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

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 < 85 th percentile of CDC growth charts Source: Huang JS et al, Pediatrics 2007:120:e1126 e119

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

An obese child BMI-for-age 95 th 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 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.

Obesity and extreme obesity, US women, 20+ years, 2009-2010 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.

Prevalence of Obesity Children and Teens, 2-19 years, 2009-10 30 25 Non Hispanic white Non Hispanic black Hispanic 26.5 22.6 Differences in both boys and girls 24.8 Percent 20 15 17.5 14.7 19.8 10 5 0 Boys Girls Source: CDC/NCHS National Health and Nutrition Examination Survey; Ogden et al, JAMA 2012

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% 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 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 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. 2010.

Childhood obesity by poverty income ratio, 2005-8 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. 2010.

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 30 Non-Hispanic white Mexican American Non-Hispanic black All Percent 20 10 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 Source: Ogden et al. 2012, JAMA; NHANES 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 >= 95 th 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 15 17.2 16.1 15.9 15.9 14.8 14.0 10 5 0 Males Females SOURCE: CDC/NCHS, NHANES, 2005-2008.

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 25 PIR < 130% 130% PIR < 350% PIR 350% 20 No difference Percent 15 16.8 16.1 16.2 15.9 15.7 15.2 10 5 0 Males Females NOTES: PIR is poverty income ratio. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008.

*Significant linear trend; PIR: poverty income ratio Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008 Mean percent of total daily kilocalories from sugar drinks, by PIR, US, ages 2 years and older, 2005-08 <130% PIR 130-350% PIR >=350% PIR 2-19 years* 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 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. 2006 Oct;118(4):1510-8.

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

Change in BMI distribution, boys 12-19 y 90 th percentile Source: NHANES III, 1999-2002 and 2007-2010

Change in BMI distribution, girls12-19 y 90 th 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 Mixed dishes 144% 180% Pizza 425% Vegetable -43% Fried potato % decrease 18% 0% % increase Source: Cleveland USDA; NFCS 1977-78 and WWEIA, NHANES 2001-02, 1 day