Definitions

On This Page

Obesity / Weight Status
Breastfeeding – Behavior
Breastfeeding - Environmental or Policy
Fruits and Vegetables – Behavior
Fruits and Vegetables - Environmental or Policy Supports
Physical Activity – Behavior

Physical Activity - Environmental or Policy Supports
Sugar Drinks – Behavior
Sugar Drinks - Environmental or Policy Supports
Television Viewing – Behavior
Television Viewing - Environmental or Policy Supports

Obesity and Weight Status

Percent of adults aged 18 years and older who have obesity

Adult obesity is defined as body mass index (BMI) ≥ 30.0; BMI was calculated from self-reported weight and height (weight [kg]/ height [m²). Respondents reporting weight < 50 pounds or ≥ 650 pounds; height < 3 feet or ≥ 8 feet; or BMI: <12 or ≥ 100 were excluded. Pregnant respondents were also excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults aged 18 years and older who have an overweight classification

Adult overweight is defined as body mass index (BMI) ≥ 25.0 but <30.0; BMI was calculated from self-reported weight and height (weight [kg]/ height [m²]). Respondents reporting weight < 50 pounds or ≥ 650 pounds; height < 3 feet or ≥ 8 feet; or BMI: <12 or ≥ 100 were excluded. Pregnant respondents were also excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of students in grades 9-12 who have obesity

For teens, obesity is defined as body mass index (BMI)-for-age and sex ≥95th percentile 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)

Percent of students in grades 9-12 who have an overweight classification

For teens, overweight is defined as body mass index (BMI)-for-age and ≥85th percentile but < 95th percentile 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)

Percent of WIC children aged 2 to 4 years who have obesity

WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. For children, obesity is defined as body mass index (BMI)-for-age and sex ≥95th percentile based on the 2000 CDC growth chart; BMI was calculated from measured weight and height (weight [kg]/ height [m²]). Children with missing values of height, weight, and BMI were excluded. In addition, children with biological implausible values for height, weight, and BMI defined as the following z-scores values, were excluded from the analyses: height-for-age < -5.0 or > 4.0, weight-for-age < -5.0 or > 8.0, and BMI-for-age < -4.0 or > 8.0.

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

Percent of WIC children aged 2 to 4 years who have an overweight classification

Overweight is defined as body mass index (BMI)-for-age and sex ≥85th but < 95th percentile based on the 2000 CDC growth chart; BMI was calculated from measured weight and height (weight [kg]/ height [m²]). Children with missing values of height, weight, and BMI were excluded. In addition, children with biological implausible values for height, weight, and BMI defined as the following z-scores values, were excluded from the analyses: height-for-age < -5.0 or > 4.0, weight-for-age < -5.0 or > 8.0, and BMI-for-age < -4.0 or > 8.0.

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

Percent of WIC children aged 3-23 months old who have a high weight-for-length

High weight-for-length is defined as ≥2 standard deviations (SDs) above the sex and age-specific median in the World Health Organization (WHO) growth standards. Weight was measured to the nearest one-quarter pound, and length to the nearest one-eighth inch by using an infant measuring board according to CDC surveillance standards. Children with missing values of sex, weight, or length, or 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 from analyses defined as weight-for-age < -6 or >5 SDs, length-for-age < -6 or >6, and weight-for-length < -5 or >5 based on WHO growth standards cutpoints.

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

Top of Page

Breastfeeding – Behavior

Percent of infants who were ever breastfed

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

Breastfeeding rates through 2008 births are based on the National Immunization Survey’s landline sampling frame. Starting with 2009 births, rates are based on the National Immunization Survey’s dual-frame sample that includes respondents surveyed on landline or cellular telephones. If you would like more information about the sampling methodology and the impact of adding a sample of cellular telephone respondents to the National Immunization Survey, you can visit https://www.cdc.gov/breastfeeding/data/nis_data/survey_methods.htm.

