Hawaii isn't just a nice state for a vacation. It may also be the healthiest state in which to live, at least according to one metric: Only 19 percent of Hawaii residents suffer from obesity. That's the lowest of any state, according to the Gallup-Healthways Well-Being Index released this week.
Hawaii was also one of five states that reduced its obesity rate the most between 2013 and 2014, when the survey was conducted.
By contrast, obesity grew nationwide to 27.7 percent in 2014, up from 27.1 percent in 2013 and 25.5 percent in 2008, the first year that Gallup-Healthways conducted its well-being survey. The state with the highest obesity level in the nation was Missouri, with 30.9 percent of its population suffering from the condition.
Obesity carries a host of health consequences, including an increased risk for heart disease, stroke, Type 2 diabetes and certain kinds of cancers, according to the National Institutes of Health. And, according to Dan Witters, the research director of the Well-Being Index, there are emotional and social consequences as well.
"With obesity, it’s not just about the physical wellness," Witters told The Huffington Post, adding that people who are obese are more likely to have low levels of well-being across all four of the remaining well-being elements -- social, purpose, financial and community well-being.
"The economic impact and productivity loss that are associated with obesity in this country is pretty staggering," Janet Calhoun, senior vice president at Healthways, told HuffPost. People who are not obese have higher job performance than people who are, and people who are obese tend to miss more work days and be absent than those who are not, she said.
So how did Hawaii become number one? Calhoun emphasized that Hawaii has implemented "an enormous amount of programming around health and healthy lifestyle behaviors." Kathryn Braun, director of the Office of Public Health Studies and a professor of public health at the University of Hawaii, confirmed this sentiment. Hawaii -- particularly the island of Kauai -- has seen a variety of island-wide health initiatives in recent years, including more walking and bike paths and safer routes to schools for children, she said.
Braun also pinpointed effective health strategies, such as the Hawaii State Department of Health's Healthy Hawaii initiative, which since 2000 has focused on reducing smoking rates, increasing physical activity and promoting healthy eating among residents, as well as the PILI ‘Ohana Partnership, a community-based research organization specifically designed to reduce health disparities such as obesity in the Native Hawaiian and Pacific populations.
Here are three other things Hawaii is doing right:
1. Hawaii residents don't smoke
According to a 2015 study published in the journal PLOS, heavy smokers were more likely to be obese than their non-smoking counterparts. Formerly heavy smokers who quit were also at risk for obesity. "Hawaii has a nice low smoking level," Witters said. "Just 17 percent in the state are smokers, so that’s part of the story."
2. Hawaii is food secure
A 2012 study published in the Journal of the Academy of Nutrition and Dietetics found that food insecure adults were 32 percent more likely than food secure adults to be obese. In the new Gallup survey, 17 percent of Americans reported that they didn't have enough money to buy food at least one time in 2014. In comparison, only 12 percent of Hawaii residents said they felt food insecure during that period.
3. Hawaii residents benefit from low levels of depression
Mental health is another important, but often overlooked, obesity factor. A 2010 study published in JAMA Psychiatry found a reciprocal link between depression and obesity. Being obese increased an individual's risk for depression, and people who suffered from depression were also more likely to become obese. "Hawaii really has a lot going for it in this regard," Witters said. "It’s lowest in the country [tied with Alaska] in terms of clinical diagnosis of depression. Just 5.9 percent report that they’ve been diagnosed with depression or are currently being treated for it. So with such low depression rates, you are also going to have lower levels of obesity."
But there's still work to do
On the other hand, low obesity and smoking levels doesn't mean Hawaii's residents should rest easy. Hawaii has the highest diabetes, kidney failure and tuberculosis rates in the country, according to a Honolulu Civil Beat Op-Ed written Dr. Kathleen Kozak, in November.
"Statistics can be quite misleading, and can be used to bring about any point of view if used in certain ways. If the purpose is to motivate people to take better care of themselves, then that's fine," Kozak told The Huffington Post. "But if it's to suggest that one state has the healthiest people, but doesn't really accurate reflect the nuances in population and also our state spread over the different islands, then it's not a true reflection of what's really going on in Hawaii."
Asians and Pacific Island populations are particularly at risk for kidney disease, with more than 162,000 residents of Hawaii suffering from the disease. Hawaii has a 30 percent higher incidence rate than the rest of the United States, according to Pacific Business News.
To conduct the Gallup-Healthways survey, researchers conducted 176,702 interviews in 2014, asking respondents to self-report height and weight. They later calculated the respondents' body mass index scores based on these self-reports. Respondents with BMIs of 30 or greater were classified as obese. Demographic data were weighted on a state-to-state basis to make sure that the data collected accurately represented the demographic breakdown of each state.