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Childhood Obesity in the United States, 1976-2008: Trends and Current Racial/Ethnic, Socioeconomic, and Geographic Disparities

  • October 2010
Authors:
Gopal K Singh at U.S. Department of Health and Human Services
Gopal K Singh
Michael D Kogan at U.S. Department of Health and Human Services
Michael D Kogan
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1
Childhood Obesity in the
United States, 1976-2008:
Tr e n d s a n d Cu r r e n T ra C i a l /eT h n i C , so C i o e C o n o m i C , a n d Ge o G r a p h i C di s p a r i T i e s
Gopal K. Singh, PhD and Michael D. Kogan, PhD
U.S. Department of Health and Human Services
Health Resources and Services Administration
Maternal and Child Health Bureau
Childhood Obesity in the United States
1
The prevalence of childhood obesity has increased dramati-
cally in the United States, with the rate having increased more
than three-fold during the past three decades (1-4). Increases
in obesity prevalence have been substantial among all gender,
race, and socioeconomic groups (1, 3, 4). Because of a
relatively high prevalence, a rapidly increasing trend, and the
existence of large racial/ethnic and socioeconomic dispari-
ties, childhood obesity is recognized as a major public health
problem in the United States (1-5).
Monitoring disparities in childhood obesity by socioeconomic
and demographic factors is important for several reasons (3).
First, obesity has been identified as one of the ten leading health
indicators for the nation, and reducing or eliminating racial and
socioeconomic inequalities in health is one of the major goals of
the national health initiative, Healthy People 2010 (6). Second,
an analysis of both temporal and contemporary racial/ethnic
and socioeconomic patterns in childhood obesity is important
because it could help identify key population subgroups who
may not only be at high risk but who may also have experienced
significant increases in their obesity rates and who therefore
can be targeted for obesity prevention programs (3-5). Third,
documenting disparities between the least and most advantaged
social groups or geographic areas can tell us the extent to which
reductions in obesity prevalence can be achieved (3-5).
In this report, we examine time trends and current patterns
in obesity and overweight prevalence among U.S. children and
adolescents according to gender, race/ethnicity, household
socioeconomic status (SES), and state of residence. The data
on childhood obesity are obtained from two large, nationally
representative federal health surveys and data systems: the
1976-2008 National Health and Nutrition Examination Surveys
(NHANES) and the 2003 and 2007 National Survey of Children’s
Health (NSCH) [1, 3-5, 7, 8]. Both the NHANES and the NSCH
are conducted by the Centers for Disease Control and Preven-
tion’s (CDC) National Center for Health Statistics (1, 3). However,
the Health Resources and Services Administration’s Maternal
and Child Health Bureau provides the funding and direction for
the NSCH. Details of the two survey data systems are provided
elsewhere (3-5, 8). While the NHANES provides the long-term
trend obesity data by gender and race, data on detailed racial/
ethnic, socioeconomic, and geographic disparities are drawn
from the NSCH (1, 3).
Long-Term Trends in Obesity and Overweight Prevalence
Overweight and obesity in children are defined as body
mass index (BMI) at or above the gender- and age-specific
85th and 95th percentile BMI cutoff points from the 2000 CDC
growth charts (1, 3-5). BMI in the NSCH was calculated from
parent-reported height and weight data for children aged 10-17
years (3-5). BMI in the NHANES was based on measured height
and weight data for children aged 6-17 years (1, 3, 7). Note that
the overweight category (BMI ≥85th percentile) includes obese
children (BMI ≥95th percentile).
According to the NHANES data, the prevalence of obesity
among children aged 6-17 increased sharply between 1976 and
Fi g u r e 1: Trend in Obesity and Overweight Prevalence (%)
among U.S. Male and Female Children Aged 6-17 Years,
1976-2008
5.7
30.7
0
5
10
15
20
25
30
35
40
45
1976-1980 1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
Obese, Total Obese, Male
Obese, Female Overweight , Total
Overweight , Male Overweight , Female
36.1
19.7
Source: The National Health and Nutrition Examination Survey, 1976-2008.
Fi g u r e 2: Trend in Obesity and Overweight Prevalence (%)
among U.S. Children Aged 6-17 Years, by Race/Ethnicity,
1999-2008
11.3
17.9
21.5
23.5
21.6
23.9
26.5
34.1
39.3
39.6
38.5
43.3
0
5
10
15
20
25
30
35
40
45
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
Obese, Non-Hisp White Obese, Non-Hisp Black
Obese, Hispan ic Overweight , Non- Hisp White
Overweight , Non- Hisp Black Overweight , Hispanic
Source: The National Health and Nutrition Examination Survey, 1999-2008.
Childhood Obesity in the United States
2
2008 for the total child population as well as for male and female
children (Figure 1). The obesity prevalence for male children
quadrupled from 5.5% in 1976-1980 to 21.6% in 2007-2008.
For female children, the obesity prevalence tripled from 5.8% in
1976-1980 to 17.7% in 2007-2008. The average annual rate of
increase in obesity prevalence was 4.5% for male children and
3.8% for female children.
