Adirondack Health Institute: Obesity In The North County Report

OBESITY IN
THE NORTH COUNTRY

Prevalence of
Obesity

Among Adults
and Youth

Adirondack Health Institute is an independent, non-profit organization supporting hospitals, physician
practices, behavioral health providers, community-based organizations, patients and others in our region

to transform health care and improve population health.

CONTENTS

INTRODUCTION

0 2 The Obesity Epidemic: An Overview
0 4 Adult and Youth Obesity in the U.S.
0 6 Obesity and People with Disability
Section 1:

OBESITY IN THE
NORTH COUNTRY

0 8 Adult Obesity
0 9 Youth Obesity and People With Disability
Section 2:

FACTORS ASSOCIATED
WITH OBESITY IN THE
NORTH COUNTRY

13 Obesity in Rural Communities
14 Obesity-Related Behaviors
16 Food Insecurity
17 Community Environment
18 Access to Healthy Food
19 Access to Exercise Opportunities
20 Health Effects of

Overweight and Obesity
Section 3:

OBSERVATIONS ABOUT
OBESITY IN THE
NORTH COUNTRY

22 Discussion
24 Appendix
26 County Maps

1

INTRODUCTION

THE OBESITY EPIDEMIC:
AN OVERVIEW

Obesity in the United States is at an all-time “ONE-THIRD OF WORLD NOW
high; nearly 40% of adults and 19% of youth OVERWEIGHT, WITH U.S.
are obese. From 2000 to 2016, the percentage of LEADING THE WAY”
obese adults (20 years and older) and youth (aged — NBC News 6/12/2017
2 – 19 years) increased significantly.

According to The State of Obesity, a project of the
Trust for America’s Health and the Robert Wood
Johnson Foundation, “if these trends continue,
children today could be the first generation to live
shorter, less healthy lives than their parents.”

Approximately 300,000 deaths a year are currently
associated with overweight and obesity, second only
to tobacco use as the leading cause of preventable
death in the United States. Individuals who are
obese are at increased risk for type 2 diabetes,
heart disease, some forms of cancer, dementia and
a number of other health concerns. Children who
are overweight or obese are at greater risk for high
blood pressure, type 2 diabetes and heart disease.
And the longer children are overweight or obese,
the more likely they are to remain so into adulthood.

2

INTRODUCTION

Obesity impacts U.S. society on many different and obesity and provide the greatest opportunity for
levels including: actions and interventions designed for prevention
and treatment.
FINANCIALLY: This report presents and discusses national, New
The obesity crisis costs the U.S. more than $150 York State, and North Country data regarding the
billion in health care costs annually and billions of prevalence of obesity (and overweight), as well as
dollars more in lost productivity. data on the socio-economic, cultural, and behavioral
factors that are associated with obesity. The report
NATIONAL SECURITY: includes a series of maps that depict communities
The obesity crisis impacts our nation’s military in the North Country that have higher percentages
readiness. Being overweight or obese is the leading of residents who have been diagnosed and treated
cause of medical disqualifications, with nearly one- for conditions related to obesity (type 2 diabetes
quarter of service applicants rejected for exceeding and hypertension).
the weight or body fat standards. The report is intended to help inform regional and
local discussions and strategies to address and
COMMUNITY SAFETY: reverse the obesity epidemic in the North Country.
With millions of obese and overweight Americans
serving as first responders, firefighters, police INCREASE IN OBESITY IN U.S., 2000–2016
officers and in other essential community service Source: National Center for Health Statistics (NCHS), National Health and
and protection roles, public safety is at risk.
Nutrition Examination Survey (NHANES).
CHILD DEVELOPMENT AND
ACADEMIC ACHIEVEMENT:
Childhood obesity is correlated with poor
educational performance and increased risk for
bullying and depression.

EQUITY:
Obesity disproportionately affects low-income and
rural communities as well as certain racial and
ethnic groups, including Blacks, Latinos and Native
Americans.

Obesity is a complex condition with biological, genetic,
behavioral, social, cultural, and environmental
influences. Behavioral and environmental factors,
in particular, are large contributors to overweight

DEFINITION OF OBESITY:
Obesity in adults is defined as a Body Mass Index (BMI) of greater than or equal to 30.
Obesity in youth is defined as a BMI of greater than or equal to the age- and sex-specific
95th percentile of the 2000 Centers for Disease Control and Prevention growth charts.

3

OBESITY IN THE UNITED STATES

ADULT OBESITY

PREVALENCE OF ADULT OBESITY BY PREVALENCE OF ADULT OBESITY BY SEX, RACE
AGE & SEX, 2015–2016 (BY PERCENTAGE) & HISPANIC ORIGIN, 2015–2016
(BY PERCENTAGE)

Key Findings: Key Findings:

• The data show a steady progression of the prevalence • Non-Hispanic black and Hispanic Americans have
of obesity as Americans age. The only age cohort that significantly higher prevalence of obesity compared with
experiences a slight decrease in the prevalence of obesity non-Hispanic whites.
are people 60 and older.
• When considering race/ethnicity and sex, non-Hispanic
• When considering age and sex, women between the ages black American women have the highest prevalence of
40 to 59 have the highest prevalence of obesity (44.7%). obesity (54.8%) among adults.

