obesity in the us - national minority quality forum extreme obesity notes: estimates age- adjusted...

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

http://www.cdc.gov/minorityhealth/CHDIReport.html

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

http://www.cdc.gov/nchs/data/ad/ad347.pdfhttp://www.cdc.gov/nchs/data/nhsr/nhsr010.pdfhttp://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

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=40

2-19 years Overweight:

85th percentile

BMI-for-age < 85th percentile of CDC

growth charts

Source: Huang JS et al, Pediatrics 2007:120:e1126e119

A normal weight child

BMI-for-age 85th 95th percentile of

CDC growth charts

An overweight child


BMI-for-age 95th percentile of CDC

growth charts

An obese child


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

NOTES: Estimates age-adjusted to 2000 US census population. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey; Flegal et al JAMA 2012.

Obesity Extreme obesity

No difference in obesity among men

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

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.

Big difference in obesity among women

Prevalence of Obesity Children and Teens, 2-19 years, 2009-10

17.5

14.7

22.6

24.826.5

19.8

0

5

10

15

20

25

30

Boys Girls

Perc

ent

Non Hispanic white Non Hispanic black Hispanic

Source: CDC/NCHS National Health and Nutrition Examination Survey; Ogden et al, JAMA 2012

Differences in both boys and girls

Prevalence of Obesity, boys 12-19 years

Percent

SOURCE: CDC/NCHS: National Health and Nutrition Examination Survey III 1988-1994, 2009-2010;

No difference in 1988-94 now prevalence is highest in Mexican Americans

Do SES disparities explain race/ethnic disparities?

PIR>=350% 130-

Boys

Girls

Percent

Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.

Childhood obesity by poverty income ratio 1988-1994 and 2005-2008

College graduate Some college High school graduate < High school

Total Non-Hispanic white Non-Hispanic black Mexican American

Percent Percent

Boys Girls

Source: CDC/NCHS, National Health and Nutrition Examination Survey; Ogden et al. 2010.

Childhood obesity by education, 2005-08

Has the prevalence of obesity plateaued in the US?

No change since 2007-2008

Source: Ogden et al. 2012, NCHS data brief; Flegal et al JAMA 2010; Ogden et al JAMA 2010; National Health and Nutrition Examination Survey

Adults Children and adolescents

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

0

10

20

30

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010

Perc

ent

Non-Hispanic white Non-Hispanic black

Mexican American All

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 >= 95th 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

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey

Boys Girls

17.2 16.1 15.9 15.9

14.8 14.0

0

5

10

15

20

25 Non-Hispanic white Non-Hispanic black Mexican American

Perc

ent

Males Females

Mean percent of kilocalories from added sugars, aged 2 - 19 years, US, 2005-2008

SOURCE: CDC/NCHS, NHANES, 2005-2008.

*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 total daily kilocalories from sugar drinks, US, ages 2 years and older, 2006-2008

2-19 years 20+ years

16.1 15.9 16.8

15.7 16.2 15.2

0

5

10

15

20

25

PIR < 130% 130% PIR < 350% PIR 350%

Perc

ent

Mean percent of kilocalories from added sugars aged 2 - 19 years, by poverty income ratio, United States, 2005-2008

NOTES: PIR is poverty income ratio. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008.

Males Females

No difference

*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

=350% PIR

2-19 years* 20+ years*

Teens and physical activity

Source: YRBS 2009; http://apps.nccd.cdc.gov/youthonline/App/Default.aspx

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%

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

Perc

ent

BMI percentile

Psychosocial problems

Cardiovascular risk factors High blood pressure High cholesterol Abnormal glucose tolerance or

diabetes Type II diabetes low

(

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

87% of obese adolescents were obese adults 39% of obese adolescents were severely obese adults

Freedman et al, Pediatrics 2009

Long-term Consequences of Childhood Obesity

Change in BMI distribution, boys 12-19 y

90th percentile

Source: NHANES III, 1999-2002 and 2007-2010

Change in BMI distribution, girls12-19 y

90th percentile

Source: NHANES III, 1999-2002 and 2007-2010

Per capita availability of calories

SOURCE: http://www.ers.usda.gov/Data/FoodConsumption/NutrientAvailIndex.htm

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

Fried potato

Salted snacks

Mixed dishes

Pizza

Source: Cleveland USDA; NFCS 1977-78 and WWEIA, NHANES 2001-02, 1 day

0% % increase % decrease

Candy

Vegetable -43%

320%

144%

425%

18%

180%

obesity in the us - national minority quality forum extreme obesity notes: estimates age- adjusted...

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