (+/-3.6%)      34%   (+/- 7.9%)  23%   (+/-3.3%)   1579   26%  (+/-3.5%)    51%  (+/-14.4%)   28% (+/-3.4%)
 30-39            2633   27%   (+/-3.0%)      38%   (+/- 6.3%)  28%   (+/-2.7%)   2886   31%  (+/-2.7%)    53%  (+/- 9.3%)   33% (+/-2.6%)
 40-49            2710   29%   (+/-2.9%)      53%   (+/- 6.4%)  33%   (+/-2.7%)   2935   36%  (+/-2.9%)    64%  (+/- 7.4%)   39% (+/-2.8%)
 50-59            1810   36%   (+/-3.8%)      57%   (+/- 8.2%)  40%   (+/-3.5%)   2328   41%  (+/-3.2%)    66%  (+/- 7.3%)   43% (+/-3.0%)
 60-69            1431   34%   (+/-4.2%)      62%   (+/- 8.9%)  39%   (+/-3.9%)   2195   45%  (+/-3.6%)    71%  (+/- 6.1%)   49% (+/-3.3%)
  >=70             844   37%   (+/-6.0%)      67%   (+/-10.0%)  45%   (+/-5.6%)   2227   51%  (+/-3.7%)    76%  (+/- 5.4%)   57% (+/-3.3%)

Education (yrs)
 Less than high
  school diploma  1636   47%   (+/-4.3%)      68%   (+/- 7.5%)  52%   (+/-3.8%)   2941   53%  (+/-3.2%)    79%  (+/- 4.4%)   58% (+/-2.8%)
 High school
 graduate         3653   34%   (+/-2.7%)      54%   (+/- 5.1%)  38%   (+2.4%)   5214   40%  (+/-2.1%)    68%  (+/- 4.8%)   43% (+/-2.0%)
 Some college     2914   23%   (+/-2.7%)      36%   (+/- 6.1%)  25%   (+/-2.5%)   3746   31%  (+/-2.5%)    53%  (+/- 7.2%)   32% (+/-2.4%)
 College graduate 2811   18%   (+/-2.2%)      34%   (+/- 7.6%)  20%   (+/-2.2%)   2249   24%  (+/-2.9%)    45%  (+/-10.2%)   26% (+/-2.8%)

Level of
 overweight
 Moderate **       7130   26%   (+/-1.8%)      46%   (+/- 3.9%)  30%   (+/-1.7%)   9564   35%  (+/-1.6%)    64%   (+/-3.9%)   39% (+/-1.5%)
 Severe ++         3884   34%   (+/-2.6%)      58%   (+/- 5.9%)  38%   (+/-2.4%)   4586   42%  (+/-2.4%)    71%   (+/-5.4%)   46% (+/-2.2%)

Total            11,014   29%   (+/-1.5%)      49%   (+/- 3.3%)  33%   (+/-1.4%) 14,150   37%  (+/-1.3%)    66%   (+/-3.2%)   41% (+/-1.2%)
-------------------------------------------------------------------------------------------------------------------------------------------------
*  No reported leisure-time activity during the preceding month.
+  Body mass index (BMI) >=27.8 for men and >=27.3 for women.
&  n=25,164.
@  Confidence interval.
** Body mass index (BMI) >=27.8 and <31.1 for men and>=27.3 and <32.3 for women. ++ BMI>=31.1 for men and >=32.3 for women.
=================================================================================================================================================

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