Between 1999 and 2008, the obesity and overweight preva-
lence among children aged 6-17 years, based on the measured
BMI data from the NHANES, increased by 29% and 18%,
respectively. In 2007-2008, 19.7% of U.S. children aged 6-17
were obese and 36.1% were overweight (Figure 1). Between
1999 and 2008, the obesity prevalence increased by 58% for
non-Hispanic white children aged 6-17, 9% for black children,
and by 11% for Hispanic children. The overweight prevalence for
non-Hispanic white children aged 6-17 rose by 29% from 26.5%
in 1999-2000 to 34.1% in 2007-2008 (Figure 2).
Racial/Ethnic Disparities in Childhood Obesity and
Overweight Prevalence
Since the NHANES lacks obesity data for children and
adolescents other than those for non-Hispanic white, black, and
Hispanic children, obesity rates for children from detailed racial/
ethnic groups were obtained from the NSCH. The 2007 NSCH
data indicate substantial racial/ethnic disparities in obesity and
overweight prevalence for children aged 10-17 years (Figure 3).
In 2007, 16.4% of U.S. children aged 10-17 were obese and
31.6% were overweight. The obesity prevalence was highest
among non-Hispanic Black children (23.9%), followed by His-
panic children (23.4%), American Indian/Alaska Native children
(23.0%), Hawaiian/Pacific Islander children (20.9%), mixed-race
children (14.2%), and Asian children (8.7%). The overweight
prevalence ranged from a low of 18.4% for Asian children
aged 10-17 to a high of 44.3% for Hawaiian/Pacific
Islander children; 41% of Black and Hispanic children were
overweight (Figure 3).
Trends in Socioeconomic Disparities in Obesity and
Overweight Prevalence
The obesity and overweight prevalence increased
significantly in relation to decreased levels of household
education and income in both 2003 and 2007 (Figures
4 and 5). Specifically, the obesity prevalence for children
with parents having fewer than 12 years of education
was 30.4% in 2007, 3.1 times higher than the obesity
prevalence (9.7%) for children whose parents had a college
degree (Figure 4). The obesity prevalence for children
living below the poverty line was 27.4% in 2007, 2.7 times
higher than the obesity prevalence (10.0%) for children with
family income exceeding 400% of the poverty threshold
(Figure 5). Nearly half of all children in low-education and
low-income groups in 2007 were overweight, compared with less
than 23% of children in the high-education or high-income group.
Socioeconomic differentials in childhood obesity and
overweight prevalence were greater in 2007 than in 2003 as
the relative risks of obesity and overweight among children in
low SES groups compared to children in high SES groups were
smaller in 2003 than in 2007 (4). Moreover, while the obesity and
overweight prevalence among children in the lowest SES groups
increased significantly between 2003 and 2007, the prevalence
actually declined among children in the highest SES groups
(Figures 4 and 5).
Geographic Disparities in Obesity and Overweight
Prevalence
According to the NSCH data, the obesity prevalence in
2007 varied from a low of 9.6% for children in Oregon to a high
of 21.9% for children in Mississippi (5). Overweight prevalence
varied from a low of 23.1% for children in Utah to a high of 44.5%
for children in Mississippi. Among male children, the obesity
prevalence in 2007 was lowest in Oregon (11.0%) and highest in
Arkansas (27.2%). Female children in Wyoming and Texas had
the lowest and highest obesity prevalence, 5.5% and 20.2%,
respectively (5).
A relatively higher prevalence of obesity and overweight was
observed in the Southeastern region of the United States, and a
larger number of states showed a shift towards higher prevalence
in 2007 compared to 2003 (Figures 6-9). The obesity prevalence
increased between 2003 and 2007 by 46% for children in
Arizona and by 32% for children in Illinois. Between 2003 and
Fi g u r e 3: Obesity and Overweight Prevalence (%), U.S. Children
Aged 10-17 Years, 2007
16
13
24 23
14
23
9
21
32
27
41 41
35
38
18
44
5
10
15
20
25
30
35
40
45
50
All Races Non-Hispanic
White
Non-Hispanic
Black
Hispanic Mixed Race American
Indian/Alaska
Native
Asian Hawaiian/
Pacific
Islander
Obese
Overweight
Source: The National Survey of Children’s Health, 2007.
Childhood Obesity in the United States
3
2007, the obesity prevalence declined by 32% for children in
Oregon. The overweight prevalence increased by 21% and 29%
for children in Mississippi and Nevada, respectively (5).
Summary and Discussion
The long-term trend data from the NHANES show a
four-fold increase in obesity prevalence among male children
and a three-fold increase in obesity prevalence among female
children between 1976 and 2008 (3). The latest 2007-2008
NHANES data show a current obesity prevalence of 20% and
an overweight prevalence of 36% for children aged 6-17 years.
The number of obese children aged 6-17 years increased from
6.9 million in 1999-2000 to 9.3 million in 2007-2008, while the
number of obese or overweight children aged 6-17 grew from
14.1 million in 1999-2000 to 17.1 million in 2007-2008 (3).
