Estimates of Childhood Overweight and Obesity at the Region, State, and County Levels: A Multilevel Small Area Estimation Approach.

Local-level childhood overweight and obesity (OWO) data are often used to implement and evaluate community programs, as well as allocate resources to combat OWO. The most current sub-state estimates of United States (U.S.) childhood obesity use data collected in 2007. Using a spatial multilevel model and the 2016 National Survey of Children's Health, we estimated childhood OWO prevalence rates at the census regional division, state, and county levels using small area estimation with poststratification. A sample of 24,162 children aged 10-17 years was used to estimate a national OWO rate of 30.7% (95% Confidence Interval: 27.0%, 34.9%). There was substantial county-to-county variability (range: 7.0% to 80.9%), with 31 out of 3143 counties having an OWO rate significantly different from the national rate. Estimates from counties located in the Pacific region had higher uncertainty than other regions, driven by a higher proportion of underrepresented sociodemographic groups. Child-level OWO was related to their race/ethnicity, gender, parental highest education (all p<0.01), as well as county-level walkability (p=0.03), and urban-rural designation (p=0.02). OWO remains a vital issue for U.S. youth, with substantial area-level variability. The additional uncertainty for underrepresented groups shows surveys need to better target diverse samples.