Obesity prevalence, disparities, trends and persistence among US children <5 y Cynthia Ogden, PhD NHANES Analysis Branch Chief and Nutritional Epidemiologist National Center for Health Statistics Division of Health and Nutrition Examination Surveys
The findings and conclusions in this presentation are those of the author and not necessarily of CDC DISCLAIMER
Prevalence of obesity in the US, 2011-2012 Children & teens 2-19 y 16.9% Adults 20 y 34.9% Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA 2014
Millions of people 90+ million obese individuals in the US 80 70 60 50 40 78.6 30 20 10 0 Adults, 20+ years 12.7 Children & adolescents, 2-19 years Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012; Ogden et al. NCHS Data Brief 2013
DATA SOURCE
National Health and Nutrition Examination Survey (NHANES) Complex multi-stage probability sample of the US civilian non-institutionalized population, all estimates have confidence intervals Approximately 5,000 people surveyed each year
Survey periods Survey Dates Ages NHES I 1960-62 18-79 years NHES II 1963-65 6-11 years NHES III 1966-70 12-17 years NHANES I 1971-75 1-74 years NHANES II 1976-80 6 mo.-74 years HHANES 1982-84 6 mo.-74 years NHANES III 1988-94 2 mo. + Note: NHES, National Health Examination Survey
Continuous NHANES, All ages Dates 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012
Anthropometry
Definitions Children Comparison to a reference population <24 months Weight-for-recumbent length 2-5 years BMI-for-age BMI = kg/m 2
Infants and toddlers <24 months CDC recommendation: Weight-for-recumbent length at or above the 97.7 th percentile (+2 SD) WHO charts Sometimes see: Weight-for-recumbent length at or above the 95 th percentile CDC charts Reference: Grummer-Strawn et al. MMWR Recomm Rep. 2010 Sep 10;59(RR-9):1-15.
Children 2-5 years Overweight: BMI-for-age 85 th to 95 th percentile Obesity: BMI-for-age at or above 95 th percentile Severe obesity: BMI-for-age at or above 120% of the 95 th percentile Readings: Ogden & Flegal KM. Natl Health Stat Report; Flegal et al. Am J Clin Nutr. 2009
CDC growth charts For children 2-5 years Based on NHANES data from 1971-1994 At those time points, by definition, obesity prevalence of 5%
MEASURED VERSUS PARENT REPORT
Percent Prevalence of obesity, 1999-2004 Measured versus proxy weight & height 60 50 Measured data: NHANES Proxy-report data: NHIS Proxy-report data: NSCH 40 30 20 10 0 2-3 4-5 Age (years) SOURCE: Akinbami and Ogden, Obesity 2009
PREVALENCE
Percent Prevalence of high weight-for-recumbent length, birth-<24 months, 2011-2012 20 boys < girls 15 10 5 8.1 5 11.4 11 7.1 3.5 Total Boys Girls 0 CDC reference WHO reference Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012, Ogden et al. JAMA 2014
Percent Prevalence of overweight and obesity, 2-5 years, 2011-2012 20 No difference between boys and girls 15 14.4 14.4 14.5 10 8.4 9.5 7.2 Total Boys Girls 5 0 Overweight Obesity Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012, Ogden et al. JAMA 2014
DISPARITIES
Percent Prevalence of high weight-for-recumbent length by race/hispanic origin, birth-<24 mo, 2011-2012 20 No significant differences 15 10 5 5.5 7.3 9.6 8.8 0 non-hispanic white non-hispanic black non-hispanic Asian Hispanic Source: CDC/NCHS, National Health and Nutrition Examination Survey, Ogden et al. JAMA 2014, definition: WHO reference
Percent Prevalence of obesity by race/hispanic origin, 2-5 years, 2011-2012 Non-Hispanic whites and Non-Hispanic Asians generally lower Pattern somewhat different for boys and girls non-hispanic white non-hispanic black 20 15 non-hispanic Asian 16.7 Hispanic 18 13.9 15.2 11.3 10 9 5 0 3.5 6.3 4.7 3.4 1.9 0.6 Total Boys Girls Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012, Ogden et al JAMA 2014
FIGURE 2. Prevalence of obesity among low-income, preschool-aged children Pediatric Nutrition Surveillance System, United States, 2011 Prevalence of obesity among the states/territories ranged from 9.2% to 17.9% http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6231a4.htm?s_cid=mm6231a4_w
CHANGES IN MEAN BODY WEIGHT
Pounds Change in mean weight among US girls 50 +3.4 pounds 45 40 35 30 25 20 15 10 1976-1980 2007-2010 +1.7 pounds +1.7 pounds +0.9 pounds +0.3 pounds 37.4 39.1 32.8 34.5 28.6 29.5 23.8 24.1 43.2 46.6 5 0 1 year 2 years 3 years 4 years 5 years Source: CDC/NCHS, National Health and Nutrition Examination Survey www.cdc.gov/nchs/data/ad/ad347.pdf; http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf; http://www.cdc.gov/nchs/data/series/sr_11/sr11_238.pdf
US TRENDS
Trends in obesity among children and adolescents 2-19 years, by sex: US, 1971-74 through 2011-12 Percent 30 Males Females Total 20 10 0 1971-74 1976-80 1988-94 1999-00 2003-04 2007-08 2011-12. Source: CDC/NCHS. National Health Examination Surveys II (ages 6-11), III (ages 12-17), and National Health and Nutrition Examination Surveys (NHANES) I-III, and NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012.