PREVALENCE OF ADULT OBESITY BY PREVALENCE OF ADULT OBESITY BY
HOUSEHOLD INCOME & SEX, 2011–2014 EDUCATION LEVEL & SEX, 2011–2014

(BY PERCENTAGE) (BY PERCENTAGE)

Key Findings: Key Findings:

• Overall, the prevalence of obesity decreases with increasing • The prevalence of obesity decreases with increasing
income levels. education levels.

• The prevalence of obesity decreased with increasing income • The data show that college graduates have a significantly
in women, but there was no difference in obesity prevalence lower prevalence of obesity compared to individuals
between the lowest and highest income groups among men. with a high school diploma or less (27.8% compared to
40%, respectively).
4

OBESITY IN THE UNITED STATES

YOUTH OBESITY

PREVALENCE OF YOUTH OBESITY BY AGE, PREVALENCE OF YOUTH OBESITY BY SEX, RACE
2015–2016 (BY PERCENTAGE) & HISPANIC ORIGIN, 2015–2016
(BY PERCENTAGE)

Key Finding: Key Finding:

• The prevalence of obesity is higher among youth aged 6 – 11 • The overall prevalence of obesity is higher among non-
years and adolescents aged 12 – 19 years compared with Hispanic black and Hispanic youth than among non-
children aged 2 – 5 years. Hispanic whites and non-Hispanic Asian youth. The same
pattern is seen among adults.
PREVALENCE OF YOUTH OBESITY BY
HOUSEHOLD INCOME & SEX, 2015–2016 PREVALENCE OF YOUTH OBESITY BY
EDUCATION OF HEAD OF HOUSEHOLD & SEX,
(BY PERCENTAGE)
2015–2016 (BY PERCENTAGE)

Key Finding: Key Finding:

• The prevalence of youth obesity is lower among youth • The prevalence of obesity decreases among youth in
living in households in the highest income group. households headed by persons with higher education levels.

Understanding the prevalence of obesity by certain demographic characteristics is essential to informing
and developing effective strategies to address and reduce overweight and obesity. The data depicted on

this spread provides an overview of the U.S. adult and youth populations most impacted by obesity.

The sources for the data presented on this spread are the Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS), National Health
and Nutrition Examination Survey, 2011–2014 and 2015-2016.
5

OBESITY IN THE UNITED STATES

PEOPLE WITH DISABILITY

“40% OF
CANCERS ARE
LINKED TO BEING
OVERWEIGHT”

— Time 10/5/2017

Obesity is more prevalent among people with Children and adults with mobility limitations and
disability than among people without disability. intellectual or learning disability are at the greatest
risk for obesity. People with disability can find it
ACCORDING TO NATIONAL DATA: more difficult to eat healthy, control their weight,
• Obesity rate for adults with disability and be physically active. This might be due to:

is 58% higher than for adults without • A lack of access to healthy food choices.
disability, 36% to 23%, respectively • Difficulty with chewing or swallowing food,
(BRFSS 2008);
• Obesity rate for children with disability or its taste or texture.
is 38% higher than for children without • Medications that can contribute to weight gain,
disability, 22% to 16%, respectively
(NHANES 2008). weight loss, and changes in appetite.
• Health and fitness professionals who lack

knowledge about adaptations to facilitate
physical activity.
• Pain.
• A lack of energy.
• A lack of accessible environments (for example,
sidewalks, parks, and exercise equipment) that
can enable exercise.
• A lack of resources (for example, money,
transportation, and social support from family,
friends, neighbors, and community members).

6

SECTION 1

OBESITY IN
THE NORTH COUNTRY

7

OBESITY IN THE NORTH COUNTRY

ADULT OBESITY

PREVALENCE OF ADULT OBESITY, 2014
(BY PERCENTAGE)

PREVALENCE OF ADULTS WHO ARE The prevalence of adults who are obese in New
OVERWEIGHT OR OBESE, 2014 (BY PERCENTAGE) York State is below the national percentage.
According to the most recently reported data (2014),
Source for above graphs: NYS Expanded Behavioral Risk the prevalence of adult obesity for New York State
Factor Surveillance System (eBRFSS), 2014. is 24.6%. This compares favorably with the national
adult obesity prevalence of 29.6%.* New York State
is among the states with the lowest percentages
of obese adults (only Utah, California, Hawaii,
Massachusetts, District of Columbia, and Colorado
have lower percentages of adults who are obese).

However, the North Country is not immune to the
national obesity epidemic. As the chart to the left
indicates, the prevalence of adult obesity in the
North Country region exceeds both the national
and state prevalence. Furthermore, the prevalence
in each county in the region exceeds the New
York State value and the prevalence in half of the
counties (Essex, Franklin, Warren) exceed the
national percentage of adults with obesity.

*WHY ARE REPORTED NATIONAL OBESITY RATES HIGHER THAN STATE-BY-STATE RATES?

