Obesity in the US:
Understanding the Data on
Disparities in Children
Cynthia Ogden, PhD, MRP
National Center for Health Statistics
Division of Health and Nutrition Examination Surveys
Obesity in the US, 2009-2010
• Children & teens 2-19 y
 16.9% obese
• ~12.5 million children
• Adults ≥20 y
 35.7% obese
• ~78 million men & women
Source: Ogden et al. 2012, JAMA; Flegal et al. 2012 JAMA; NHANES 2009-2010
What is the weight of the nation?
• Average American adult is
more than 25 pounds heavier
today than in 1960
• 25.6 million (11.3%) of adults
have diabetes
• About 55% of adults with
diagnosed diabetes are
obese
Photo source: www.obesityinamerica.org/
Sources: www.cdc.gov/nchs/data/ad/ad347.pdf; http://www.cdc.gov/nchs/data/nhsr/nhsr010.pdf; http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf;
www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a2.htm
What is obesity and how is it measured?
• Obesity refers to excess body fat
 Often impractical to measure
• Proxy: Excess weight for height
 Easy to obtain
 Various indices
• Index of choice: Body mass index (BMI)
 Weight (kg)/height(m)2
 Recommended for adults, adolescents, and children
 Does not distinguish between fat and muscle
Cut points
• Adults
 Overweight: 25<=BMI<30
 Obesity: BMI>=30
 Extreme obesity: BMI>=40
• 2-19 years
 Overweight:
85th percentile<=BMI-for-age<95th percentile
 Obesity: BMI-for-age>=95th percentile
A normal weight child
BMI-for-age < 85th
percentile of CDC
growth charts
Source: Huang JS et al, Pediatrics 2007:120:e1126–e119
An overweight child
BMI-for-age
85th ≤95th percentile of
CDC growth charts
Source: Huang JS et al, Pediatrics 2007:120:e1127–e119
An obese child
BMI-for-age ≥95th
percentile of CDC
growth charts
Source: Huang JS et al, Pediatrics 2007:120:e1128–e119
Prevalence of high adiposity among US girls by BMI-for-age
category, 8-19 years, 1999-2004
Percent
Source: CDC/NCHS, National Health and Nutrition Examination Surveys 1999-2004; Flegal et al AJCN 2010
Race/ethnic disparities in
obesity prevalence
Obesity and extreme obesity ,
US men, 20+ years, 2009-2010
No difference in
obesity among men
Obesity
NOTES: Estimates age-adjusted to 2000 US census population.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey; Flegal et al JAMA 2012.
Extreme obesity
Obesity and extreme obesity,
US women, 20+ years, 2009-2010
Big difference in
obesity among women
Obesity
NOTES: Estimates age-adjusted to the 2000 US Census population .
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey; Flegal et al JAMA 2012.
Extreme obesity
Prevalence of Obesity
Children and Teens, 2-19 years, 2009-10
Non Hispanic white
30
26.5
Percent
25
20
Non Hispanic black
Hispanic
Differences in both boys and girls
24.8
22.6
19.8
17.5
14.7
15
10
5
0
Boys
Source: CDC/NCHS National Health and Nutrition Examination Survey; Ogden et al, JAMA 2012
Girls
Prevalence of Obesity, boys 12-19 years
Percent
No difference in 1988-94 now
prevalence is highest in
Mexican Americans
SOURCE: CDC/NCHS: National Health and Nutrition Examination Survey III 1988-1994, 2009-2010;
Do SES disparities explain
race/ethnic disparities?
Obesity by poverty income ratio, adults, 2005-8
PIR>=350%
Men
130-<350% PIR
PIR<130%
Women
Total
Non-Hispanic white
Non-Hispanic black
Mexican American
Percent
Percent
Source: Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS
data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010.
Childhood obesity by poverty income ratio, 2005-8
Boys
Girls
Total
Non-Hispanic white
Non-Hispanic black
Mexican American
Percent
*Significant trend; Children and adolescents 2-19 years of age; PIR: poverty income ratio
Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.
Percent
PIR>=350%
130-<350% PIR
PIR<130%
Childhood obesity by poverty income ratio, 2005-8
Boys
Girls
Total
Non-Hispanic white
Non-Hispanic black
Mexican American
Percent
*Significant trend; Children and adolescents 2-19 years of age; PIR: poverty income ratio
Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.
Percent
PIR>=350%
130-<350% PIR
PIR<130%
Number of obese children and adolescents by
poverty income ratio, 2005-08
PIR>=350%
130-<350% PIR
PIR<130%
Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.
Childhood obesity by poverty income ratio
1988-1994 and 2005-2008
Boys
Girls
Percent
Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.
Childhood obesity by education, 2005-08
Boys
Girls
Total
College graduate
Some college
High school graduate
< High school
Non-Hispanic white
Non-Hispanic black
Mexican American
Percent
Percent
Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.
Has the prevalence of obesity
plateaued in the US?
