TUESDAY, May 21, 2002 (HealthDayNews) -- Win some, lose some, says a new state-by-state survey of America's health, but the battle against obesity is being lost in every corner of the nation.
The survey, done over the past decade by the Centers for Disease Control and Prevention (CDC), finds ups and downs in five health risk factors and use of six preventive services.
On the plus side, more Americans are buckling up, getting vaccinated and getting screened for cancer and heart disease. On the other hand, the rate of smoking rose in 14 states and was unchanged in 32, mostly in the Midwest and South. Binge drinking rose in 19 states and declined in only three.
The most striking fact was that "obesity increased in every state" between 1991 and 2000, says the survey, which appears in tomorrow's issue of the Journal of the American Medical Association.
"There's no question that it's a mess," says Dr. David E. Nelson, the epidemiologist who led the survey. "For obesity, every state got worse."
Otherwise, it?s a "good news, bad news" story, says Nelson, who is now with the National Cancer Institute. "The good news is that safety belt use, mammography and adult immunizations all increased. That is really encouraging. The bad news includes an increase in binge alcohol use and a lack of decline in smoking in many states, and that widespread epidemic of obesity."
It's hard to make generalizations about a survey covering so many facts about all the states, Nelson says. Some states did better than others. For example, New York, Maryland, Delaware, and Kentucky seem to have done the best, with improvements in eight of the 11 subjects covered. Alaska did the worst, showing no improvement in any category.
The results come from annual telephone surveys of randomly chosen adults. The five health risk factors are smoking, binge drinking (having five or more drinks at least once in the last month), physical inactivity, obesity and safety belt use. The six preventive services are mammography, cervical cancer screening, colorectal cancer screening, cholesterol screening and flu vaccination.
The idea is that the information will help guide preventive health measures in each state, showing which programs are working and which are falling short, Nelson says: "Each of the states has things that need to be looked at."
However, the CDC study is just the latest indicator that "obesity is clearly emerging as the leading public health issue of the 21st century," says Morgan Downey, executive director of the American Obesity Association.
"We don't think that enough has been invested in the problem," Downey says. "We're looking at strategies other than just telling people to eat better and exercise more. These are starting to emerge now. For example, there is more pressure on schools to start looking at vending machines and the like. We're hoping that major health-care organizations such as Medicare, Medicaid and health management organizations will get involved."
Trends in two other risk factors are described as "discouraging" in the CDC report. Binge drinking increased in 19 states, and nearly a third of all states reported an increase in smoking. Only one state, Minnesota, saw a significant drop in the smoking rate. However, safety belt use increased in 39 states.
For the clinical preventive measures, 43 states showed an increased use of mammography, 44 an increase in flu vaccination, and 48 an increase in pneumonia vaccination. There were smaller increases in screening for colorectal and cervical cancer and for cholesterol levels.
While colorectal cancer screening did increase in a quarter of the states, "there's a long way to go," Nelson says. "After all, that's the second leading cause of cancer deaths."
The survey shows it's much easier to deliver preventive services than to change behavior, Dr. J. Michael McGinnis of the Robert Wood Johnson Foundation writes in an accompanying editorial. "Achieving the best outcome, and achieving it for all, will require stronger public health and stronger partnerships than currently exist. The health of the American people -- in the parts and in the whole -- depends on it."
What To Do: You can learn about the nation's health goals from Healthy People 2010. Meanwhile, the Centers for Disease Control and Prevention and the American Obesity Association have information about the obesity epidemic.