State (and county) obesity rates are collected by the Behavioral Risk Factor Surveillance System (BRFSS), which relies on self-reported height and
weight. Research has demonstrated that respondents tend to overestimate their height and underestimate their weight. In fact, one study found that,
due to this phenomenon, the BRFSS may underestimate obesity rates by nearly 10 percent. The National Health and Nutrition Examination Survey,
from which the national obesity rate is derived, calculates its obesity rate based on physical examinations of respondents. Accordingly, the higher rates
reflected by the National Health and Nutrition Examination Survey are likely a more accurate reflection of the true extent of the obesity epidemic. The
prevalence for adult obesity in the U.S. as reported by National Health and Nutrition Examination Survey is 39.6%.

When you include the percentage of adults in the North Country who are overweight to the picture, the magnitude of the issue confronting the
region becomes alarmingly clear. More than 60% of adults in the North Country are overweight or obese.* Studies show that the risk of death rises
with increasing weight. Even moderate overweight (10 to 20 excess pounds for a person of average height) increases the risk of death, particularly
among adults aged 30 to 64 years.

8* A BMI between 25 and 29.9 is considered overweight and a BMI >=30 is considered obese.

OBESITY IN THE NORTH COUNTRY

YOUTH OBESITY

According to information from the Centers for PREVALENCE OF ELEMENTARY SCHOOL STUDENTS
Disease Control and Prevention, childhood WHO ARE OVERWEIGHT OR OBESE, 2014–2016
obesity has immediate and long-term effects on (BY PERCENTAGE)
physical, social, and emotional health. For example:
PREVALENCE OF MIDDLE & HIGH SCHOOL STUDENTS
• Children with obesity are at higher risk of WHO ARE OVERWEIGHT OR OBESE, 2014–2016
having other chronic health conditions and (BY PERCENTAGE)
diseases that influence physical health. These
include asthma, sleep apnea, bone and joint
problems, type 2 diabetes, and risk factors for
heart disease.

• Children with obesity are bullied and teased
more than their normal weight peers and
are more likely to suffer from social isolation,
depression, and lower self-esteem.

• In the long term, a child with obesity is more
likely to be obese as an adult.

Similar to the adult prevalence, the percentage of
children in the North Country who are overweight
or obese is higher than the New York State value,
and the prevalence in each county in the region
exceeds the state’s value.

Source for graphs to the right: New York State Department of Health.
Data for United States and Hamilton County are not available.

PEOPLE WITH DISABILITY

National data indicate that obesity is more prevalent among people with disability than among people
without disability. This health disparity exists in New York State, the North Country and in each county
in the region, with the exception of Essex County.

PREVALENCE OF OBESITY AMONG ADULTS PREVALENCE OF OBESITY AMONG ADULTS
WITHOUT AND WITH DISABILITY, 2014 WITHOUT AND WITH DISABILITY, 2014
(BY PERCENTAGE) (BY PERCENTAGE)

Source for graphs: NYS Expanded Behavioral Risk Factor Surveillance System 9
(eBRFSS), 2014.

SECTION 2

FACTORS
ASSOCIATED WITH
OBESITY IN THE
NORTH COUNTRY

1100

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

As the national prevalence data regarding The highest rates of adult
obesity among adults and youth demonstrate, obesity are found among:
rates of obesity are influenced by race-ethnicity,
gender, age, income, and educational attainment. • Women age 40 to 59
• Non-Hispanic Black women
The data show that the greatest risks for obesity • Women with household income less than 130%
are concentrated among women and girls, racial/
ethnic minorities, people with lower household of the Federal Poverty Level
income and people with lower levels of educational • Women with a high school education or less
attainment. • People with disability

Education and income appear to be protective The highest rates of youth
factors associated with lower obesity prevalence. obesity are found among:
College graduates, and youth living in households
headed by a college graduate, have significantly • Females age 12 to 19
lower rates of obesity compared to individuals with • Hispanic males
a high school diploma or less. Similar differences • Females in households with incomes between
in the prevalence of obesity hold true for adults
and youth living in households with higher income 130% and 350% of the Federal Poverty Level
levels in comparison to lower income levels. • Females in households where the head of the

household has a high school education or less

11

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

WHAT IS THE STATUS OF THE RISK AND
PROTECTIVE FACTORS ASSOCIATED WITH

OBESITY IN THE NORTH COUNTRY?

Age and Sex Income and Poverty

The North Country’s population is aging. The median The median household income for the North
age is 43.4 years which is within the age range Country is substantially lower than the New
with the highest prevalence of obesity nationally York State median household income ($54,334
(40 to 59). Almost 30% of the region’s population compared to $66,418, respectively). The percentage
is between the ages of 45 and 64. Only 23% of of people living below the Federal Poverty Level
the North Country’s population is 20 or younger. in the North Country is slightly lower than the
Males comprise 51% of the total population and percentage for New York State (15.0% compared
females 49%. to 15.7%, respectively). However, the percentage of
people living in poverty in Clinton County (16.5%)
People with Disability and Franklin County (20.3%) exceed the New York
State value.
According to the New York State Department of
Health, 24% of the adults in the North Country Race and Ethnicity
have a disability (defined as limited in any activities
because of physical, mental, or emotional problems). The North Country is predominantly white (92%).
The percentages of the region’s total population by
Education other races are: Black/African Americans (3.39%);
two or more races (1.61%); American Indian (1.38%);
Almost half (48.8%) of the North Country population Asian (0.09%). Just over 3% of the North Country’s
25 years of age and older has either a high school population is Hispanic/Latino; 64% of the Hispanic/
diploma or has not completed high school. In Latino population in the region are males.
contrast, only 11% of the region’s population age
25 and older are college graduates.