Between 1999 and 2008, the obesity prevalence increased
significantly for all children and for non-Hispanic white, black, and
Hispanic children aged 6-17.
According to the NSCH data, 16.4% of U.S. children aged
10-17 years (i.e., 5.2 million children) were obese in 2007,
which suggests an increase of 10% in prevalence or 570,000
additional obese children aged 10-17 since 2003 (3, 4). An
overweight prevalence of 31.6% in 2007 meant that there were
over 10 million U.S. children aged 10-17 years who were obese
or overweight – an additional 512,000 overweight children aged
10-17 since 2003 (3, 4).
Large racial/ethnic disparities in obesity and overweight
prevalence exist among U.S. children. Although black and
Hispanic children have two times higher obesity rates than
non-Hispanic white children, analysis of detailed ethnic dispari-
ties indicates that black, Hispanic, Hawaiian/Pacific Islander,
and American Indian/Alaska Native children have nearly three
times higher risks of obesity and overweight than Asian children
(3, 4). Almost one in four Black, Hispanic, or American Indian/
Alaska Native children is obese, compared with fewer than one
in ten of Asian American children. The overweight prevalence
for Black, Hispanic, and Hawaiian/Pacific Islander children
currently exceeds 40%. A recent study showed an increase in
the magnitude of racial/ethnic disparities in childhood obesity and
overweight prevalence between 2003 and 2007 (4).
Household socioeconomic status is a powerful determinant
of childhood obesity in the United States. An inverse, significant
association between household income, education, and employ-
ment and obesity and overweight prevalence exists for children in
all major racial/ethnic groups (3, 4, 9). Children from low-educa-
tion and low-income households have three times higher obesity
prevalence than children from high SES households. Nearly half
of all children in the low SES group are overweight, compared
with one in four children from the high SES group. However, the
socioeconomic gradients in obesity and overweight prevalence
are not just limited to differences between the highest and lowest
SES groups. Instead, the gradient in obesity and overweight risks
extends progressively downward from the poor through the lower
middle class, upper middle class, and to the most affluent group.
30.4
20.5
17.9
9.7
23
19.9
16.4
10.5
38.3
34.2
22.8
41.1
37.7
24.4
5
10
15
20
25
30
35
40
45
50
Less than High School High School Some College College Graduate
Obese, 2007
Obese, 2003
Overweight, 2007
Overweight, 2003
33
47.4
Source: The National Survey of Children’s Health, 2003 and 2007.
Fi g u r e 4: Trends in Obesity and Overweight Prevalence (%)
among Children Aged 10-17 Years, by Household or Parental
Education, United States, 2003-2007
27.4
21.2
14.5
10
22.2
18.7
13.8
9.3
45.1
38
30.4
22.3
39.9%
36.9
28.9
22.9
0
5
10
15
20
25
30
35
40
45
50
Below 100% FPL 100 - 199% of FPL 200 -399% of FPL ≥ 400% of FPL
Obese, 2007
Obese, 2003
Overweight, 2007
Overweight, 2003
Source: The National Survey of Children’s Health, 2003 and 2007.
Fi g u r e 5: Trends in Obesity & Overweight Prevalence (%)
among Children Aged 10-17 Years, by Household Income/
Poverty Status (Federal Poverty Level (FPL)), United States,
2003-2007
Childhood Obesity in the United States
4
<12%
12-17.99%
>=18%
<12%
12-17.99%
>=18%
Fi g u r e 6: Obesity Prevalence, Children Aged 10-17 Years, 2007 (The National Survey of Children’s Health)
Fi g u r e 7: Obesity Prevalence, Children Aged 10-17 Years, 2003 (The National Survey of Children’s Health)
Childhood Obesity in the United States
5
<27%
27-32.99%
>=33%
Fi g u r e 8: Overweight Prevalence, Children Aged 10-17 Years, 2007 (The National Survey of Children’s Health)
Fi g u r e 9: Overweight Prevalence, Children Aged 10-17 Years, 2003 (The National Survey of Children’s Health)
Childhood Obesity in the United States
6
The excess obesity burden is therefore shared greatly by children
and families in the middle SES groups who make up more than
half of the child population or households (3).
Substantial geographic disparities in childhood obesity
exist, with the Southeastern states (such as Mississippi and
Georgia) having the highest obesity prevalence and the Western
states (such as Oregon and Wyoming) with the lowest obesity
prevalence. In 2007, the childhood obesity rates for states such
as Mississippi, Georgia, Kentucky, Illinois, Louisiana, Tennes-
see, Arkansas, Texas, and the District of Columbia exceeded
20%, whereas the obesity rates for Oregon and Wyoming were
approximately 10% (5).
The geographic disparities in childhood obesity prevalence
increased between 2003 and 2007. Oregon was the only state
for which obesity prevalence declined significantly between 2003
and 2007. The obesity prevalence increased significantly for
children in Arizona and Illinois (5). However, there were a number
of states, such as Arkansas, Colorado, Georgia, Florida, Ohio,
and Utah, that experienced large but statistically insignificant
increases in their obesity and/or overweight prevalence. Overall,
when geographic patterns for 2003 and 2007 are compared, an
apparent shift toward higher obesity and overweight prevalence
in 2007 can be seen for a number of states (5).
