1. 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.

2. 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…. 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…..

3. 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.)

4. 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?

5. Body Mass Index (BMI) BMI = Weight / Height 2 (in kilograms and meters)

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

7. Obesity rates in JCUSH Canada Canada United States United States Weight categories % Men, 18+ years of age Under/Normal Under/Normal Overweight Overweight Obese Obese 39.940.917.8 37.741.419.6 Women, 18+ years of age Under/Normal Under/Normal Overweight Overweight Obese Obese 57.324.911.9 48.824.320.0 Blue font = statistically significant difference between Canada and U.S. (at 0.05 level)

8. Distribution of BMI for Canadian men X-axis = BMI metric Y-axis = Proportion (weighted) of population

9. Distribution of BMI for U.S. men X-axis = BMI metric Y-axis = Proportion (weighted) of population

10. 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

11. X-axis = BMI metric Y-axis = Proportion (weighted) of population Distribution of BMI for Canadian women

12. Distribution of BMI for U.S. women X-axis = BMI metric Y-axis = Proportion (weighted) of population

13. 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

14. 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

15. Distribution of BMI for Canadian women & Canadian men Legend Canadian women Canadian men X-axis = BMI metric Y-axis = Proportion (weighted) of population

16. % overweight and obese, by race, women only Blue font = statistically significant difference between Canada and U.S. Canadian women (race) OverweightObese White White Other Other27.2%21.5%12.5%13.8% U.S. women (race) U.S. women (race) White White Other Other24.7%30.0%19.2%28.3% U.S. women (race/ethnicity) Non-Hispanic white Non-Hispanic white Hispanic Hispanic Non-Hispanic black Non-Hispanic black Non-Hispanic other Non-Hispanic other33.3%44.9%30.8%28.0%19.3%20.1%33.2%18.2%

17. Results of multivariate analysis, women only Odds ratios for being obese, by race/ethnicity Blue font = statistically significant Characteristic Odds Ratios Race (Canada) CanadaU.S. White (ref) Other1.001.25nana Race/ethnicity (U.S.) Non-Hispanic white (ref) Hispanic Non-Hispanic black Non-Hispanic other nananana1.000.952.530.68

18. Distribution of BMI for Canadian white women X-axis = BMI metric Y-axis = Proportion (weighted) of population

19. Distribution of BMI for Canadian other women X-axis = BMI metric Y-axis = Proportion (weighted) of population

20. Distribution of BMI for Canadian women by race Legend White women Other women X-axis = BMI metric Y-axis = Proportion (weighted) of population

21. Distribution of BMI for U.S. Non-Hispanic white women X-axis = BMI metric Y-axis = Proportion (weighted) of population

22. Distribution of BMI for U.S. Non-Hispanic black women X-axis = BMI metric Y-axis = Proportion (weighted) of population

23. Distribution of BMI for U.S. Non-Hispanic other women X-axis = BMI metric Y-axis = Proportion (weighted) of population

24. Distribution of BMI for U.S. Hispanic women X-axis = BMI metric Y-axis = Proportion (weighted) of population

25. 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

26. 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

27. 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

28. 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

29. 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