RISK AND PROTECTIVE FACTORS
NYS AND NORTH COUNTRY (BY PERCENTAGE)

As the chart to the left illustrates, in
comparison to the total New York State

population, North Country residents
experience greater risk factors (age, disability)

and fewer protective factors (income,
educational attainment). The combination
of greater risk factors and fewer protective
factors contribute to the higher rate of adult

obesity in the North Country.

*MEDIAN HOUSEHOLD INCOME:
NEW YORK STATE $66,418 • NORTH COUNTRY $54,334

12

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

OBESITY IN RURAL COMMUNITIES

Rural counties in the United States and New York “OBESITY’S HEFTY PRICE TAG:
State have higher rates of obesity than urban AMERICA GRAPPLES WITH
or suburban counties. According to The State of COSTS FROM WEIGHT-LOSS
Obesity, rural communities face different challenges SURGERY TO EXTRA-WIDE
than their urban and suburban counterparts. For HOSPITAL BEDS”
instance, in comparison to urban and suburban — Politico 3/8/2017
communities, rural communities experience: “TOO FAT TO FIGHT:
IS THE OBESITY CRISIS A
• Fewer children walking to school; NATIONAL SECURITY RISK?”
• Heavy reliance on automobiles for — NBC News 5/30/2017

transportation; “OBESITY EPIDEMIC AT NEW
• Higher rates of television watching; HIGH, COSTS $150B A YEAR,
• Higher calorie consumption; HURTS MILITARY RECRUITING”
• Lower rates of exercise;
• Lack of nutrition education; — Washington Examiner 9/1/2017
• Fewer nutrition services;
• Fewer sidewalks;
• Reduced access to facilities that foster healthy

behavior such as recreation centers and
supermarkets that sell healthy, affordable food.

These same factors and challenges exist in the
North Country. Data about some of these factors
are depicted next.

13

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

OBESITY-RELATED BEHAVIORS

“AMERICA’S The Centers for Disease Control and Prevention
OBESITY notes that healthy behaviors related to
PROBLEM overweight and obesity include a healthy diet
pattern and regular physical activity. A healthy
ISN’T GETTING diet pattern follows the Dietary Guidelines for
BETTER” Americans which emphasizes eating whole grains,
fruits, vegetables, lean protein, low-fat and fat-free
— Associated Press 10/12/2017 dairy products and drinking water. The Physical
Activity Guidelines for Americans recommends
14 adults do at least 150 minutes of moderate intensity
activity or 75 minutes of vigorous intensity activity,
or a combination of both, along with 2 days of
strength training per week.

Behaviors that influence excess weight gain include
eating high-calorie, low-nutrient foods and beverages,
not getting enough physical activity, sedentary
activities such as watching television or other screen
devices, medication use, and sleep routines.

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

OBESITY-RELATED BEHAVIORS

New York State collects data from adults age 18 ADULTS WHO CONSUME ONE OR MORE
and older on a number of behaviors related to SUGARY DRINKS DAILY, 2014 (BY PERCENTAGE)
overweight and obesity. This data is presented in ADULTS WHO CONSUME FAST FOOD THREE OR
the graphs to the right. MORE TIMES PER WEEK, 2014 (BY PERCENTAGE)

Diet: ADULTS WHO ARE SEDENTARY, 2014
(BY PERCENTAGE)
Percentage of Adults Who Consume One or
More Sugary Drinks Daily (Sugary drinks include
regular soda, and sugar-sweetened drinks)
North Country adults consume sugary drinks at a
higher percentage than all New Yorkers.

Fast Food Consumption:

Percentage of Adults Who Consume
Fast Food Three or More Times Per Week
Fast food consumption among North Country
adults is just below New York State value, however,
the percentage of adults residing in Clinton and
Washington counties who consume fast food is
significantly above the New York State percentage.

Physical Activity

Percentage of Adults who are Sedentary
This indicator shows the percentage of adults who
did not participate in any leisure-time activities
(physical activities other than their regular job)
during the past month.

With the exception of adults residing in Franklin and
Washington counties, North Country adults are more
active than the rest of New York State residents.

Notes about the graphs:
Columns in blue depict the benchmark value;

columns in green depict values that are
better than the benchmark value; columns
in red depict values that are worse than the

benchmark value.