Socioeconomic, behavioral, neighborhood social conditions,
and built environmental characteristics have been shown to
account for a substantial portion of the racial/ethnic, SES, and
geographic disparities in childhood obesity and overweight
prevalence documented here (3-5, 10). Sedentary behaviors
such as physical inactivity, excess television viewing time, and
recreational computer use have been related to increased obesity
risks in U.S. children (4, 9). Neighborhood socioeconomic condi-
tions and the built environments, including access to sidewalks
or walking paths, bike trails, clean and safe streets, adequate
housing, playgrounds and outdoor parks, adequate public
transportation, and access to healthy foods, have also been
shown to influence obesity risks in children (5, 10).
The recent increase in the prevalence of childhood obesity at
the national level and in several of the states may partly be attrib-
uted to increases in the proportion of the socially disadvantaged
populations as the percentage of households with Hispanic
children and children from low-income, high-unemployment,
and non-English speaking households grew between 2003 and
2007 (4, 5). Additionally, a more rapid increase in the obesity
prevalence among Hispanic children and among children from
lower socioeconomic backgrounds has been cited as a major
factor in the rise of social inequalities in U.S. childhood obesity
(4). However, the extent to which changes in the social, built,
or obesogenic environments might have contributed to recent
trends in childhood obesity is not clear (4, 5). The 2003 and 2007
NSCH data did not show any marked changes in levels of physi-
cal inactivity or other sedentary activities at the national level (4).
Dietary factors such as mean calorie intake and fat intake have
increased consistently over time among both youth and adults in
the U.S. (1, 3, 11), and recent trends in these factors may have
contributed to the increase in childhood obesity at the national
level as well as in specific states.
The United States has one of the highest rates of childhood
obesity in the industrialized world (3, 9). Existence of large racial/
ethnic, socioeconomic, and geographic inequalities in obesity, as
those shown here, has been suggested as one of the reasons
for its unfavorable international standing (3, 9). Monitoring such
social disparities in U.S. childhood obesity rates is therefore vital
in tracking progress toward achieving the broad national health
objectives of reducing and ultimately eliminating health inequali-
ties and in evaluating the impact of specific policy interventions
in reducing childhood obesity (3-5). As of 2007, children and
adolescents in all racial/ethnic and socioeconomic groups as
well as in all states fell considerably short of the national goal for
childhood obesity prevalence – which is set at 5% for the year
2010 (3-6). In fact, the recent patterns in the obesity prevalence
seem to indicate that the rates for children in most social groups
are moving farther away from the national target.
Marked racial/ethnic, socioeconomic, and geographic dispari-
ties shown here indicate the potential for considerable reduction
in U.S. childhood obesity (3-5). However, continuing disparities
in childhood obesity prevalence are likely to exacerbate health
inequalities among both children and adults (3, 5). Obesity pre-
vention programs should not only include behavioral interventions
aimed at reducing children’s physical inactivity levels and limiting
their television viewing and recreational screen time, but should
also include social policy measures aimed at improving the
broader social and physical environments that create obesogenic
conditions that put children at risk for poor diet, physical inactivity,
and other sedentary activities (3-5, 10).
8
re F e r e n c e s
1. National Center for Health Statistics. Health, United States, 2009 with Special Feature on Medical Technology. Hyattsville, MD:
U.S. Department of Health and Human Services; 2010.
2. Koplan JP, Liverman CT, Kraak VA (editors). Preventing Childhood Obesity: Health in the Balance. Institute of Medicine. Washing-
ton, DC: The National Academies Press; 2005.
3. Singh GK, Kogan MD. Contemporary racial/ethnic and socioeconomic patterns in U.S. childhood obesity. In: Bagchi D (editor).
Global Perspectives on Childhood Obesity: Current Status, Consequences and Prevention. San Diego, CA: Academic Press;
2010. Pp 71-85.
4. Singh GK, Siahpush M, Kogan MD. Rising social inequalities in US childhood obesity, 2003-2007. Ann Epidemiol.
2010;20(1):40-52.
5. Singh GK, Kogan MD, van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States
from 2003 to 2007. Arch Pediatr Adolesc Med. 2010;164(7):598-607.
6. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd edition. Wash-
ington, DC: U.S. Government Printing Office; 2000.
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2007-2008. JAMA. 2010;303(3):242-249.
8. Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children’s Health 2007:
The Health and Well-Being of Children, A Portrait of States and the Nation. Rockville, Maryland: U.S. Department of Health and
Human Services; 2009.
9. Singh GK, Kogan MD, van Dyck PC, Siahpush M. Racial/ethnic, socioeconomic, and behavioral determinants of childhood and
adolescent obesity in the United States: analyzing independent and joint associations. Ann Epidemiol. 2008;18(9):682-695.
10. Singh GK, Siahpush M, Kogan MD. Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health
Aff (Millwood). 2010;29(3):503-512.
