Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a
plateau or slowed around 2008, and that this change coincided with obesity plateaus and
increases in physical activity. However, national estimates can obscure important variations in
geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes,
obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted
prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were
generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to
smooth these estimates over time, we estimated the average annual percentage point change
(APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity
prevalence in each county. Compared to 2004–2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008–2012 (diabetes APPC difference = 0.16, 95%
CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors
remained high with most counties merely slowing rather than reversing, which suggests that
all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to
identify high risk areas and populations for preventive interventions. Awareness of how these
factors are changing might assist local policy makers in targeting and tracking the impact of
efforts to reduce diabetes, obesity and physical inactivity.