Percent Most recent obesity trends in youth 2-19 y: 2-year surveys 30 Boys Girls 20 10 0 No significant linear trend over the last 10 years 2003-2004 to 2011-2012 overall or in boys or girls 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2012, NCHS data brief; Ogden et al. 2014 JAMA
Percent Excess weight, children birth-<24 months of age, US, 1999-2009 Boys Girls 20 No significant linear trend 1999-2000 through 2011-2012 OR 2003-2004 to 2011-2012 10 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 Year Source: CDC/NCHS: National Health and Nutrition Examination Survey; Ogden et al. JAMA 2012. Weight-for-length>=97.7 th percentile WHO growt charts
Trends in obesity among children and adolescents 2-19 years, by age: US, 1971-74 through 2011-12 Percent 30 2-5 years 6-11 years 12-19 years 20 10 0 1971-74 1976-80 1988-94 1999-00 2003-04 2007-08 2011-12. Source: CDC/NCHS. National Health Examination Surveys II (ages 6-11), III (ages 12-17), and National Health and Nutrition Examination Surveys (NHANES) I-III, and NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012.
Trends in obesity prevalence among youth 2-5 years, by age, US, 2003-2004 to 2011-2012 20 15 5.5 percentage point decrease (95% confidence interval of 1.4 to 9.6 percentage point decrease) 10 13.9 10.7 10.1 12.1 8.4 5 0 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys
Percent Trends in obesity prevalence among children 2-5 years, US, 2003-2004 to 2011-2012 20 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 15 13.9 15.1 14.4 10 10.7 10.1 12.1 8.4 10.4 9.3 9.5 12.7 11 10.9 9.6 7.2 5 0 1. p=.03 for linear trend 2. p=.21 for linear trend 3. p=.07 for linear trend Total 1 Boys 2 Girls 3 SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, estimates are weighted
Trends in obesity among children and adolescents 2-5 years, by sex: US, 1971-74 through 2011-12 Percent 20 Males Females Total 15 10 5 0 1971-74 1976-80 1988-94 1999-00 2003-04 2007-08 2011-12. Source: CDC/NCHS. National Health Examination Surveys II (ages 6-11), III (ages 12-17), and National Health and Nutrition Examination Surveys (NHANES) I-III, and NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012.
Trends in obesity among children and adolescents 2-5 years, by sex: US, 1971-74 through 2011-12 Percent 20 Males Females Total 15 4 year estimates except 2011-2012 Quadratic trend Total p value.036 10 5 0 1971-74 1976-80 1988-94 1999-02 2003-06 2011-12 2007-10. Source: CDC/NCHS. National Health Examination Surveys II (ages 6-11), III (ages 12-17), and National Health and Nutrition Examination Surveys (NHANES) I-III, and NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012.
OTHER TRENDS IN PRESCHOOL AGE CHILDREN
2-4 year olds, slight drop from 2008-2011 Pediatric Nutrition Surveillance System http://www.cdc.gov/media/dpk/2013/dpk-vs-child-obesity.html#graphics
Percent Source: Koebnick C, Mohan YD, Li X, Young DR. Secular Trends of Overweight and Obesity in Young Southern Californians 2008-2013. J Pediatr. 2015 Sep 21. pii:s0022-3476(15)00971-3. doi: 10.1016/j.jpeds.2015.08.039. Epub ahead of print]pubmed PMID: 26421485. Obesity trends, Southern California, Kaiser Permanente, 2-5 years 15 10 13 12.3 12.3 12.1 11.6 11 5 0 2008 2009 2010 2011 2012 2013
DISTRIBUTION CHANGES
http://www.cdc.gov/nchs/data/databriefs/db01.pdf
Distribution of BMI 1999-2000 and 2009-2010, by sex, 2-5 years 1999-2000 2009-2010 Percent Boys Percent Girls 18 18 16 16 14 14 12 12 10 10 8 8 6 6 4 4 2 2 0 10 20 30 Body Mass index (BMI) 0 10 20 30 Body Mass index (BMI) BMI: body mass index SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys; Ogden et al JAMA 2012
PERSISTENCE
Select studies: Association of childhood obesity with adult obesity Bogalusa, 2-5 years (Freedman) Moderately associated with adult obesity (correlation.33-.41) Kids with obesity 4 times likely obese as adults v <50 th P Fels, 3-4 years (Guo) Probability of adult obesity if child with obesity 14-25% Young Finns, age 3 years (Juhola) Moderately associated with adult obesity (correlation.29-.36) Note: These are examples and not the only studies Sources: Freedman et al Pediatrics 2005 ; Guo et al AJCN 2002; Juhola, et al. J Peds 2011;
Select studies: Association of childhood obesity with adult or adolescent obesity Washington HMO, 1-5 years (Whitaker) Odds of adult obesity if child with obesity 1-2 y OR 1.3 (0.6-3.0) 3-5 y OR 4.7 (2.5-8.8) Risk depends upon whether child has parent with obesity ECLS-K, 1998-1999, mean 5.6 years (Cunningham) 47% probability of being obese in 8 th grade if obese in K Note: These are examples and not the only studies Sources: Whitaker et al NEJM 1997; Cunningham et al NEJM 2014
Young children (<5 years): Persistence of obesity Little published on children < 5 years Different birth cohorts Different years of follow-up Different methodologies and measures Magnitude increases with age
US Children <5 years 7-8% with excess weight Disparities: Patterns differ Race/ethnic differences among 2-5 y but not among <24 mo Trends last 10 years No change among <24 months Decline in 2-5 year olds NHANES 2013-2014 will help clarify trends Other data sources show similar trends Persistence Weaker in youngest children, increases with age
Thank you to my colleagues David Freedman, PhD Katherine Flegal, PhD Brian Kit, MD, MPH Margaret Carroll, MSPH National Center for Health Statistics Division of Health and Nutrition Examination Surveys