11. Singh GK, Siahpush M, Hiatt RA, Timsina LR. Dramatic increases in obesity and overweight prevalence among ethnic-immigrant
and social class groups in the United States, 1976-2008. J Community Health. 2010; June 12 (Epub ahead of print). doi10.1007/
s10900-010-9287-9.
Copyright Information:
All materials appearing in this report are in the public domain and may be reproduced or copied without permission; citation as to
source, however, is appreciated.
Suggested Citation:
Singh GK, Kogan MD. Childhood Obesity in the United States, 1976-2008: Trends and Current Racial/Ethnic, Socioeconomic, and
Geographic Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health
Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
This publication is available online at http://www.mchb.hrsa.gov/
All photos are credited to iStockphoto.
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Article
  • Jul 2018
Background: Childhood obesity in the United States is a critical public health issue. Although multiple child and parental factors are associated with childhood obesity, few models evaluate how socioeconomic status influences these risk factors. We aimed to create a model to examine how socioeconomic status modifies risk factors for child obesity. Methods: We conducted a secondary data analysis of the Early Childhood Longitudinal Birth Cohort. Using logistic regression, we modeled childhood obesity status from known parental and child risk factors for childhood obesity and tested interactions with socioeconomic status. Results: Compared with healthy-weight children, socioeconomic status, race, birth weight, parental smoking, and not eating dinner as a family were associated with kindergarten-aged children being overweight or obese. Parental smoking increased the odds of a child being overweight or obese by 40%, and eating dinner as a family reduced the odds of a child being overweight or obese by 4%. In addition, black or Hispanic children had a 60% increased odds of being overweight or obese when compared with their white counterparts. Native American children had almost double the odds of being overweight or obese compared with white children. Socioeconomic status did not modify any of these associations. Conclusion: Parental smoking, birth weight, and not eating dinner as a family were two modifiable factors associated with overweight and obesity in kindergarten-age children, regardless of socioeconomic status. Changing these life-style factors could reduce the child's risk for obesity.
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... Individuals living in obesogenic environments characterised by high poverty and lack of affordable fruit and vegetables have been found to have low intake of fruit and vegetables (Finkelstein et al., 2005;Lovasi et al., 2009). Children living below the federal poverty level are more likely to be obese compared to those who are above the federal poverty level (Singh and Kogan, 2010;State of Obesity, 2016). The effect of poverty on CHO has been traced to children as young as 2 years old (Klebanov et al., 2014). ...
Children’s healthy eating habits and parents’ socio-demographic characteristics in rural Texas, USA
Article
  • Jan 2018
Objective Due to the disproportionately high rates of obesity within the US Hispanic community, there is a critical need to address this health disparity issue. The aim of this study is to examine the relationship between parents’ socio-demographic characteristics and their children’s food consumption. Design Cross-sectional study. Setting Participants were recruited from schools in a predominately Hispanic rural area of Texas, USA. Method Parents ( n = 298) of fourth grade (9–10 years old) children completed the survey. The independent variables were parents’ socio-demographic characteristics (e.g. ethnicity and income). The outcome variable was a Healthy Eating Index that refleting children’s frequencies of food consumption measured as daily frequency of consumption for healthy foods (e.g. skimmed milk), less healthy foods (e.g. potato) and unhealthy foods (e.g. Coke). We performed multiple linear regression. Results Regression analysis shows that 13.7% variance of children’s food consumption could be predicted by their parents’ gender, ethnicity, marital status, education and income ( R ² = .137, p < 0.01). Parents’ ethnicity, education and income variables were strong predictors for children’s food consumption. Conclusion Healthy eating can help reduce childhood obesity; however, we found children of US Hispanic parents ate less healthily. Culturally specific education programmes should be adopted for parents or families of Hispanic or Latino origin.
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... Obesity is estimated as 20 % among US children aged 6–17 years [1]. While some studies suggest even higher estimates in children with developmental disabilities (DDs)2345, they were limited in that DDs were either generally defined (i.e. by combining DDs with differing functional impacts as a single entity) [2, 3,678 or the focus was limited to a single condition such as autism [5] or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) [4]. ...
Prevalence and Impact of Unhealthy Weight in a National Sample of US Adolescents with Autism and Other Learning and Behavioral Disabilities
Article
Full-text available
We estimated the prevalence of obesity, overweight, and underweight among US adolescents with and without autism and other learning and behavioral developmental disabilities (DDs) and assessed the health consequences of obesity among adolescents with DDs. From the 2008 to 2010 National Health Interview Survey, we selected 9,619 adolescents ages 12-17 years. Parent respondents reported weight, height, presence of DDs and health conditions. We calculated body mass index (BMI) and defined obesity, overweight, and underweight as ≥95th, ≥85th to <95th, and <5th percentiles, respectively, using established criteria. We created mutually-exclusive DD subgroups using the following order of precedence: autism; intellectual disability; attention-deficit-hyperactivity-disorder; learning disorder/other developmental delay. We compared BMI outcomes among adolescents in each DD group versus adolescents without DDs using multivariable logistic regression. Socio-demographic factors and birthweight were included as confounders. Estimates were weighted to reflect the US population. Both obesity and underweight prevalences were higher among adolescents with than without DDs [adjusted prevalence ratios (aPR) 1.5 (1.25-1.75) and 1.5 (1.01-2.20), respectively]. Obesity was elevated among adolescents with all DD types, and was highest among the autism subgroup [aPR 2.1 (1.44-3.16)]. Adolescents with either a DD or obesity had higher prevalences of common respiratory, gastrointestinal, dermatological and neurological conditions/symptoms than nonobese adolescents without DDs. Adolescents with both DDs and obesity had the highest estimates for most conditions. Obesity is high among adolescents with autism and other DDs and poses added chronic health risks. Obesity prevention and management approaches for this vulnerable population subgroup need further consideration.
