# Presentation: 136979

## Obesity and Body Mass Index: Differences between Canadian and American Adults:Findings from the Joint Canada/United States Survey of Health (JCUSH)

**Jane F. Gentleman, Ph.D., **
**Debra L. Blackwell, Ph.D., **
**and Michael Martinez, MPH, MHSA **
**    ****National Center for Health Statistics**
**Centers for Disease Control and Prevention**
**The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the National Center for Health Statistics, Centers for Disease Control and Prevention.**

## 	
From the Winnipeg Sun and Edmonton Sun, June 3, 2004: 
Yank Women Fatter
    Ottawa – When it comes to obesity, American women tip the scales compared with their Canadian sisters, a cross border health study confirms for the first time.  Overall, 21% of Americans were obese compared with 15% of Canadians, says the study released yesterday by Statistics Canada and the U.S. National Center for Health Statistics....

								continued.....

**From the *****Winnipeg Sun***** and *****Edmonton Sun*****, June 3, 2004: **
**Yank Women Fatter**
**    ****Ottawa – When it comes to obesity, American women tip the scales compared with their Canadian sisters, a cross border health study confirms for the first time.  Overall, 21% of Americans were obese compared with 15% of Canadians, says the study released yesterday by Statistics Canada and the U.S. National Center for Health Statistics....**
**	**
***	******	******	******	******	******	******	******	******continued.....***

## 	
	Previous research has suggested obesity may be more prevalent in the United States, but this is the first definitive confirmation, said Diane Finegood, a scientific director of the Canadian Institutes for Health Research (CIHR).

	“Whenever I go down there I think, God, there really is a difference, but this is in fact the first data I’m aware of where a survey was done at the same time in Canada and the United States with the same question and the same methodology by the same people,” said Finegood.   (Emphasis added.)

**	****Previous research has suggested obesity may be more prevalent in the United States, but this is the first definitive confirmation, said Diane Finegood, a scientific director of the Canadian Institutes for Health Research (CIHR).**
**	****“****Whenever I go down there I think, God, there really is a difference, but this is in fact the first data I’m aware of where a survey was done at the *****same***** time in Canada and the United States with the *****same***** question and the *****same***** methodology by the *****same***** people,” said Finegood.**   ***(Emphasis added.)***

## Today

**Comparisons (obesity rates & Body Mass Index):**
**Canadians vs. Americans**
**Women vs. men**
**Women vs. women**
**Focus on race/ethnicity differences**
**What other factors might explain the differences for women?**

## Body Mass Index (BMI)

**BMI = Weight / Height****2**
**(in kilograms and meters)**

## DEFINITIONS

**   ****Underweight:               ****BMI  ****< 18.5**** ****Normal weight: ****18.5 ****≤ BMI < 25****Overweight:         ****25 ****≤ BMI < 30**** ****Obese:                 ****30 ****≤ BMI**
**based on World Health Organization (WHO) standards**
**	****	**

## Obesity rates in JCUSH

|  |                            Canada |  |                  United States |  |
| --- | --- | --- | --- | --- |
| Weight categories |  | % |  | % |
| Men, 18+ years of age
  Under/Normal
  Overweight
  Obese
   | 
 | 
39.9
40.9
17.8
 |  
 |  
37.7
41.4
19.6
 |
| Women, 18+ years of age
  Under/Normal
  Overweight
  Obese
   | 
 | 
57.3
24.9
11.9
 |  
 |  
48.8
24.3
20.0
 |

***Blue font = statistically significant difference between ***
***Canada and U.S. (at 0.05 level)***

## Distribution of BMI for Canadian men

**Distribution of BMI for Canadian men**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian men (black)

These graphs are kernel estimates: smoothed histograms.

## Distribution of BMI for U.S. men

**Distribution of BMI for U.S. men**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. men (blue)

## Distribution of BMI for Canadian men (black) & U.S. men (blue)

**Distribution of BMI for Canadian men (black) & U.S. men (blue)**

**Legend**
- U.S. men
- Canadian men

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian men (black) & U.S. men (blue)

## Distribution of BMI for Canadian women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Distribution of BMI for Canadian women**