Only breastfeeding rates based on a dual-frame sample that includes respondents surveyed on landline or cellular telephones are included in trend graphics. If you would like more information about the sampling methodology and the impact of adding a sample of cellular telephone respondents to the National Immunization Survey, you can visit https://www.cdc.gov/breastfeeding/data/nis_data/survey_methods.htm

National Immunization Survey

Percent of infants who were breastfed at 6 months

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

Data Source: National Immunization Survey

Percent of infants who were breastfed at 12 months

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

Data Source: National Immunization Survey

Percent of infants who were exclusively breastfed through 3 months

Exclusive breastfeeding is defined as ONLY breast milk – No solids, no water, and no other liquids.

Data Source: National Immunization Survey

Percent of infants who were exclusively breastfed through 6 months

Exclusive breastfeeding is defined as ONLY breast milk – No solids, no water, and no other liquids.

Data Source: National Immunization Survey

Percent of breastfed infants who were supplemented with infant formula within 2 days of life

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

Data Source: National Immunization Survey

Percent of breastfed infants who were supplemented with infant formula before 3 months

Formula supplementation is defined as supplementation of breast milk with formula (with or without other supplementary liquids or solids) among infants breastfed at 3 months.

Data Source: National Immunization Survey

Percent of breastfed infants who were supplemented with infant formula before 6 months

Formula supplementation is defined as supplementation of breast milk with formula (with or without other supplementary liquids or solids) among infants breastfed at 6 months.

Data Source: National Immunization Survey

Top of Page

Breastfeeding – Environmental or Policy

Average Maternity Practice in Infant Nutrition and Care (mPINC) score among hospitals and birthing facilities

This score is the average across seven categories of supports that hospitals and birth centers can provide for breastfeeding. These categories include:

Labor and delivery,
Breastfeeding assistance,
Mother-newborn contact,
Newborn feeding practices,
Breastfeeding support after discharge,
Nurse/birth attendant breastfeeding training and education, and
Structural and organizational factors related to breastfeeding.

The score can range from 0 to 100. State score represents average score across participating birth facilities in the state.

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

Percent of live births occurring at facilities designated as “baby friendly” by the Baby Friendly Hospital Initiative (BFHI)

Numerator: Number of live births at hospitals designated as “baby friendly”. Denominator: Number of live births.

Data Source: Breastfeeding Surveillance Sources

Top of Page

Fruits and Vegetables – Behavior

Percent of adults who report consuming fruit less than one time daily

Adults aged ≥18 years. Respondents were asked to report via telephone survey how many times per day, week or month they consumed the following fruits and vegetables: 1) 100% pure fruit juices; 2) fruit; 3) green salad; 4) fried potatoes; 5) other potatoes; and 6) other vegetables. Total daily fruit consumption was calculated based on responses to questions 1 and 2.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults who report consuming vegetables less than one time daily

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of students in grades 9-12 who consume fruit less than 1 time daily

Data were obtained from the Youth Risk Behavior Survey (YRBS) fruit and vegetable module and include consumption of both fruit and 100% fruit juice.

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Percent of students in grades 9-12 who consume vegetables less than 1 time daily

Data were obtained from the Youth Risk Behavior Survey (YRBS) fruit and vegetable module and include consumption of all vegetables with specific query of green salad, potatoes (not including French fries, fried potatoes, or potato chips), carrots, and other vegetables.

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Top of Page

Fruits and Vegetables – Environmental or Policy Supports

Number of farmers markets per 100,000 residents

Numerator: Total number of farmers markets per state. United States Department of Agriculture (USDA), Agricultural Marketing Services. USDA National Farmers Market Directory. Denominator: Estimated number of residents/100,000. United States Census Bureau.