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... 11 Socioeconomic position is negatively associated with overweight and obesity in children. [12][13][14] Six of the 10 states with the nation's highest obesity rates also have the nation's highest poverty rates. 4 The prevalence of obesity is significantly lower among individuals with college degrees compared to those with only some college or less education. ...
The Healthy Weight Collaborative: Quality Improvement Methods Promoting Healthy Weight
Article
Full-text available
Promoting healthy weight requires innovative approaches and a concerted response across all sectors of society. This commentary features the framework guiding the Healthy Weight Collaborative, a two-phased quality improvement (QI) learning collaborative and key activity of the Collaborate for Healthy Weight initiative. Multi-sector teams from primary care, public health, and community-based organizations use QI to identify, test, and implement program and policy changes in their communities related to promoting healthy weight. We describe the Collaborative's overall design based on the Action Model to Achieve Healthy People 2020 Goals and our approach of applying QI methods to advance implementation of sustainable ways to promote healthy weight and healthy equity. We provide specifics on measurement and change strategies as well as examples of Plan-Do-Study-Act cycles from teams participating in Phase 1 of the Collaborative. These teams will serve as leaders for sustainable, positive change in their communities.
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Club Fit: Development of a Physical Activity and Healthy Eating Intervention at a Boys & Girls Club After School Program
Article
Full-text available
Children and adolescents from minority and low income backgrounds face social and environmental challenges to engaging in physical activity and healthy eating to maintain a healthy weight. In this study, we present pilot work to develop and implement a multi-component physical activity and healthy eating intervention at a Boys & Girls Club (BGC) afterschool program. Using a community-based participatory approach, BGC staff and academic researchers developed intervention components informed by formative studies and based on a Social Ecological Theory framework. Components included healthy eating and physical activity policy implementation, staff training, a challenge and self-monitoring program for healthy behaviors, a peer-coaching program for healthy behaviors, and a social marketing campaign. We assessed pilot feasibility through a single group, pre-post study design with measures collected at baseline and 6 months. The sample included 61 children with a mean age of 10.4 years. Mean (SD) body mass index (BMI) percentile was 72.8 (28.9); 47.5% were in the healthy weight range for their age. We found statistically significant improvements of self-efficacy and motivation for physical activity. Self-efficacy and motivation for fruit and vegetable consumption, sugary beverage consumption, and screen time improved but were not statistically different from baseline. We found no improvements of perceived social support, objectively measured physical activity, or self-reported dietary quality. Though BMI did not improve overall, a dose effect was observed such that attendance in Club Fit specific programming was significantly correlated with decreased BMI z scores. Processes and products from this study may be helpful to other communities aiming to address childhood obesity prevention through afterschool programs.
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A randomized controlled trial of orthodontist-based brief advice to prevent child obesity
Article
Objective: We conducted a randomized controlled trial to test whether brief exercise and diet advice provided during child patient visits to their orthodontic office could improve diet, physical activity, and age-and-gender-adjusted BMI. Methods: We enrolled orthodontic offices in Southern California and Tijuana, Mexico, and recruited their patients aged 8-16 to participate in a two-year study. At each office visit, staff provided the children with "prescriptions" for improving diet and exercise behaviors. Multilevel models, which adjusted for clustering, determined differential group effects on health outcomes, and moderation of effects. Results: We found differential change in BMI favoring the intervention group, but only among male participants (p < 0.001; Cohen's d = 0.085). Of four dietary variables, only junk food consumption changed differentially, in favor of the intervention group (p = 0.020; d = 0.122); the effect was significant among overweight/obese (p = 0.001; d = 0.335) but not normal weight participants. Physical activity declined non-differentially in both groups and both genders. Conclusion: The intervention, based on the Geoffrey Rose strategy, had limited success in achieving its aims. Implications: Orthodontists can deliver non-dental prevention advice to complement other health-practitioner-delivered advice. Higher fidelity to trial design is needed to adequately test the efficacy of clinician-based brief advice on preventing child obesity and/or reversing obesity.
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Challenging Autism With Exercise: An Opportunity Worth Stretching For
Article
  • Mar 2017
Apply It! By reading this article, the health and fitness professional will Gain a better understanding of autism-Those with autism learn differently. You will learn a successful and proven approach in teaching exercise using visuals, creating structured routines, and establishing the right goals for those with autism. See an opportunity to help-School systems that are challenged with limited resources are leaving those with autism both wandering and wondering in physical education classes. Parents of children with autism who are already overwhelmed with therapies, education, and difficult family dynamics need your help to introduce the proven benefits of exercise. This is important, not only because of the health benefits exercise brings, but in the autism population, exercise also helps to reduce maladaptive behaviors and improves focus and academics.