**Notes:**
Distribution of BMI for Canadian women (green)

## Distribution of BMI for U.S. women

**Distribution of BMI for U.S. women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. women (red)

## Distribution of BMI for Canadian women (green) & U.S. women (red)

**Distribution of BMI for Canadian women (green) & U.S. women (red)**

**Legend**
- U.S. women
- Canadian women

**X-axis =**
**Y-axis =**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women (green) & U.S. women (red)

## Distribution of BMI for U.S. women & U.S. men

**Distribution of BMI for U.S. women & U.S. men**

**Legend**
- U.S. women
- U.S. men

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. women (red) & U.S. men (blue)

## Distribution of BMI for Canadian women & Canadian men

**Distribution of BMI for Canadian women & Canadian men**

**Legend**
- Canadian women
- Canadian men

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women (green) & Canadian men (black)

## % overweight and obese, by race, women only 

| Blue font = statistically significant difference  
between Canada and U.S.  |
| --- |

| Canadian women (race) | Overweight  | Obese  |
| --- | --- | --- |
|     White
    Other | 27.2%
21.5% | 12.5%
13.8% |
|  U.S. women (race) |  |  |
|     White 
    Other | 24.7%
30.0% | 19.2%
28.3% |
| U.S. women (race/ethnicity)
    Non-Hispanic white
    Hispanic
    Non-Hispanic black
    Non-Hispanic other | 
33.3%
44.9%
30.8%
28.0% | 
19.3%
20.1%
33.2%
18.2% |

## Results of multivariate analysis, women onlyOdds ratios for being obese, by race/ethnicity

***Blue font = statistically significant***

| Characteristic | Odds Ratios  |  |
| --- | --- | --- |
| Race (Canada) | Canada  | U.S. |
| White (ref)
Other | 1.00
1.25  | na 
na |
| Race/ethnicity (U.S.) |  |  |
| Non-Hispanic white (ref)
Hispanic
Non-Hispanic black
Non-Hispanic other | na
na
na
na | 1.00
0.95
2.53
0.68 |

## Distribution of BMI for Canadian white women

**Distribution of BMI for Canadian white women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian white women (blue)

Categories for Canadian race:
     White
     Other

## Distribution of BMI for Canadian other women

**Distribution of BMI for Canadian other women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian other women (green)

## Distribution of BMI for Canadian women by race

**Distribution of BMI for Canadian women by race**

**Legend**
- White women
- Other women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women by race:
     White (blue)
     Other (green)

## Distribution of BMI for U.S. Non-Hispanic white women

**Distribution of BMI for U.S. Non-Hispanic white women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. Non-Hispanic white women (pink)

Categories for U.S. race/ethnicity:
     Non-Hispanic white
     Non-Hispanic black
     Non-Hispanic other
     Hispanic

## Distribution of BMI for U.S. Non-Hispanic black women

**Distribution of BMI for U.S. Non-Hispanic black women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. Non-Hispanic black women (red)

## Distribution of BMI for U.S. Non-Hispanic other women

**Distribution of BMI for U.S. Non-Hispanic other women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. Non-Hispanic other women (orange)

## Distribution of BMI for U.S. Hispanic women

**Distribution of BMI for U.S. Hispanic women**

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. Hispanic women (brown)

## Distribution of BMI for U.S. women, by race/ethnicity

**Distribution of BMI for U.S. women, by race/ethnicity**

**Legend**
- Hispanic women
- NH-white women
- NH-black women
- NH-other women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for U.S. women, by race/ethnicity:
     Non-Hispanic white (pink)
     Non-Hispanic black (red)
     Non-Hispanic other (orange)
     Hispanic (brown)

## Distribution of BMI for Canadian women and U.S. NH-white women

**Distribution of BMI for Canadian women and U.S. NH-white women**

**Legend**
- Canadian women
- U.S. NH-white women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women (green) & U.S. NH-white women (pink)

Now comparing Canada to U.S.

## Distribution of BMI for Canadian women & U.S. NH-black women

**Distribution of BMI for Canadian women & U.S. NH-black women**

**Legend**
- Canadian women
- U.S. NH-black women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women (green) & U.S. NH-black women (red)

## Distribution of BMI for Canadian women and U.S. Hispanic women

**Distribution of BMI for Canadian women and U.S. Hispanic women**

**Legend**
- Canadian women
- U.S. Hispanic women

**X-axis = BMI metric**
**Y-axis = Proportion (weighted) of population**

**Notes:**
Distribution of BMI for Canadian women (green)  and U.S. Hispanic women (brown)

## Other big differencesassociated with obesitybetween Canadian & American women

**Age**
**Education**
**Income**
**Self-reported health status**
**Leisure-time physical activity**
**Having a regular medical doctor**