Source for graphs: NYS Expanded Behavioral Risk Factor
Surveillance System (eBRFSS), 2014.
15

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

FOOD INSECURITY

Food insecurity is an economic and social insecurity compared to Americans overall. While
indicator of the health of a community. The household food insecurity has long been associated
U.S. Department of Agriculture (USDA) defines with poor nutrition, adverse physical and mental
food insecurity as limited or uncertain availability health outcomes, and low academic achievement,
of nutritionally-adequate foods or uncertain ability a growing body of research is exploring the role
to acquire these foods in socially-acceptable of food insecurity in the development of obesity.
ways. Poverty and unemployment are predictors Results from studies targeting children and men
of food insecurity in the United States. A survey have been mixed, but a consistent link has been
commissioned by the Food Research and Action found between food insecurity and overweight
Center (FRAC) found that one in four Americans and obesity in women.
worries about having enough money to put food
on the table in the next year. Food insecurity is associated with chronic health
problems in adults including diabetes, heart disease,
Households with incomes below the Federal Poverty high blood pressure, hyperlipidemia, obesity, and
Level, families with children, and families headed by mental health issues including major depression.
single women are disproportionately at risk for food

ADULTS WHO EXPERIENCED FOOD CHILDREN WHO EXPERIENCED FOOD
INSECURITY WITHIN PAST 12 MONTHS, 2014 INSECURITY WITHIN PAST 12 MONTHS, 2015

(BY PERCENTAGE) (BY PERCENTAGE)

Source: NYS Expanded Behavioral Risk Factor Source: Feeding America, 2015.
Surveillance System (eBRFSS), 2014.
Child Food Insecurity Rate
Adults Experiencing Food
Insecurity* in the Past 12 Months This indicator shows the percentage of children
(under 18 years of age) living in households that
*Worried or stressed about having enough money to buy experienced food insecurity at some point during
nutritious meals. the year. Similar to the adult food insecurity rate,
Food insecurity among Franklin County adults Franklin County’s child food insecurity rate is well
greatly exceeds both the state and regional values. above the state and North Country rates.

16

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

COMMUNITY ENVIRONMENT

People and families may make decisions based on numbers of stores that sell healthy foods. People
their environment or community. For example, living farther away from grocery stores are less
a person may choose not to walk or bike to the likely to access healthy food options on a regular
store or to work because of a lack of sidewalks basis and thus more likely to consume foods which
or safe bike trails. Community, home, child care, are readily available at convenience stores and fast
school, health care, and workplace settings can all food outlets.
influence people’s daily behaviors. Therefore, it is
important to create environments in these locations People with Low Access
that make it easier to engage in physical activity to a Grocery Store
and eat a healthy diet.
This indicator shows the percentage of individuals
Food Environment Index living more than one mile from a supermarket or
large grocery store if in an urban area, or more
The food environment index combines two measures than 10 miles from a supermarket or large grocery
of food access: the percentage of the population store if in a rural area.
that is low-income and has low access to a grocery
store, and the percentage of the population that did The accessibility, availability, and affordability of
not have access to a reliable source of food during healthy and varied food options in the community
the past year (food insecurity). The index ranges increase the likelihood that residents will have a
from 0 (worst) to 10 (best) and equally weights the balanced and nutritious diet. People living farther
two measures. away from grocery stores are less likely to access
healthy food options on a regular basis and thus
A lack of access to healthy foods is often a more likely to consume foods which are readily
significant barrier to healthy eating habits. Low- available at convenience stores and fast food outlets.
income and underserved areas often have limited

FOOD ENVIRONMENT INDEX, 2018 PEOPLE WITH LOW ACCESS TO A GROCERY
(BY PERCENTAGE) STORE, 2015 (BY PERCENTAGE)

Source: County Health Rankings, 2018. Data for North Country Source: U.S. Department of Agriculture — Food Environment Atlas,
Region is not available. 2015. The NYS value is not available.
17

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

ACCESS TO HEALTHY FOOD

Low Access to a Grocery Store: Grocery Store Density

Children, People 65+, Low-Income People, and This indicator shows the number of supermarkets
People without a Vehicle and grocery stores per 1,000 population.
Low access is defined as the percentage of Convenience stores and large general merchandise
individuals living more than one mile from a stores such as supercenters and warehouse club
supermarket or large grocery store if in an urban stores are not included in this count. There are
area, or more than 10 miles from a supermarket or strong correlations between the density of grocery
large grocery store if in a rural area. stores in a neighborhood and the nutrition and diet
In comparison to other groups, people with low of its residents. The availability and affordability of
incomes have the least access to grocery stores in healthy and varied food options in the community
the North Country. increase the likelihood that residents will have a
balanced and nutritious diet. Rural communities
LOW ACCESS TO A GROCERY STORE BY often have a high number of convenience stores,
DEMOGRAPHIC CHARACTERISTIC, 2015 where healthy and fresh foods are less available
than in larger, retail food markets.
GROCERY STORE, FARMERS MARKET,
FAST FOOD RESTAURANT DENSITY PER 1000 Farmers Market Density

POPULATION, 2014 This indicator shows the number of farmers
markets per 1,000 population. A farmers market
Source for above graphs: U.S. Department of Agriculture — Food is a retail outlet in which vendors sell agricultural
Environment Atlas, 2015. The NYS value is not available. products directly to customers. Farmers markets
provide a way for community members to buy
fresh and affordable agricultural products while
supporting local farmers.

