Faculty, Staff and Student Publications
Language
English
Publication Date
1-23-2026
Journal
International Journal of Environmental Research and Public Health
DOI
10.3390/ijerph23020142
PMID
41752225
PMCID
PMC12940917
PubMedCentral® Posted Date
1-23-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Adult obesity rates have risen steadily across the United States over the past decade, with more than 40% of adults affected. Persistent geographic and demographic disparities exist in obesity prevalence across the nation. While prior research has examined individual or environmental associated factors of obesity, limited studies have addressed both physical activity and food environments across the nation using multilevel approaches. This cross-sectional ecological study (2014-2024) used a two-level random intercept model to assess the association between county- and state-level factors and adult obesity prevalence across over 3000 U.S. counties nested within 51 states. County-level associated factors included food insecurity, poverty, unemployment, median household income, limited access to stores, and the density of various food outlets (grocery stores, convenience stores, supercenters, fast-food restaurants, Supplemental Nutrition Assistance Program (SNAP)-authorized retailers, and farmers' markets), along with access to recreational facilities. State-level factors included SNAP benefits per capita and the presence of soda and chip taxes. Variables were group-mean- or grand-mean-centered to distinguish within- and between-state effects. Results showed that food insecurity, poverty, unemployment, limited access to stores, and a higher density of fast-food and convenience stores were positively associated with adult obesity prevalence. While higher recreational facility access, supercenter availability, median household income, SNAP benefits per capita were associated with lower adult obesity prevalence, these associations varied in strength across counties and states. These results emphasize the need for place-based strategies that address both the physical activity and food environment in shaping obesity disparities.
Keywords
United States, Obesity, Humans, Food Supply, Exercise, Cross-Sectional Studies, Multilevel Analysis, Food Insecurity, Prevalence, Socioeconomic Factors, Socioeconomic Disparities in Health, adult obesity, food environment, physical activity environment, multilevel modeling, U.S. counties, socioeconomic disparities, SNAP benefits, food insecurity, recreational access, public health policy
Published Open-Access
yes
Recommended Citation
Abraham, Ann Mary; Swartz, Michael D; van den Berg, Alexandra E; et al., "Multilevel Analysis of the Food and Physical Activity Environment and Adult Obesity Across U.S. Counties and States" (2026). Faculty, Staff and Student Publications. 1469.
https://digitalcommons.library.tmc.edu/uthsph_docs/1469