Obesity and Overall Health Status of Residents in the States with Appalachian Counties

Objective: To investigate differences in the relationship of obesity and overall health status between Appalachian and non-Appalachian residents of the states within the Appalachian region using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) data. 

Design and Setting: A cross-sectional multi-stage probability sample study of 110,345 residents of states with Appalachian counties who responded to the 2007 BRFSS survey.

Outcome Measures: Self-reported data on Health-Related Quality of Life was used to evaluate a five-level ordinal variable measuring the general health status of the survey respondents.

Results: There were statistically significant differences between Appalachian and non-Appalachian residents for all of the covariates except gender. There were statistically significant differences based on BMI category for all of the covariates except race. However, Appalachian residence (an Appalachia effect) was not statistically significant when education and income levels were considered. Being overweight significantly increased the odds of experiencing poor health, regardless of residence. A consistent relationship between exercise/nutrition and health status was present in each model.

Conclusions: Residents of Appalachia are one of the vulnerable populations in the United States. They have been consistently identified as less healthy than the general population. This paper explored whether Appalachian residence might exacerbate the well-established relationship between obesity and overall health. The impact of obesity was confirmed. However, Appalachian residence did not worsen the effects of obesity on general health. Any contextual effects of living in Appalachia were outweighed by the compositional effects associated with the individuals living there.