Fast Food Restaurant Density

This indicator shows the number of fast food
restaurants per 1,000 population. These include
limited-service establishments where people pay
before eating. Fast food is often high in fat and calories
and lacking in recommended nutrients. Frequent
consumption of these foods and an insufficient
consumption of fresh fruits and vegetables increase
the risk of overweight and obesity. Fast food outlets
are more common in low-income neighborhoods and
studies suggest that they strongly contribute to the
high incidence of obesity and obesity-related health
problems in these communities.

With the exception of Hamilton County, fast food
restaurant density is substantially greater than
grocery store and farmers market density in North
Country counties.

18

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

ACCESS TO EXERCISE OPPORTUNITIES

ADULTS WHO CONSIDER NEIGHBORHOOD INDIVIDUALS WHO LIVE REASONABLY CLOSE
SUITABLE FOR WALKING AND PHYSICAL TO PARK OR RECREATIONAL FACILITY, 2015
ACTIVITY, 2014 (BY PERCENTAGE) (BY PERCENTAGE)

Source: NYS Expanded Behavioral Risk Factor Surveillance System Source: County Health Rankings, 2015
(eBRFSS), 2014.

A word of caution: It should be noted that the high scores for Essex, Hamilton and Warren County may
be a function of their proximity to hiking trails in the Adirondack Park. The scores may not be an accurate
indication of access to exercise opportunities for all the residents of those counties.

19

FACTORS ASSOCIATED WITH OBESITY IN THE NORTH COUNTRY

HEALTH EFFECTS

OF OVERWEIGHT AND OBESITY

People who are obese, compared to those with a Other Health Outcomes
normal or healthy weight, are at increased risk
for many serious diseases and health conditions, The North Country rates or percentages for the
including: all-causes of death; high blood pressure; obesity-related conditions listed below exceed the
type 2 diabetes; coronary heart disease; stroke; New York State rates or percentages.
some cancers (endometrial, breast, colon, kidney,
gallbladder, and liver); low quality of life; and mental Source: NYSDOH 2013-2015
illness such as clinical depression, anxiety, and other
mental disorders. Hospital Discharges:
Type 2 Diabetes and Hypertension
Premature Death
Obesity is a major risk factor for developing type
The high prevalence of obesity in the North Country 2 diabetes and being overweight or obese makes
takes its toll on the region’s residents. As illustrated individuals more likely to develop hypertension
below, the rates of premature death (age 35 to 64 (high blood pressure) than if they are at their
years) for the indicated obesity-related diseases in desirable weight.
the North Country exceed the rates for all of New
York State.

PREMATURE DEATH RATE PER
100,000 POPULATION, 2015

Source: 2013-2015 NYSDOH Vital Statistics Data as of April 2017.

20

SECTION 3

O B S E R VAT I O N S
ABOUT OBESITY IN
THE NORTH COUNTRY

221

DISCUSSION

Overweight and obesity are at epidemic In comparison to New York State, the North Country
proportions in the North Country. As the chart population has a higher median age, lower median
below illustrates, the North Country values for all household income, fewer college graduates, and a
five measures of overweight and obesity reported higher percentage of people with disability. These
by the New York State Department of Health exceed demographic and socio-economic characteristics
the New York State values. are known to contribute to a population’s prevalence
of overweight and obesity.
OVERWEIGHT AND OBESITY MEASURES, Also, in comparison to New York State as a whole,
2014-2016 the North Country has higher consumption of
sugary drinks, comparable fast food consumption,
Source: New York State Department of Health. more child food insecurity, and less access to parks
and recreational facilities.
On the positive side, data indicates that North
Country adults are less sedentary than their state
counterparts, adult food insecurity is at a lower
level than the state, and more adults report that
their neighborhoods are suitable for walking and
physical activity.
However, overweight and obesity take a heavy
toll on North Country residents as demonstrated
by higher rates of premature death and mortality
from conditions related to obesity.

22

DISCUSSION

Obesity is a complex condition with biological, of creating community environments that can
genetic, behavioral, social, cultural, and help residents readily access healthy foods and
environmental influences. There is no one single easily incorporate physical activity into their
factor that results in obesity, nor one single daily routines.
intervention that will prevent or reduce obesity in
a population. Creating a healthy community environment cannot
be done in isolation by any one organization or field.
While reversing North Country demographic trends It requires coordinated and comprehensive efforts
(an aging population, an increasing percentage of by multiple organizations, leaders, fields and sectors.
people with disability) and improving the region’s It also requires bottom-up efforts where different
socio-economic factors (increasing educational stakeholders can come to a common understanding
attainment, raising household incomes) may have of the issues impacting the community’s health and
the biggest positive impact on the prevalence have a voice in developing local solutions.
of obesity in the region, these outcomes may be
beyond the ability of local communities to achieve. The data contained in this report are intended to
help create that common understanding of the
Behavioral and environmental factors that factors that have resulted in the high prevalence of
contribute to the obesity epidemic in the North adult and childhood overweight and obesity in the
Country provide the greatest opportunity for North Country and to help inform the development
actions and interventions that have the potential of regional and local solutions to halt and reverse
to positively impact obesity in the region. Common the obesity epidemic.
sense and emerging research point to the benefits