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Preventing childhood obesity
Article
Full-text available
  • Mar 2005
The health of children and youth in US faces a dangerous setback regarding the epidemic of obesity. More than 9 million children over the age of 6 are considered obese, which means that they face serious immediate and long-term health risks. Schools are one of the primary locations for reaching children and youth, so it is important that the total school environment be structured to promote healthy eating habits and physical activity. Parents, the primary caretakers have profound effect on their children by fostering values and attitudes, rewarding specific behaviors and serving as role models. Preventing childhood obesity requires a comprehensive science-based approach that involves government, industry, communities, schools and families.
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Dramatic Increases in Obesity and Overweight Prevalence and Body Mass Index Among Ethnic-Immigrant and Social Class Groups in the United States, 1976-2008
Article
Full-text available
This study examined trends in US obesity and overweight prevalence and body mass index (BMI) among 30 immigrant groups, stratified by race/ethnicity and length of immigration, and among detailed education, occupation, and income/poverty groups from 1976 to 2008. Using 1976-2008 National Health Interview Surveys, differentials in obesity, overweight, and BMI, based on self-reported height and weight, were analyzed by using disparity indices, logistic, and linear regression. The obesity prevalence for the US population aged ≥18 tripled from 8.7% in 1976 to 27.4% in 2008. Overweight prevalence increased from 36.9% in 1976 to 62.0% in 2008. During 1991-2008, obesity prevalence for US-born adults increased from 13.9 to 28.7%, while prevalence for immigrants increased from 9.5 to 20.7%. While immigrants in each ethnic group and time period had lower obesity and overweight prevalence and BMI than the US-born, immigrants' risk of obesity and overweight increased with increasing duration of residence. In 2003-2008, obesity prevalence ranged from 2.3% for recent Chinese immigrants to 31-39% for American Indians, US-born blacks, Mexicans, and Puerto Ricans, and long-term Mexican and Puerto Rican immigrants. Between 1976 and 2008, the obesity prevalence more than quadrupled for those with a college education or sales occupation. Although higher prevalence was observed for lower education, income, and occupation levels in each period, socioeconomic gradients in obesity and overweight decreased over time because of more rapid increases in prevalence among higher socioeconomic groups. Continued immigrant and socioeconomic disparities in prevalence will likely have substantial impacts on future obesity trends in the US.
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Neighborhood Socioeconomic Conditions, Built Environments, And Childhood Obesity
Article
Full-text available
We examine the impact of neighborhood socioeconomic conditions and "built environments" on obesity and overweight prevalence among U.S. children and adolescents using the 2007 National Survey of Children's Health. The odds of a child's being obese or overweight were 20-60 percent higher among children in neighborhoods with the most unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers than among children not facing such conditions. The effects were much greater for females and younger children; for example, girls ages 10-11 were two to four times more likely than their counterparts from more favorable neighborhoods to be overweight or obese. Our findings can contribute to policy decisions aimed at reducing health inequalities and promoting obesity prevention efforts such as community-based physical activity and healthy diet initiatives.
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Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008
Article
Full-text available
The prevalence of high body mass index (BMI) among children and adolescents in the United States appeared to plateau between 1999 and 2006. To provide the most recent estimates of high BMI among children and adolescents and high weight for recumbent length among infants and toddlers and to analyze trends in prevalence between 1999 and 2008. The National Health and Nutrition Examination Survey 2007-2008, a representative sample of the US population with measured heights and weights on 3281 children and adolescents (2 through 19 years of age) and 719 infants and toddlers (birth to 2 years of age). Prevalence of high weight for recumbent length (> or = 95th percentile of the Centers for Disease Control and Prevention growth charts) among infants and toddlers. Prevalence of high BMI among children and adolescents defined at 3 levels: BMI for age at or above the 97th percentile, at or above the 95th percentile, and at or above the 85th percentile of the BMI-for-age growth charts. Analyses of trends by age, sex, and race/ethnicity from 1999-2000 to 2007-2008. In 2007-2008, 9.5% of infants and toddlers (95% confidence interval [CI], 7.3%-11.7%) were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% (95% CI, 9.8%-13.9%) were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% (95% CI, 14.1%-19.6%) were at or above the 95th percentile; and 31.7% (95% CI, 29.2%-34.1%) were at or above the 85th percentile of BMI for age. Prevalence estimates differed by age and by race/ethnic group. Trend analyses indicate no significant trend between 1999-2000 and 2007-2008 except at the highest BMI cut point (BMI for age > or = 97th percentile) among all 6- through 19-year-old boys (odds ratio [OR], 1.52; 95% CI, 1.17-2.01) and among non-Hispanic white boys of the same age (OR, 1.87; 95% CI, 1.22-2.94). No statistically significant linear trends in high weight for recumbent length or high BMI were found over the time periods 1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008 among girls and boys except among the very heaviest 6- through 19-year-old boys.
