Obesity in the US: Understanding the Data on Disparities in Children Cynthia Ogden, PhD, MRP

Transcription

1 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

2 Obesity in the US, 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 JAMA; NHANES

3 What is the weight of the nation? Average American adult is more than 25 pounds heavier today than in million (11.3%) of adults have diabetes About 55% of adults with diagnosed diabetes are obese Photo source: Sources:

4 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

5 Cut points Adults Overweight: 25<=BMI<30 Obesity: BMI>=30 Extreme obesity: BMI>= years Overweight: 85th percentile<=bmi-for-age<95th percentile Obesity: BMI-for-age>=95th percentile

6 A normal weight child BMI-for-age < 85 th percentile of CDC growth charts Source: Huang JS et al, Pediatrics 2007:120:e1126 e119

7 An overweight child BMI-for-age 85 th 95 th percentile of CDC growth charts Source: Huang JS et al, Pediatrics 2007:120:e1127 e119

8 An obese child BMI-for-age 95 th percentile of CDC growth charts Source: Huang JS et al, Pediatrics 2007:120:e1128 e119

9 Prevalence of high adiposity among US girls by BMI-for-age category, 8-19 years, Percent Source: CDC/NCHS, National Health and Nutrition Examination Surveys ; Flegal et al AJCN 2010

10 Race/ethnic disparities in obesity prevalence

11 Obesity and extreme obesity, US men, 20+ years, No difference in obesity among men Obesity Extreme obesity NOTES: Estimates age-adjusted to 2000 US census population. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey; Flegal et al JAMA 2012.

12 Obesity and extreme obesity, US women, 20+ years, Big difference in obesity among women Obesity Extreme 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.

13 Prevalence of Obesity Children and Teens, 2-19 years, Non Hispanic white Non Hispanic black Hispanic Differences in both boys and girls 24.8 Percent Boys Girls Source: CDC/NCHS National Health and Nutrition Examination Survey; Ogden et al, JAMA 2012

14 Prevalence of Obesity, boys years Percent No difference in now prevalence is highest in Mexican Americans SOURCE: CDC/NCHS: National Health and Nutrition Examination Survey III , ;

15 Do SES disparities explain race/ethnic disparities?

16 Obesity by poverty income ratio, adults, PIR>=350% 130-<350% PIR PIR<130% Men Total Women 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 and NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics

17 Childhood obesity by poverty income ratio, Boys Total Girls PIR>=350% 130-<350% PIR PIR<130% Non-Hispanic white Non-Hispanic black Mexican American Percent 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

18 Childhood obesity by poverty income ratio, Boys Total Girls PIR>=350% 130-<350% PIR PIR<130% Non-Hispanic white Non-Hispanic black Mexican American Percent 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

19 Number of obese children and adolescents by poverty income ratio, PIR>=350% 130-<350% PIR PIR<130% Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al

20 Childhood obesity by poverty income ratio and Boys Girls Percent Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al

21 Childhood obesity by education, 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

22 Has the prevalence of obesity plateaued in the US?

23 No change since 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

24 Obesity trends by race/ethnicity, boys 2-19 years, US, Source: Ogden et al. 2012, JAMA; NHANES

25 Obesity trends by race/ethnicity, girls 2-19 years, US, Non-Hispanic white Mexican American Non-Hispanic black All Percent Source: Ogden et al. 2012, JAMA; NHANES

26 National Health and Nutrition Examination Survey

27 NHANES Mobile Exam Center

28 Prevalence of obesity, Measured versus proxy weight & height NOTE: Obesity: BMI-for-age >= 95 th percentile of CDC 2000 growth charts; SOURCE: Akinbami and Ogden, Obesity 2009

29 Diet & physical activity

30 Mean total daily calorie intake, US children and adolescents, Boys Girls SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey

31 Mean percent of kilocalories from added sugars, aged 2-19 years, US, Non-Hispanic white Non-Hispanic black Mexican American 20 Percent Males Females SOURCE: CDC/NCHS, NHANES,

32 Mean percent of total daily kilocalories from sugar drinks, US, ages 2 years and older, years 20+ years *Significantly different from Mexican Americans; **Significantly different from non-hispanic whites Source: CDC/NCHS, National Health and Nutrition Examination Survey,

33 Mean percent of kilocalories from added sugars aged 2-19 years, by poverty income ratio, United States, PIR < 130% 130% PIR < 350% PIR 350% 20 No difference Percent Males Females NOTES: PIR is poverty income ratio. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey,

34 *Significant linear trend; PIR: poverty income ratio Source: CDC/NCHS, National Health and Nutrition Examination Survey, Mean percent of total daily kilocalories from sugar drinks, by PIR, US, ages 2 years and older, <130% PIR % PIR >=350% PIR 2-19 years* 20+ years*

35 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;

36 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;

37 Percentage of children who walk or bike to school Source: McDonald NC. Am J Prev Med 2007;32:509; National Personal transportation Survey

38 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

39 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

40 Immediate Consequences of Psychosocial problems Childhood Obesity Cardiovascular risk factors 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 BMI percentile Percent Freedman et al, J Pediatrics 2007 SEARCH for Diabetes in Youth Study Group et al. Pediatrics Oct;118(4):

41 Long-term Consequences 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 of Childhood Obesity 87% of obese adolescents were obese adults 39% of obese adolescents were severely obese adults Freedman et al, Pediatrics 2009

42 Change in BMI distribution, boys y 90 th percentile Source: NHANES III, and

43 Change in BMI distribution, girls12-19 y 90 th percentile Source: NHANES III, and

44 Per capita availability of calories SOURCE:

45 Food Consumed in 1952 Source: CDC Childhood obesity Public Health Grand Rounds June 2010/ William Dietz, MD

46 Food consumed today Source: CDC Childhood obesity Public Health Grand Rounds June 2010/ William Dietz, MD

47 Change in mean intake to children 6-11 years old, US Salted snacks 320% Candy Mixed dishes 144% 180% Pizza 425% Vegetable -43% Fried potato % decrease 18% 0% % increase Source: Cleveland USDA; NFCS and WWEIA, NHANES , 1 day