Data Source: Fruits and Vegetables Surveillance Sources

Percent of farmers markets that accept SNAP benefits

Numerator: Number of farmers markets that accept Supplemental Nutrition Assistance Program (SNAP) benefits. United States Department of Agriculture (USDA), Agricultural Marketing Service. USDA National Farmers Market Directory. Denominator: Total number of farmers markets. United States Department of Agriculture, Agricultural Marketing Service. USDA National Farmers Market Directory.

Data Source: Fruits and Vegetables Surveillance Sources

Percent of farmers markets that accept WIC Farmers Market Nutrition Program coupons

Numerator: Number of farmers markets that accept WIC Farmers Market Nutrition Program coupons. United States Department of Agriculture (USDA), Agricultural Marketing Services.Denominator: Total number of farmers markets. USDA, Agricultural Marketing Services.

Data Source: Fruits and Vegetables Surveillance Sources

Number of food hubs in each state

The number of food hubs by state was based on the list available on the United States Department of Agriculture (USDA), Agricultural Marketing Service website as of the accessed date. Multiple models of food hubs are included in the list: farm to consumer, farm to business/institution, and a combination of the two. Food hubs may be cooperative, nonprofit, publicly held, or privately held business. USDA, Agricultural Marketing Service. Working List of Food Hubs.

Data Source: Fruits and Vegetables Surveillance Sources

Number of local food policy councils in each state

Active local food policy councils were identified using the online ‘Food Policy Council Directory’ maintained on the Johns Hopkins Center for a Livable Future website. Local food policy councils included in this national directory are identified by ongoing self-registration and verified via the annual survey of food policy councils conducted by John Hopkins Center for a Livable Future.

Data Source: Fruits and Vegetables Surveillance Sources

Existence of state-level Food Policy Council

Active state-level food policy councils were identified using the online ‘Food Policy Council Directory’ maintained on the Johns Hopkins Center for a Livable Future website, as of the accessed date. State food policy councils included in this national directory are identified by ongoing self-registration and verified via the annual survey of food policy councils conducted by John Hopkins Center for a Livable Future.

Data Source: Fruits and Vegetables Surveillance Sources

State-level farm to school/preschool policy

State-level farm to school/preschool policies include adopted or enacted state legislation during January 1, 2002-March 31, 2017 that supported any of the three core elements of a farm to school program or initiative. Policies targeted grades K-12 or child care or early care and education. Core elements include: serving fruit and vegetables purchased from local/regional farms; providing agriculture and nutrition education opportunities; or school gardens.

Data Source: Fruits and Vegetables Surveillance Sources

State child care regulations align with national standards for serving fruits

Data were derived from the National Resource Center for Health and Safety in Child-care and Early Education’s (NRC) analysis of the degree to which state child care regulations (for licensed child care centers, large or group family child care homes, and small family child care homes) reflected national nutrition standards for serving fruits and vegetables as described in the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs. The standards specify that children be served a variety of fruits, especially whole fruits and vegetables, specifically dark green, orange, deep yellow and root vegetables. States whose regulations were given a score of 4 (regulation fully addresses standard) across all 3 childcare types were designated as “yes” whereas states that received a score of less than 4 in any childcare type were designated as “no”.

Data Source: Early Care and Education Surveillance Sources

State child care regulations align with national standards for serving vegetables

Data Source: Early Care and Education Surveillance Sources

Percent of secondary schools that offered a self-serve salad bar to students

Data were derived from CDC’s School Health Profiles (Profiles). This indicator used one question from the Profiles Principal Questionnaire. Schools where the principal answered, “Yes” to the question, “During this school year, has your school done any of the following: Offered a self-serve salad bar to students?” were classified as having a salad bar.

