Health Education & Behavior XX(X) 1 –10 © 2013 Society for Public Health Education Reprints and permission: sagepub.com/journalsPermissions.nav

Obesity in the United States is an increasing health concern whose growing prevalence has been well documented (Cen-ters for Disease Control and Prevention, 2010; Ford, Li, Zhao, & Tsai, 2011). This trend over the past few decades is occurring despite increased efforts to improve and empha-size the importance of physical activity, attention to proper nutrition, and public awareness of the consequences of obe-sity. From 2000 to 2008, the average BMI (body mass index) in America increased from 27.8 to 28.5 in men and from 28.2 to 28.6 in women (Ford et al., 2011). The prevalence of obe-sity in the United States in 2008 was 32.2 % among males, 35.5 % among females, and 33.8 % overall (Flegal, Carroll, Ogden, & Curtin, 2010). In 2000, no states reported a preva-lence of obesity ≥30%, yet nine states exceeded that mark in 2009, far from the goal of ≤15 % established by Healthy Peo-ple 2010 (Centers for Disease Control and Prevention, 2010). The morbidity and mortality associated with obesity have also been well documented. Compared with the nonobese pop-ulation, obese individuals are at much greater risk for diseases such as type 2 diabetes mellitus, coronary artery disease, and hypertension, along with associated comorbidities (Haslam & James, 2005). In addition, obese individuals have a greater mortality risk, specifically related to cardiovascular disease but also with some obesity-related cancers, renal failure, and dia