Many organizations put out listings of the fittest and least fit cities in the United States each year. WalletHub has released its 2016 list of the 100 most populated cities in America and ranked them from least fit to most fit. Here is a map depicting their findings:
The cities denoted with the blue dots are the least fit, with the brightest shades of blue scoring the worst. The cities in the middle of the pack are indicated with gray or light brown dots. The fittest cities range from orange-brown (better than average) dots to bright orange (most fit).
Unlike many other previous studies that have led to similar rankings, WalletHub’s 2016 survey takes into consideration many relevant factors beyond BMI (body mass index), which is a number derived from height and weight.
This is important because BMI alone has been shown to be an inconsistent predictor of true fitness. The most obvious reason is that lean mass (muscle and bones) is denser and weighs more compared to the same volume of fat mass. Therefore, for example, a muscular Olympic athlete may erroneously fall in the overweight category on the BMI chart.
While the study did factor in percentages of the population in each of the cities who fell into the overweight and obese categories based on BMI, WalletHub also took into consideration 14 factors beyond BMI. For example, they also examined the percentage of inactive individuals, percentage of low consumption of produce and prevalence of lifestyle related conditions such as diabetes, high cholesterol and hypertension. This is a step in the right direction for these types of surveys.
WalletHub is a financially focused website. So, it’s understandable that the main purpose of this study was to rank the fitness levels of the largest cities in the country in order to do a financial comparison to determine how much more costly it is for a city – both in healthcare costs and lower productivity – to have a predominately unhealthy population. What I’d prefer to see is a study focused specifically on health and fitness (as opposed to cost) that uses similar factors beyond BMI.
In addition, given that the authors of the study seemed to recognize the short-comings of the BMI chart, it would have been better for them to give more weight to the percentage of the population who fell into the obese category as opposed to weighting obese and overweight factors equally. The short-comings of the BMI are more pronounced for those in the overweight category compared to those in the obese category. Yet, this survey gave both categories the same weight to determine a city’s total score.
What all these studies almost always ignore is the other end of the BMI spectrum – those who are underweight. Being underweight has its own set of serious health risks and sometimes are an indication of chronically ill or frail individuals. This population, though obviously much smaller in number than the overweight and obese populations, incur similar costs associated with healthcare and low productivity. The percentages of low BMI may not be large enough to impact the final rankings, but it’s nonetheless an error to make the judgement that below normal BMI numbers are neutral or better as compared to high BMI numbers.
If there’s one thing I object to the most in this study and others like it is the semantics and the picture those words paint. The WalletHub rankings are entitled “fattest to fittest” cities in America. The depiction utilizes a health descriptor (fittest) at one end of the spectrum with a body image descriptor (fattest) at the other end. In every way, this is incorrect.
From a linguistic standpoint, fattest and fittest are not opposites. If they want to use fattest, then the opposite would be skinniest. I think anyone would recognize that this isn’t what these studies and surveys are measuring. After all skinny doesn’t always, and maybe not even often, equate to fit. And, as I pointed out before, we certainly know that an above average BMI doesn’t always equal unfit.
What they are trying to measure, indeed, is the fitness or health of a city’s population. In this sense, the survey is ranking most unfit to fittest or unhealthiest to healthiest. The word fat shouldn’t even be part of the conversation.
Still, no matter the words used to describe those cities at the very bottom of the health spectrum, the numbers are troubling. This is a serious quality of life issue for millions of Americans, both young and old. And we, as a society, really need to understand why these areas are struggling to adopt a fitter, healthier lifestyle. We can’t help them develop solutions until we understand the underlying causes.
So, while these annual surveys serve a purpose in determining the where, what and who of this problem, it’s time to start focusing on the why. Until we do that, we can’t know how to turn this ship around.