23

APPENDIX

The appendix to this report contains a series of PERCENTAGE OF INPATIENT DISCHARGES:
maps that depict hospital discharge data for DIAGNOSIS & TREATMENT FOR OBESITY, 2015
North Country residents who were diagnosed and
treated for obesity with type 2 diabetes, and another PERCENTAGE OF INPATIENT DISCHARGES:
series of maps for residents diagnosed and treated DIAGNOSIS & TREATMENT FOR OBESITY WITH
for obesity with hypertension. The maps illustrate
the ranking of zip code areas in each of the six North HYPERTENSION, 2015
Country counties by the degree of percentages PERCENTAGE OF INPATIENT DISCHARGES:
(lowest to highest) of hospital discharges for the DIAGNOSIS & TREATMENT FOR OBESITY WITH
two obesity-related conditions.
TYPE 2 DIABETES, 2015
The maps are included to help identify communities
in the region that are experiencing poorer health
outcomes due to obesity. This information can be
used to engage the communities in discussing,
identifying and advancing potential solutions to
address local factors that contribute to obesity and
the resulting poor health outcomes.

The data used to construct the maps is from the
New York State Department of Health Statewide
Planning and Research Cooperative System
(SPARCS). The data are based on hospital inpatient
stays/discharges that occurred in 2015. The zip code
information used to map the relative percentages of
discharges in each county is based on each patient’s
zip code of residence.

The data used for the maps represent three
cohorts of patients:

• Patients discharged from a hospital inpatient
stay with a diagnosis and treatment for obesity;

• Patients discharged from a hospital inpatient
stay with a diagnosis and treatment for obesity
with hypertension; and

• Patients discharged from a hospital inpatient
stay with a diagnosis and treatment for obesity
with type 2 diabetes.

The regional and county percentages for each
patient cohort is depicted in the graphs to the right.

24

APPENDIX

The Chazen Companies Methodology

The Chazen Companies developed the series of maps The data used to prepare the following maps are
included in the appendix. The Chazen Companies from the New York State Department of Health
is an employee-owned, multidisciplinary firm Statewide Planning and Research Cooperative
providing engineering, land surveying, planning, System (SPARCS). SPARCS is a comprehensive
environmental and safety consulting, landscape all payer data reporting system that collects patient-
architecture, construction services, transportation level detail on patient demographics, diagnoses
planning and traffic engineering to clients in the and treatments, services, and charges. The data
private and public sectors. used for this map are based on hospital inpatient
stays/discharges that occurred in 2015. Geographic
Map Appendix (Pages 26-37) Information System (GIS) software was utilized
to analyze zip code boundaries. Where zip code
12 Maps: boundaries extend beyond the Population Health
Improvement Program North Country region, the
• 6 county zip code level maps of inpatient data were prorated based on the percentage of the
discharges with diagnosis and treatment of zip code population living in the study area.
obesity WITH hypertension

• 6 county zip code level maps of inpatient
discharges with diagnosis and treatment of
obesity WITH type 2 diabetes

25

WARREN COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage of inpatient discharges diagnosed and treated for obesity WITH hypertension.
The percentage is calculated by dividing the number of inpatient discharges for obesity with hypertension
within a zip code by the total number of inpatient discharges for obesity within the same zip code. When
compared to PHIP’s six-county North Country region as a whole (Clinton, Essex, Franklin, Hamilton,
Warren, and Washington), Warren County’s overall percentage of 53% is higher than the entire region’s
percentage of 52%.

26

WARREN COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage of inpatient discharges diagnosed and treated for obesity WITH type 2
diabetes. The percentage is calculated by dividing the number of inpatient discharges for obesity with
type 2 diabetes within a zip code by the total number of inpatient discharges for obesity within the same
zip code. When compared to PHIP’s six-county North Country region as a whole (Clinton, Essex, Franklin,
Hamilton, Warren, and Washington), Warren County’s overall percentage of 49% is higher than the entire
region’s percentage of 48%.

27

WASHINGTON COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage of
inpatient discharges diagnosed and
treated for obesity WITH hypertension.
The percentage is calculated by dividing
the number of inpatient discharges for
obesity with hypertension within a zip
code by the total number of inpatient
discharges for obesity within the same
zip code. When compared to PHIP’s six-
county North Country region as a whole
(Clinton, Essex, Franklin, Hamilton,
Warren, and Washington), Washington
County’s overall percentage of 52%
is comparable to the entire region’s
percentage of 52%. Note that Comstock
includes the prison population.

28

WASHINGTON COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage of
inpatient discharges diagnosed and
treated for obesity WITH type 2
diabetes. The percentage is calculated
by dividing the number of inpatient
discharges for obesity with type 2
diabetes within a zip code by the total
number of inpatient discharges for
obesity within the same zip code. When
compared to PHIP’s six-county North
Country region as a whole (Clinton,
Essex, Franklin, Hamilton, Warren, and
Washington), Washington County’s
overall percentage of 40% is lower
than the entire region’s percentage of
48%. Note that Comstock includes the
prison population.

