What city in America has the fittest population? According to the American College of Sports Medicine (ACSM) report, the fittest city, this year, is Washington, DC. The rating system, called the “index” was started in 2008 and concerns such issues as chronic diseases, access to health care, the level of obesity and policies that support and encourage physical activity.
ACSM Declares Washington, DC Fittest City (but Still Fat!)

Writing about the award in Bodywork, Erin Beresini raised the issue of how what she called “slacker cities” such as Indianapolis and Oklahoma City—which consistently received low rankings—were holding up. Both cities have received grants from ACSM to initiate locally driven health improvement efforts.
Unfortunately, according to Beresini, obesity in Oklahoma City has risen from 28.6% of the population in 2011 to 32.6% in 2014. On the good news side, the percent of people smoking fell from 22.8% to 20%. Obesity in Indianapolis also increased, from 28.2% to 30.1% of the population, while the percent of people smoking remained about the same at 21.6%.
Citizens of Oklahoma City and Indianapolis should not feel too badly. Washington, DC, this year’s winner city, saw its own obesity rates rise between 2011 and 2014, from 21.4% to 24.1%.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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