Data Source: School Health Profiles (Profiles)

Top of Page

Physical Activity – Behavior

Percent of adults who engage in no leisure-time physical activity

Respondents were classified as participating in no leisure-time physical activity if they responded “no” to the following question: “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?” Adults aged ≥ 18 years. Respondents with missing data were excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults who achieve at least 150 minutes a week of moderate-intensity aerobic physical activity or 75 minutes a week of vigorous-intensity aerobic activity (or an equivalent combination)

Respondents 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. Adults aged ≥ 18 years. Respondents whose physical activity level could not be categorized due to missing physical activity data were excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults who achieve at least 300 minutes a week of moderate-intensity aerobic physical activity or 150 minutes a week of vigorous-intensity aerobic activity (or an equivalent combination)

Respondents 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. Adults aged ≥ 18 years. Respondents whose physical activity level could not be categorized due to missing physical activity data were excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults who engage in muscle-strengthening activities on 2 or more days a week

Muscle-strengthening includes activities such as yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands. Adults aged ≥ 18 years. Respondents with missing data were excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of adults who achieve at least 150 minutes a week of moderate-intensity aerobic physical activity or 75 minutes a week of vigorous-intensity aerobic physical activity and engage in muscle-strengthening activities on 2 or more days a week

Respondents 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. Muscle-strengthening includes activities such as yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands. Adults aged ≥ 18 years. Respondents whose physical activity level could not be categorized due to missing physical activity data were excluded.

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Percent of students in grades 9-12 who achieve 1 hour or more of moderate-and/or vigorous-intensity physical activity daily

Respondents were classified as active if they answered, “7 days”, to the following question: “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.)”

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Percent of students in grades 9-12 who participate in daily physical education

Respondents were classified as participating in daily physical education if they answered, “5 days”, to the following question: “In an average week in school when you go to school, how many days do you attend physical education classes?” Denominator: Students surveyed in grades 9-12.

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Percent of adults in the state who usually biked or walked to work in the last week

The U.S. Census Bureau’s American Community Survey (ACS) is an ongoing, annual survey of a percentage of the U.S. population. This report used the journey to work question that asks, “How did this person usually get to work last week?” People 16 years of age or over 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

Top of Page

Physical Activity – Environmental or Policy Supports

Percent of youth with parks or playground areas, community centers and sidewalks or walking paths available in their neighborhood

Numerator: Number of youth whose parents answered, “yes”, to all of the following questions 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: 1) park or playground area? 2) a recreation center, community center, or boys’ or girls’ club? 3) sidewalks or walking paths?” Denominator: Youth aged ≤17 years old.

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

Percent of U.S. population living within 1/2 mile of a park

Data derived from the CDC’s National Environmental Public Health Tracking Network. Numerator: Estimated number of each census tract’s population within ½-mile buffer around local parks and beaches from Esri StreetMap Premium/HERE and state and national parks from the Protected Areas Database of the United States (PAD-US). The estimated population living within ½ mile of a park was summed over all census tracts in a state to estimate the total state-level population residing within ½ mile of a park. Denominator: Census tract and state population from the American Community Survey 5-Year Estimates.

Data Source: National Environmental Public Health Tracking Network

State has adopted some form of a Complete Streets policy

Data were derived from the National Complete Streets Coalition’s policy analysis. States that have a state-level complete streets policy were given a “Yes.” An ideal Complete Streets policy includes a vision statement, specifies all users, applies to new and retrofit projects, makes exceptions specific, is adoptable by all agencies, encourages street connectivity, directs the use of the latest design criteria, complements the context of the community, establishes performance standards, and includes specific implementation steps. State policy did not have to include all ideal components to be counted as a “yes”. A list of complete streets policies, including state-level policies, is available at https://smartgrowthamerica.org/program/national-complete-streets-coalition/policy-atlas/.

Data Source: National Complete Streets Coalition

State child care regulations align with national standards for moderate- to vigorous- intensity physical activity for preschoolers

Data derived from the National Resource Center for Health and Safety in Child-care and Early Education (NRC). Describes the degree to which state child care regulations for licensed child care center types (1) child care centers, (2) large or group family child care homes, and (3) small family child care homes reflect national standards for moderate-to vigorous- intensity physical activity for preschoolers as described in the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs. Standards specify that preschoolers should be allowed 90 to 120 minutes of moderate-to vigorous- intensity physical activity per eight-hour day. States with regulations fully addressing standards for all three licensed child care types were designated as “yes”. States with regulations that did not fully address standards in any child care type were designated as “no.”

