Data, Trends, and Maps Definitions and Sources

Obesity and weight status

Adult obesity is defined as body mass index (BMI) ≥ 30.0. Adult overweight is defined as BMI ≥ 25.0 but < 30.0.

For both obesity and overweight, BMI was calculated from self-reported weight and height (weight [kg]/ height [m²]). Respondents who reported the following were excluded:

• Weight < 50 pounds or ≥ 650 pounds.
• Height < 3 feet or ≥ 8 feet.
• BMI: <12 or ≥ 100.
• Pregnant respondents.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

For teens, obesity is defined as BMI-for-age and sex ≥ 95th percentile and overweight is defined as BMI-for-age and sex ≥ 85th percentile but < 95th percentile.

For both obesity and overweight, percentiles are based on the 2000 CDC growth chart. BMI was calculated from self-reported weight and height (weight [kg]/ height [m²]).

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. For children, obesity is defined as BMI-for-age and sex ≥ 95th percentile. Overweight is defined as BMI-for-age and sex ≥ 85th but <95th percentile.

Percentiles are based on the 2000 CDC growth chart. BMI was calculated from measured weight and height (weight [kg]/ height [m²]).

Children with the following modified z-scores were excluded.

• Height-for-age Z < -5.0 or > 4.0.
• Weight-for-age Z < -5.0 or > 8.0.
• BMI-for-age Z < -4.0 or > 8.0.

Data Source: Women, Infants, and Children Participant and Program Characteristics

High weight-for-length is defined as ≥2 standard deviations (SDs) above the sex and age-specific median based on the World Health Organization (WHO) growth standards for children aged 3–23 months.

Weight was measured to the nearest one-quarter pound. Length was measured to the nearest one-eighth inch using an infant measuring board.

Children who had a length outside the range (45–110 cm) in the WHO growth standards were excluded. In addition, children with biological implausible values were excluded.

• Weight-for-age Z < -6.0 or > 5.0.
• Length-for-age Z < -6.0 or > 6.0.
• Weight-for-length Z < -5.0 or > 5.0.

Data Source: Women, Infants, and Children Participant and Program Characteristics (WIC)

Breastfeeding – behavior

Ever breastfed is defined by the question "was [child] ever breastfed or fed breast milk?"

Breastfed at 6 and 12 months is defined as breastfeeding to any extent with or without the addition of complementary liquids or solids.

Data Source: National Immunization Survey. See note.A

Exclusive breastfeeding is defined as only breast milk—no solids, no water, and no other liquids

Data Source: National Immunization Survey. See note.A

Formula supplementation is defined as supplementation of breast milk with formula among infants breastfed at 2 days. This is with or without other supplementary liquids or solids.

Data Source: National Immunization Survey. See note.A

Formula supplementation is defined as supplementation of breast milk with formula among infants breastfed at 3 months or 6 months. This can be with or without other supplementary liquids or solids.

Data Source: National Immunization Survey. See note.A

Children aged 1 to 3 years whose parents answered their child was introduced to foods other than breast milk or formula before four months. Examples of foods other than breast milk and formula include water, juice, cow's milk, sugar water, baby food, and anything else. The indicator was calculated by year of child's birth rather than survey year.

Data Source: National Survey of Children's Health (NSCH)

Breastfeeding - environmental or policy

This score is from six categories of support that hospitals can provide for breastfeeding. Score can range from 0 to 100, with higher scores indicating better maternity care practices and policies. A state's score represents the average score across participating hospitals in the state.

Data Source: CDC Maternity Practices in Infant Nutrition and Care Survey

The numerator is the number of live births at hospitals designated as "baby friendly" and the denominator is the number of live births.

Data Source: Breastfeeding Report Card and CDC's Early Childhood Nutrition Report 2025

Fruit and vegetables – behaviors

Adults were asked via a telephone survey how many times per day, week, or month they consumed the following fruits and vegetables:

• 100% pure fruit juices.
• Fruit.
• Green salad.
• Fried potatoes.
• Other potatoes.
• Other vegetables.

Total daily fruit consumption was calculated based on responses to questions about fruit juices and fruit. Total daily vegetable consumption was calculated based on answers to the remaining questions.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

High school students were asked how many times per day or the past 7 days, they consumed the following fruits and vegetables:

• 100% pure fruit juices.
• Fruit.
• Green salad.
• Potatoes (not counting french fries, fried potatoes, or potato chips).
• Carrots.
• Other vegetables.

Total daily fruit consumption was calculated based on responses to questions about fruit juices and fruit. Total daily vegetable consumption was calculated based on answers to the four remaining questions.

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

NSCH is a national survey that provides data on multiple aspects of children's health and well-being. Respondents with children 1–5 years were asked about how many times in the past week did the child eat fruit? Fruit includes fresh, frozen, or canned. It does not include juice.

Respondents were also asked about how many times in the past week did the child eat vegetables? Vegetables includes fresh, frozen, or canned. It does not include French fries, fried potatoes, or potato chips.

Data Source: National Survey of Children's Health (NSCH)

Fruits and vegetables – environmental or policy supports

State and local food policy councils are identified by ongoing self-registration. Councils are verified through an annual survey of food policy councils.

Data Source: State Indicator Report on Fruits and Vegetables, 2018 and Councils | Food Policy Networks

This analysis assessed the degree to which state childcare regulations reflected national nutrition standards for serving fruits and vegetables. State childcare regulations were assessed for licensed childcare centers, large or group family childcare homes, and small family childcare homes. Standards were from Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs, 3rd Edition.

