Childhood Obesity Prevalence by Demographics and Urbanization

Study Questions:

Do rates of obesity among US youth differ by demographics and urbanization level?


Data from the 2001-2016 National Health and Nutrition Examination Surveys, a serial, cross-sectional, nationally representative survey of the US population, were used for the present analysis. Body mass index (BMI) was grouped by sex, age, race, and Hispanic origin. Area of residence was also grouped by size; metropolitan statistical areas (MSAs) (large ≥1 million population, median 250,000 to <1 million population, or small <250,000 population) and non-MSAs (i.e., rural). The primary outcome was prevalence of obesity (BMI ≥95th percentile of US Centers for Disease Control and Prevention growth charts) and severe obesity (BMI ≥120% of 95th percentile) by subgroups in 2013-2016 and trends by urbanization between 2001-2004 and 2013-2016.


A total of 6,863 children and adolescents (mean age, 11 years; female, 49%) with complete data were included in the present analysis. In 2013-2016, the prevalence among youth ages 2-19 years was 17.8% (95% confidence interval [CI], 16.1%-19.6%) for obesity and 5.8% (95% CI, 4.8%-6.9%) for severe obesity. Similar prevalence of obesity was seen for large (17.1%; 95% CI, 14.9%-19.5%), medium or small (17.2%; 95% CI, 14.5%-20.2%), and non-MSAs (21.7%; 95% CI, 16.1%-28.1%). However, severe obesity was significantly higher in non-MSAs (9.4%; 95% CI, 5.7%-14.4%) compared with large MSAs (5.1%; 95% CI, 4.1%-6.2%; p = 0.02). Obesity and severe obesity significantly increased with greater age and lower education of household head, and severe obesity increased with lower level of urbanization. Compared with non-Hispanic white youth, obesity and severe obesity prevalence were significantly higher among non-Hispanic black and Hispanic youth. Severe obesity, but not obesity, was significantly lower among non-Hispanic Asian youth than among non-Hispanic white youth. No significant linear or quadratic trends in obesity or severe obesity prevalence from 2001-2004 to 2013-2016 for any urbanization category was observed.


The authors concluded that in 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race, and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.


These data suggest that efforts to prevent or treat obesity, in particular severe obesity, must include areas of all sizes including rural areas, in addition to populations that are at particular risk (non-Hispanic black youths and those residing in households with lower education).

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

Keywords: Adolescent, Body Mass Index, Child, Demography, Obesity, Obesity, Morbid, Pediatrics, Primary Prevention, Rural Population, Urbanization

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