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DAVIS ET AL.
non-U.S.-based populations/institutions, and nonpenal
institutions. Studies with no individual-level data for
BMI or weight change, qualitative assessments, case
reports, policy briefs, and discussions were excluded.
A summary of inclusion and exclusion criteria is given
in Table 1.
Description of Data Extraction
After titles and abstracts were assessed for inclusion criteria,
full text was reviewed for extraction of information
detailed in Table 2.
The following data were extracted from each included
study: dates of study, type of facility, sample size, mean
age, gender composition, average length of incarceration,
OB percentage, method of assessment of body weight,
whether weight changes were noted, and specific factors
associated with weight change when provided.
Meta-Analysis
A meta-analysis was conducted to calculate the pooled
prevalence of obesity in incarcerated males and females
using data for the 11 included studies (Figs. 2 and 3).
Comprehensive Meta-Analysis V3.3 software (Borenstein
et al., 2009) was used. Weighted summary proportions
and 95% confidence intervals (CIs) under fixed and
random effects models were calculated (Borenstein et al.,
2009; DerSimonian & Laird, 1986; Freeman & Tukey,
1950). Cochran's Q at an alpha of p< .10 was used to
test for significant heterogeneity. Heterogeneity across
studies in the prevalence of obesity for incarcerated
women was quantified using I2 (Higgins et al., 2003).
Study Quality Assessment
Study quality was assessed using Cochrane's Grading of
Recommendations Assessment, Development and EvaluTable
1. Eligibility Criteria
Inclusion criteria
Population -U.S. correctional population
-Men and women
-Adults
-U.S. general prison
population
Outcome -BMI or equivalent
documented
-Weight change
quantified
Studies
-English
-Data collected from
1980 onward
-Prevalence
-Cross-sectional
-Cohort
-Retrospective reviews
BMI, body mass index.
Exclusion criteria
-Youth offenders
-Non-U.S. population
or institution
-Nonpenal institutions
-No individual-level
data for BMI or
weight change
-Qualitative assessment
-Language other than
English
-Data collected earlier
than 1980
-Case reports
-Policy
-Discussions
ation (GRADE) rating criteria (Ryan & Hill, 2016). The
quality of evidence is rated on the following criteria: (a)
risk of bias, (b) inconsistency, (c) indirectness, (d) imprecision,
and (e) publication bias. The GRADE system
rates the quality of evidence as high, moderate, low, or
very low. Two authors (D.D. and L.W.) independently
assessed the quality of evidence and then met to review
findings and reach a consensus.
Results
Database search results yielded 445 relevant titles. One
additional study was located using reference lists, leading
to 446 records screened. After a review of titles,
abstracts, and full texts, 11 articles were included in
this review. See Figure 1 for steps in the literature search
and review process following PRISMA guidelines.
BMI measurements were used to determine the prevalence
of OW/OB among incarcerated people in 11
studies. Individuals can be classified as OW/OB by calculating
their BMI. Our primary interest was in individuals
who were classified as OB per the World Health
Organization (2021) where OB is a BMI ‡30 kg/m2 and
OW is a BMI ‡25 kg/m2. The BMI measurement is
imprecise but correlates reasonably well with body fat
mass (Canoy &Buchan, 2007). In 5 of the 11 studies, components
of BMI (weight or height) were self-reported.
Of the 11 studies, 7 reported prevalence of OB in
incarcerated populations (Bai et al., 2015; Befus et al.,
2015; Brewer-Smyth, 2014; Brewer-Smyth et al., 2016;
Khavjou et al., 2007; Leigey & Johnston, 2015; Wolff
et al., 2012) and 4 assessed prevalence of OB as well
as weight change during incarceration (Baldwin et al.,
2016; Clarke & Waring, 2012; Drach et al., 2016;
Massie, 2000). Four studies reported on both genders
(Bai et al., 2015; Befus et al., 2015; Brewer-Smyth
et al., 2016; Wolff et al., 2012), one reported males
only (Baldwin et al., 2016), and six reported females
only (Brewer-Smyth, 2014; Clarke & Waring, 2012;
Drach et al., 2016; Khavjou et al., 2007; Leigey &
Johnston, 2015; Massie, 2000).
Five studies (Bai et al., 2015; Befus et al., 2015;
Brewer-Smyth, 2014; Brewer-Smyth et al., 2016; Wolff
et al., 2012) used self-reported BMI data, five (Baldwin
et al., 2016; Clarke & Waring, 2012; Drach et al.,
2016; Khavjou et al., 2007; Massie, 2000) used measured
BMIs, and one (Leigey & Johnston, 2015) could not
ascertain origin of BMIs as height and weight were
obtained from a statewide database. Sample sizes varied
from 81 to 4,175 individuals.
Studies Describing Prevalence of Obesity
Although some studies report weight gain, seven studies
in this analysis provide data on prevalence of OB in U.S.
incarcerated populations (Table 2). Of this subset, four
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