Prevalence and Trends of Severe Obesity Among US Children and Adolescents
Received 5 January 2009; accepted 8 April 2009. published online 29 June 2009.
Objective
To determine the extent to which the 2007 definitions for severe obesity (body mass index [BMI] ≥99th percentile for age and gender) and morbid obesity (BMI ≥40kg/m2) affects different groups of American children and adolescents and has increased over time.
Methods
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.
Results
In 1999–2004, 3.8% of children 2 to 19 years old had a BMI in the ≥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 ≤3 vs 2.5% for those with PIR>3; P=.002). BMI ≥40kg/m2 was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI ≥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.
Conclusions
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.
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Skelton); Departments of Pediatrics (Dr Cook and Dr Klein) and Neurology (Ms Auinger), University of Rochester School of Medicine and Dentistry, Rochester, NY; and Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Barlow)
Address correspondence to Joseph A. Skelton, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina 27157.
ABSTRACT