29

ESSEX COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage of inpatient discharges
diagnosed and treated for obesity WITH hypertension.
The percentage is calculated by dividing the number
of inpatient discharges for obesity with hypertension
within a zip code by the total number of inpatient
discharges for obesity within the same zip code. When
compared to PHIP’s six-county North Country region
as a whole (Clinton, Essex, Franklin, Hamilton, Warren,
and Washington), Essex County’s overall percentage of
50% is lower than the entire region’s percentage of 52%.

30

ESSEX COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage of inpatient discharges
diagnosed and treated for obesity WITH type 2 diabetes.
The percentage is calculated by dividing the number of
inpatient discharges for obesity with type 2 diabetes
within a zip code by the total number of inpatient
discharges for obesity within the same zip code. When
compared to PHIP’s six-county North Country region
as a whole (Clinton, Essex, Franklin, Hamilton, Warren,
and Washington), Essex County’s overall percentage of
47% is lower than the entire region’s percentage of 48%.

31

HAMILTON COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage of
inpatient discharges diagnosed and
treated for obesity WITH hypertension.
The percentage is calculated by dividing
the number of inpatient discharges for
obesity with hypertension within a zip
code by the total number of inpatient
discharges for obesity within the same
zip code. When compared to PHIP’s
six-county North Country region as
a whole (Clinton, Essex, Franklin,
Hamilton, Warren, and Washington),
Hamilton County’s overall percentage
of 60% is higher than the entire region’s
percentage of 52%.

32

HAMILTON COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage of
inpatient discharges diagnosed and
treated for obesity WITH type 2
diabetes. The percentage is calculated
by dividing the number of inpatient
discharges for obesity with type 2
diabetes within a zip code by the total
number of inpatient discharges for
obesity within the same zip code. When
compared to PHIP’s six-county North
Country region as a whole (Clinton,
Essex, Franklin, Hamilton, Warren,
and Washington), Hamilton County’s
overall percentage of 41% is lower than
the entire region’s percentage of 48%.

33

CLINTON COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage of inpatient discharges diagnosed and treated for obesity WITH hypertension.
The percentage is calculated by dividing the number of inpatient discharges for obesity with hypertension
within a zip code by the total number of inpatient discharges for obesity within the same zip code. When
compared to PHIP’s six-county North Country region as a whole (Clinton, Essex, Franklin, Hamilton, Warren,
and Washington), Clinton County’s overall percentage of 54% is higher than the entire region’s percentage
of 52%. Note Village of Dannemora includes the prison population.

34

CLINTON COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage of inpatient discharges diagnosed and treated for obesity WITH type 2
diabetes. The percentage is calculated by dividing the number of inpatient discharges for obesity with
type 2 diabetes within a zip code by the total number of inpatient discharges for obesity within the same
zip code. When compared to PHIP’s six-county North Country region as a whole (Clinton, Essex, Franklin,
Hamilton, Warren, and Washington ), Clinton County’s overall percentage of 53% is higher than the entire
region’s percentage of 48%. Note Village of Dannemora includes the prison population.

35

FRANKLIN COUNTY:

HYPERTENSION

About This Map

This map depicts the percentage
of inpatient discharges diagnosed
and treated for obesity WITH
hypertension. The percentage is
calculated by dividing the number
of inpatient discharges for obesity
with hypertension within a zip code
by the total number of inpatient
discharges for obesity within the
same zip code. When compared to
PHIP’s six-county North Country
region as a whole (Clinton, Essex,
Franklin, Hamilton, Warren, and
Washington), Franklin County’s
overall percentage of 47% is lower
than the entire region’s percentage
of 52%. Note that Malone includes
the prison population.

36

FRANKLIN COUNTY:

TYPE 2 DIABETES

About This Map

This map depicts the percentage
of inpatient discharges diagnosed
and treated for obesity WITH type
2 diabetes. The percentage is
calculated by dividing the number
of inpatient discharges for obesity
with type 2 diabetes within a
zip code by the total number of
inpatient discharges for obesity
within the same zip code. When
compared to PHIP’s six-county
North Country region as a whole
(Clinton, Essex, Franklin, Hamilton,
Warren, and Washington), Franklin
County’s overall percentage of
48% is comparable to the entire
region’s percentage of 48%.
Note that Malone includes the
prison population.

37

Acknowledgement

AHI and the North Country Population Health Improvement Program thank the members of the Healthy
Community Design Advisory Group who reviewed and offered comments on the report. The reviewers’

insights and comments greatly improved the report’s content.

AHI and the North Country Population Health Improvement Program

Adirondack Health Institute is an independent, non-profit organization supporting hospitals, physician
practices, behavioral health providers, community-based organizations, patients and others in our region

to transform health care and improve population health.
The North Country Population Health Improvement Program (NC PHIP), a program of AHI, is supported

through a grant from the New York State Department of Health. The NC PHIP promotes initiatives to
improve the health of communities in Clinton, Essex, Franklin, Hamilton, Warren and Washington counties.

Many of the data measures presented in this report can be found in HealthyADK, a website of the NC
PHIP. HealthyADK is a resource to locate a diverse set of data indicators associated with community

health, explore promising practices, and access key information that describe the challenges and
opportunities for improving the health of North Country communities.

HealthyADK can be found at:

www.healthyadk.org

38