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Changes in State-Specific Childhood Obesity and Overweight Prevalence in the United States From 2003 to 2007
Article
  • Jul 2010
To examine changes in state-specific obesity and overweight prevalence among US children and adolescents between 2003 and 2007. Temporal cross-sectional analysis of the 2003 and 2007 National Survey of Children's Health data. The 50 states and the District of Columbia. A total of 46 707 and 44 101 children aged 10 to 17 years in 2003 and 2007, respectively. Prevalence and odds of obesity and overweight, differentials in which were examined by bivariate and logistic regression analyses. In 2007, 16.4% of US children were obese and 31.6% were overweight. The prevalence of obesity varied substantially across the states, with Mississippi having the highest prevalence (21.9%) and Oregon the lowest prevalence (9.6%). Overweight prevalence varied from a low of 23.1% for children in Utah to a high of 44.5% for children in Mississippi. Between 2003 and 2007, obesity prevalence increased by 10% for all US children and by 18% for female children, declined by 32% for children in Oregon, and doubled among female children in Arizona and Kansas. Children in Illinois, Tennessee, Kentucky, West Virginia, Georgia, and Kansas had more than twice the adjusted odds of being obese than children in Oregon. Individual, household, and neighborhood social and built environmental characteristics accounted for 45% and 42% of the state variance in childhood obesity and overweight, respectively. Substantial geographic disparities in childhood obesity and overweight exist, with an apparent shift toward higher prevalence in 2007 for several states. Marked geographic disparities indicate the potential for considerable reduction in US childhood obesity.
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Rising Social Inequalities in US Childhood Obesity, 2003-2007
Article
  • Jan 2010
This study examines changes between 2003 and 2007 in obesity and overweight prevalence among U.S. children and adolescents 10 to 17 years of age from detailed racial/ethnic and socioeconomic groups. The 2003 (N=46,707) and 2007 (N=44,101) National Survey of Children's Health were used to calculate overweight and obesity prevalence (body mass index [BMI] > or = 85th and > or = 95th percentiles, respectively). Logistic regression was used to model odds of obesity. In 2007, 16.4% of U.S. children were obese and 31.6% were overweight. From 2003 to 2007, obesity prevalence increased by 10% for all U.S. children but increased by 23%-33% for children in low-education, low-income, and higher unemployment households. Obesity prevalence increased markedly among Hispanic children and children from single-mother households. In 2007, Hispanic, non-Hispanic Black, [corrected] and American Indian children had 3.0-3.8 times higher odds of obesity and overweight than Asian children; children from low-income and low-education households had 3.4-4.3 times higher odds of obesity than children from higher socioeconomic households. The magnitude of racial/ethnic and socioeconomic disparities in obesity and overweight prevalence increased between 2003 and 2007, with substantial social inequalities persisting even after controlling for behavioral factors. Social inequalities in obesity and overweight prevalence increased because of more rapid increases in prevalence among children in lower socioeconomic groups.
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Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations
Article
  • Oct 2008
This study examines independent and joint associations between several socioeconomic, demographic, and behavioral characteristics and obesity prevalence among 46,707 children aged 10-17 years in the United States. The 2003 National Survey of Children's Health was used to calculate obesity prevalence. Logistic regression was used to estimate odds of obesity and adjusted prevalence. Ethnic minority status, non-metropolitan residence, lower socioeconomic status (SES) and social capital, higher television viewing, and higher physical inactivity levels were all independently associated with higher obesity prevalence. Adjusted obesity prevalence varied by age, gender, race/ethnicity, and SES. Compared with affluent white children, the odds of obesity were 2.7, 1.9 and 3.2 times higher for the poor Hispanic, white, and black children, respectively. Hispanic, white, and black children watching television 3 hours or more per day had 1.8, 1.9, and 2.5 times higher odds of obesity than white children who watched television less than 1 hour/day, respectively. Poor children with a sedentary lifestyle had 3.7 times higher odds of obesity than their active, affluent counterparts (adjusted prevalence, 19.8% vs. 6.7%). Race/ethnicity, SES, and behavioral factors are independently related to childhood and adolescent obesity. Joint effects by gender, race/ethnicity, and SES indicate the potential for considerable reduction in the existing disparities in childhood obesity in the United States.
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Department of Health and Human Services
  • Jan 2009
National Center for Health Statistics. Health, United States, 2009 with Special Feature on Medical Technology. Hyattsville, MD: U.S. Department of Health and Human Services; 2010.
Healthy People 2010: Understanding and Improving Health
  • Jan 2000
U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd edition. Washington, DC: U.S. Government Printing Office; 2000.
Trends and Current Racial/Ethnic, Socioeconomic, and Geographic Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau
  • Jan 1976
  • G K Singh
  • M D Kogan
Singh GK, Kogan MD. Childhood Obesity in the United States, 1976-2008: Trends and Current Racial/Ethnic, Socioeconomic, and Geographic Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010. This publication is available online at http://www.mchb.hrsa.gov/ All photos are credited to iStockphoto.