The standards specify that children be served a variety of fruits, especially whole fruits. The standards for vegetables specifically mention dark green, orange, deep yellow, and root vegetables. States whose regulations scored 4 (regulation fully addresses standard) across all three childcare types were designated as "yes." States that received a score of less than 4 in any childcare type were designated as "no."

Data Source: National Resource Center for Health and Safety in Child Care and Early Education. See note.B

Parents of youth aged 1–17 responded to a question about which statement best describes their household's ability to afford the food needed during the past 12 months. Reponses other than "We could always afford to eat good nutritious meals" indicated they were not always able to afford nutritious meals.

Data Source: National Survey of Children's Health (NSCH)

Physical activity - behavior

Adults were asked "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?" Respondents were classified as participating in no leisure-time physical activity if they responded "no."

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Adults reported activities outside of their regular jobs and were classified as active if they reported:

• At least 150 minutes per week of moderate-intensity activity, or
• At least 75 minutes per week of vigorous-intensity activity, or
• A combination of moderate-intensity and vigorous-intensity activity (multiplied by two) totaling at least 150 minutes per week.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Adults reported activities outside of their regular jobs and were classified as highly active if they reported:

• More than 300 minutes per week of moderate-intensity activity, or
• More than 150 minutes per week of vigorous-intensity activity, or
• A combination of moderate-intensity and vigorous-intensity activity (multiplied by two) totaling more than 300 minutes per week.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Muscle-strengthening includes activities such as yoga, sit-ups, push-ups, and those using weight machines, free weights, or elastic bands.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Adults were classified as active and engaged in muscle-strengthening activities according to the above indicators.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

The U.S. Census Bureau's American Community Survey asks, "How did this person usually get to work last week?" People 16 and older who worked and reported they "bicycle" or "walked" were classified as usually biked or walked to work.

Data Source: U.S. Census Bureau's American Community Survey

Respondents were asked: "During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spend in any kind of physical activity that increases your heart rate and makes you breathe hard some of the time.)" Respondents were classified as active if they answered, "7 days."

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Respondents were asked: "In an average week in school when you go to school, how many days do you attend physical education classes?" Respondents were classified as participating in daily physical education if they answered, "5 days."

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Physical activity - environmental or policy supports

Parents of youth aged 1–17 who answered "yes" to the relevant question indicated the neighborhood feature was available. Questions were preceded by, "Please tell me if the following places and things are available to children in your neighborhood, even if [CHILD'S NAME] does not actually use them:

• Park or playground area?
• Sidewalks or walking paths?"

Data Source: National Survey of Children's Health

The percentage of the population living within one half mile of a park was estimated using the area-proportion technique, incorporating data from TomTom and the Protected Areas Database of the United States. For each census tract, the proportion of land area within a half mile of a park was calculated and then multiplied by the tract's population to estimate the number of individuals living in that area. Subsequently, the percentages of individuals living within a half mile of a park were computed by dividing the estimated population living near parks in each state by the total population of the state, as reported in the American Community Survey 5-Year Census Tract Estimates.

Data Source: National Environmental Public Health Tracking Network

States that have a state-level Complete Streets policy were given a "Yes." An inventory of Complete Streets policies in the U.S., including state-level policies, can be found at https://wordpress.smartgrowthamerica.org/wp-content/uploads/2024/10/web-excel-06162023.xlsx.

Data Source: National Complete Streets Coalition

State childcare regulations were assessed for licensed childcare centers, large or group family childcare homes, and small family childcare homes. Standards were from Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs, 3rd Edition. Standards specify that preschoolers should be allowed 90 to 120 minutes of moderate-to vigorous-intensity physical activity per eight-hour day. States whose regulations scored 4 (regulation fully addresses standard) across all three childcare types were designated as "yes." States that received a score of less than 4 in any childcare type were designated as "no."

Data Source: National Resource Center for Health and Safety in Child Care and Early Education. See note.B

Sugar drinks - behavior

Respondents were asked, "During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not include diet soda or diet pop.)" Responses ranged from "I did not drink soda or pop during the past 7 days" to "4 or more times per day." Daily consumption was defined as one or more drinks per day.

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Parents were asked how many times in the past week their child consumed sugary drinks such as soda, fruit drinks, sports drinks, or sweet tea. 100% fruit juice was not included.

Any response other than "This child did not drink sugary drinks" indicated sugar-sweetened beverages was consumed at least one time per week.

Data Source: National Survey of Children's Health

Sugar drinks - environmental or policy supports

High school principals were asked "Can students purchase each of the following snack foods or beverages from vending machines or at the school store, canteen, or snack bar?" Schools with principals who answered "Yes" to the specific sugar drink type (soda pop or fruit drinks, sports drinks, and energy drinks) were classified as allowing students to purchase those drinks.

Data Source: School Health Profiles (Profiles)

State childcare regulations were assessed for licensed childcare centers, large or group family childcare homes, and small family childcare homes. Standards were from Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs, 3rd Edition.

States whose regulations scored 4 (regulation fully addresses standard) across all three childcare types were designated as "yes." States that received a score of less than 4 in any childcare type were designated as "no."

Data Source: National Resource Center For Health and Safety In Child Care and Early Education. See note.B

Media Use - environmental or policy supports

Media viewing includes watching television, videos, DVDs, and computers. State childcare regulations were assessed for licensed childcare centers, large or group family childcare homes, and small family childcare homes. Data assessed how well facilities reflected national standards for prohibiting the use of media viewing time among children under 2 and limiting time among children 2 and older.

Standards were from Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs, 3rd Edition. States whose regulations scored 4 (regulation fully addresses standard) across all 3 childcare types were designated as "yes." States that received a score of less than 4 in any childcare type were designated as "no".

Data Source: National Resource Center For Health and Safety In Child Care and Early Education. See note.B