No change since 2007-2008
Adults
Children and adolescents
Source: Ogden et al. 2012, NCHS data brief; Flegal et al JAMA 2010; Ogden et al JAMA 2010; National Health and Nutrition Examination Survey
Obesity trends by race/ethnicity, boys 2-19 years, US, 1999-2009
Source: Ogden et al. 2012, JAMA; NHANES 2009-2010
Obesity trends by race/ethnicity, girls 2-19 years, US,
1999-2009
Percent
30
Non-Hispanic white
Non-Hispanic black
Mexican American
All
20
10
0
1999-2000
2001-2002
2003-2004
Source: Ogden et al. 2012, JAMA; NHANES 2009-2010
2005-2006
2007-2008
2009-2010
National Health and Nutrition
Examination Survey
NHANES Mobile Exam Center
Prevalence of obesity, 1999-2004
Measured versus proxy weight & height
NOTE: Obesity: BMI-for-age >= 95th percentile of CDC 2000 growth charts; SOURCE: Akinbami and Ogden, Obesity 2009
Diet & physical
activity
Mean total daily calorie intake,
US children and adolescents, 2005-2008
Boys
Girls
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey
Mean percent of kilocalories from added sugars,
aged 2 - 19 years, US, 2005-2008
25
Non-Hispanic white
Non-Hispanic black
Mexican American
20
Percent
17.2
15.9
15
16.1
14.8
15.9
14.0
10
5
0
Males
SOURCE: CDC/NCHS, NHANES, 2005-2008.
Females
Mean percent of total daily kilocalories from sugar drinks,
US, ages 2 years and older, 2006-2008
2-19 years
20+ years
*Significantly different from Mexican Americans; **Significantly different from non-Hispanic whites
Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008
Mean percent of kilocalories from added sugars aged 2 - 19
years, by poverty income ratio, United States, 2005-2008
PIR < 130%
130% ≤ PIR < 350%
PIR ≥ 350%
25
No difference
Percent
20
16.1
16.8
16.2
15.9
15.7
15
10
5
0
Males
NOTES: PIR is poverty income ratio.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008.
Females
15.2
Mean percent of total daily kilocalories from sugar drinks, by
PIR, US, ages 2 years and older, 2005-08
<130% PIR
130-350% PIR
2-19 years*
*Significant linear trend; PIR: poverty income ratio
Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008
>=350% PIR
20+ years*
Teens and physical activity
 3 hours TV
each day
 3 hours computer
each day
White
24.8%
22.1%
African American
55.5%
30.4%
Hispanic
41.9%
25.7%
Source: YRBS 2009; http://apps.nccd.cdc.gov/youthonline/App/Default.aspx
Teens and physical activity
 3 hours TV
each day
 3 hours computer
each day
White
24.8%
22.1%
African American
55.5%
30.4%
Hispanic
41.9%
25.7%
Source: YRBS 2009; http://apps.nccd.cdc.gov/youthonline/App/Default.aspx
Percentage of children who walk or bike to school
Source: McDonald NC. Am J Prev Med 2007;32:509; National Personal transportation Survey
Disparities in childhood obesity
• Complex story
• Not consistent by sex
 Higher rates in African American girls and Hispanic boys
• Not consistent by SES
 SES does not explain race/ethnic differences
• Diet & physical activity differences exist
• Levels high in all groups
 Leveling off in girls and possibly in boys
Thank you to my colleagues
Lara Akinbami, MD
Bill Dietz, MD, PhD
Katherine Flegal, PhD
Disclaimer
The findings and conclusions in this presentation are those of the
author and not necessarily of CDC
Immediate Consequences of
Childhood Obesity
• Psychosocial problems
 High blood pressure
 High cholesterol
 Abnormal glucose tolerance or
diabetes
• Type II diabetes low
(<0.25%)
• Type II represents 15% of
new cases among teens
• Over represented: Blacks,
Hispanics, American
Indians
Freedman et al, J Pediatrics 2007
SEARCH for Diabetes in Youth Study Group et al. Pediatrics. 2006 Oct;118(4):1510-8.
Percent
• Cardiovascular risk factors
BMI percentile
Long-term Consequences
of Childhood Obesity
• Obesity in childhood tracks to adulthood
This relationship is stronger for older children
A systematic review found 24%–90% of obese
adolescents become overweight/obese adults
In one study
• 87% of obese adolescents were obese adults
• 39% of obese adolescents were severely obese adults
Freedman et al, Pediatrics 2009
Change in BMI distribution, boys 12-19 y
90th percentile
Source: NHANES III, 1999-2002 and 2007-2010
Change in BMI distribution, girls12-19 y
90th percentile
Source: NHANES III, 1999-2002 and 2007-2010
Per capita availability of calories
SOURCE: http://www.ers.usda.gov/Data/FoodConsumption/NutrientAvailIndex.htm
Food Consumed in 1952
Source: CDC Childhood obesity Public Health Grand Rounds June 2010/ William Dietz, MD
Food consumed today
Source: CDC Childhood obesity Public Health Grand Rounds June 2010/ William Dietz, MD
Change in mean intake 1977-8 to 2001-2
children 6-11 years old, US
Salted snacks
320%
Candy
180%
Mixed dishes
144%
Pizza
Vegetable
425%
-43%
Fried potato
% decrease
18%
0%
Source: Cleveland USDA; NFCS 1977-78 and WWEIA, NHANES 2001-02, 1 day
% increase