Obesity Trends Among Children and Adolescents

Study Questions:

Has the prevalence of obesity among children and adolescents increased over the past several decades?

Methods:

Data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population, were used for the present analysis. Children and adolescents (ages 2-19 years) with available information on height and weight, collected between 1988-1994 and 2013-2014, were included. The primary outcome of interest was obesity, defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts.

Results:

A total of 40,780 children and adolescents (mean age 11 years) were included. Females comprised 48.8% of the study population. Among children and adolescents ages 2-19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% confidence interval [CI], 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children ages 2-5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (p < 0.001) in 2003-2004, and then decreased to 9.4% (95% CI, 6.8%-12.6%) (p = 0.03) in 2013-2014. Among children ages 6-11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (p < 0.001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; p = 0.44). Obesity increased among adolescents ages 12-19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; p < 0.001), as did extreme obesity among children ages 6-11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; p = 0.02) and adolescents ages 12-19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; p < 0.001). No significant trends were observed between 2005-2006 and 2013-2014 (p value range, 0.09-0.87).

Conclusions:

The investigators concluded that in this nationally representative study of US children and adolescents ages 2-19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children ages 2-5 years, increased until 2007-2008, and then leveled off in children ages 6-11 years, and increased among adolescents ages 12-19 years.

Perspective:

These data confirm that obesity remains a significant problem among US youth. It appears that rates have decreased recently among younger children, while rates have increased among adolescents. Understanding the factors related to these trends and providing effective interventions to adolescents may be important in preventing and treating obesity among children and adolescents.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement

Keywords: Adolescent, Body Mass Index, Body Weight, Centers for Disease Control and Prevention (U.S.), Child, Growth Charts, Nutrition Surveys, Obesity, Obesity, Morbid, Prevalence, Primary Prevention


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