Prevalence and Trends of Severe Obesity Among US Children and Adolescents

Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Academic pediatrics (Impact Factor: 2.01). 07/2009; 9(5):322-9. DOI: 10.1016/j.acap.2009.04.005
Source: PubMed


To determine the extent to which the 2007 definitions for severe obesity (body mass index [BMI] > or = 99th percentile for age and gender) and morbid obesity (BMI > or = 40kg/m(2)) affects different groups of American children and adolescents and has increased over time.
Analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES) II, III, and 1999-2004; 12 384 US children and adolescents ages 2 to 19 years were included in the analysis. Outcome measures were the proportion of subjects with severe and morbid obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables.
In 1999-2004, 3.8% of children 2 to 19 years old had a BMI in the > or = 99th percentile, with higher prevalence among boys than girls (4.6% vs 2.9%; P < .001). Prevalence was highest among blacks, 5.7% and Mexican Americans, 5.2%, compared with whites, 3.1% (P < .001). The prevalence differed by the PIR category as well (4.3% for those with PIR < or = 3 vs 2.5% for those with PIR>3; P=.002). BMI > or = 40kg/m(2) was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI > or = 99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2 to 19 years of age.
Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender, and poverty. This places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.

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    • "Given the strong tracking effect of childhood obesity into adulthood [1] [2] [3] [4] and the association of pediatric obesity with adverse health consequences [5] [6] [7], understanding behavioral factors, severity trends, and high-risk subgroups is important from both a public health and clinical perspective. Although overall pediatric obesity rates have stabilized in recent years [8], rates of severe obesity are high [9], and the fact remains that one in six US children have obesity [8, 10–12], with the burden disproportionately affecting Hispanic/Latino and black pediatric populations [13] [14] [15] [16] [17] [18]. Newer definitions for higher order obesity delineated by the body mass index (BMI) percentage above the 95th BMI percentile provide additional classification of children with severe obesity [19] [20], where a continued upward trend has been observed nationally [9] and racial/ethnic disparities are evident beginning at an early age [15] [17]. "
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    • "There are also racial/ethnic disparities in the prevalence of extreme obesity among children [9,21e23]; these disparities are evident as young as preschool and observed within limited socioeconomic strata such as low-income samples [24] [25]. Most prior studies have examined differences in the proportion of children falling above various body mass index (BMI) cutoffs (e.g., 97th or 99th percentile [9] [22] [23], 1.2 times the 95th percentile [21] [26]). National estimates for the United States suggest that non-Hispanic black children are nearly twice as likely to fall above the 97th BMI percentile for age and sex compared with non-Hispanic white children (18.6% vs. 9.8%, respectively), and rates are also high among Hispanic children (15.6% [9]). "
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