Data Source: Early Care and Education Surveillance Sources

Sugar Drinks – Behavior

Percent of students in grades 9-12 who drank regular soda/pop at least one time per day

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.)” Response categories ranged from “I did not drink soda or pop during the past 7 days” to “4 or more times per day.”

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Top of Page

Sugar Drinks – Environmental or Policy Supports

Percent of secondary schools that allowed students to purchase soda pop or fruit drinks from one or more vending machines or at the school store, canteen, or snack bar

Data were derived from CDC’s School Health Profiles. This indicator used one question from the Profiles Principal Questionnaire. Schools where the principal answered, “Yes” to the question, “Can students purchase each of the following snack foods or beverages from vending machines or at the school store, canteen, or snack bar: Soda pop or fruit drinks that are not 100% juice?” were classified as allowing students to purchase soda pop or fruit drinks.

Data Source: School Health Profiles (Profiles)

Percent of secondary schools that allowed students to purchase sports drinks from one or more vending machines or at the school store, canteen, or snack bar

Data were derived from CDC’s School Health Profiles. This indicator used one question from the Profiles Principal Questionnaire. Schools where the principal answered, “Yes” to the question, “Can students purchase each of the following snack foods or beverages from vending machines or at the school store, canteen, or snack bar: Sports drinks (e.g., Gatorade)?” were classified as allowing students to purchase sports drinks.

Data Source: School Health Profiles (Profiles)

State child care regulations align with national standards for avoiding sugar, including concentrated sweets such as candy, sodas, sweetened drinks, fruit nectars, and flavored milk

Data were derived from the National Resource Center for Health and Safety in Child-care and Early Education’s (NRC) analysis of the degree to which state child care regulations (for licensed child care centers, large or group family child care homes, and small family child care homes) reflected national nutrition standards for avoiding sugar as described in the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs. States whose regulations were given a score of 4 (regulation fully addresses standard) across all 3 childcare types were designated as “yes” whereas states that received a score of less than 4 in any childcare type were designated as “no”.

Data Source: Early Care and Education Surveillance Sources

Top of Page

Television Viewing – Behavior

Percent of students in grades 9-12 watching 3 or more hours of television each school day

Respondents were asked, “On an average school day, how many hours do you watch TV?” Response categories ranged from “I do not watch TV on an average school day” to “5 or more hours per day.”

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

Top of Page

Television Viewing – Environmental or Policy Supports

State child care regulations align with national standards for prohibiting use of media and computers with children younger than 2 years

Data were derived from the National Resource Center for Health and Safety in Child-care and Early Education’s (NRC) analysis of the degree to which state child care regulations (for licensed child care centers, large or group family child care homes, and small family child care homes) reflected national standards for prohibiting the use of media viewing (television [TV], video, and DVD) and computers with children younger than 2 years, as described in the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs. States whose regulations were given a score of 4 (regulation fully addresses standard) across all 3 childcare types were designated as “yes” whereas states that received a score of less than 4 in any childcare type were designated as “no”.

Data Source: Early Care and Education Surveillance Sources

State child care regulations align with national standards for limiting total media time for children 2 years or older to not more than 30 minutes once a week

Data were derived from the National Resource Center for Health and Safety in Child-care and Early Education’s (NRC) analysis of the degree to which state child care regulations (for licensed child care centers, large or group family child care homes, and small family child care homes) reflected national screen time standards for limiting media time for children 2 years and older as described in the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs. States whose regulations were given a score of 4 (regulation fully addresses standard) across all 3 childcare types were designated as “yes” whereas states that received a score of less than 4 in any childcare type were designated as “no”.

Data Source: Early Care and Education Surveillance Sources

Top of Page