Childhood obesity

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There has been a threefold increase in childhood obesity in the United States in the past three decades (12). Coinciding with this increase has been an increase in prevalence for type 2 diabetes, hypertension, gallbladder disease, hyperlipidemia, orthopedic complications, sleep apnea, and nonalcoholic steatohepatitis in children. Obese children are predisposed to adult obesity and have increased risks for adult obesity-related diseases (19). Approximately 30% of obese adults became obese during childhood, and 80% of obese adolescents become obese adults (20).

No single cut-point for obesity classification can be used for children because between birth and approx 20 yr of age, height and weight—and thus, BMI—vary by age. To address this children (age 2-11) and adolescents (age 12-19) are classified as at risk of overweight or overweight if they are at or above the 85th or the 95th percentile, respectively, for their age and gender using the 2000 Centers for Disease Control and Prevention Growth Charts (21). The prevalence and trends between 1971 and 2002 of overweight in 6- to 11-yr-olds and 12- to 19-yr-olds are presented in Tables 6 and 7.

The majority of the increase in overweight prevalence among children has occurred within the past 10 yr, and the most recent data indicate that this trend continues. In 1999- 2000, 29.9% of 6- to 19-yr-old children were at risk of overweight and 15% were overweight; in 2000-2001 these levels increased to 30.5% at risk of overweight and 16.5% overweight (13).

Gender and racial-ethnic differences are presented in Table 7. Distinct from adults, where women at all ages have higher rates for obesity, very little difference in overweight prevalence exists between boys and girls. Ethnic differences for overweight do exist in children. African American and Mexican American children are significantly heavier than Caucasian boys and girls. Similar to observations in adults, a pronounced upward shift (at least 2 BMI units) in the upper end of the BMI distributions in all age/gender groups occurred during this time period; however, very little change occurred in the lower end of the BMI distributions, and median BMI remained virtually unchanged. The heaviest groups of children are much heavier in NHANES III than they were in previous surveys (11).

The secular trends of the impact of SES on obesity in children have received very limited study. In Canada the prevalence of overweight has been reported to vary inversely by SES (22); however, the data used in their analysis spanned 1981 to 1996 and thus do not reflect the most recent decade. A recent report using the 1971-2002 NHANES surveys examined trends in obesity prevalence and SES status categorized by level of parental education attained (less than high school, high school, college, or higher) (Table 8) (23). The report found an overall weakening of association between obesity risk and SES category that varied by racial/ethnic groups.

Table 6

Prevalence of Overweight (> 95th Percentile) in Children and Adolescents in the United States, 1960-2002*

Table 6

Prevalence of Overweight (> 95th Percentile) in Children and Adolescents in the United States, 1960-2002*

Survey yr

Children 6-11 (%)

Adolescents 12-19 (%)

1971-1974

4.0

6.1

1976-1980

6.5

5.0

1988-1994

11.3

10.5

1999-2002

15.8

16.1

aAdapted from ref. 7.

aAdapted from ref. 7.

Table 7

Prevalence of Overweight (> 95th Percentile) by Sex, Age, and Racial/Ethnic Group in the United States, 1999-2002*

Table 7

Prevalence of Overweight (> 95th Percentile) by Sex, Age, and Racial/Ethnic Group in the United States, 1999-2002*

Non-Hispanic

Non-Hispanic

Mexican

Age

All

white

black

American

Boys

6-19

16.8

14.3

17.9

25.5

2-5

9.9

8.2

8.0

14.1

6-11

16.9

14.0

17.0

26.5

12-19

16.7

14.6

18.7

24.7

Girls

6-19

15.1

12.9

23.2

18.5

2-5

10.7

9.1

9.6

12.2

6-11

14.7

13.1

22.8

17.1

12-19

15.4

12.7

23.6

19.9

a Adapted from ref. 13.

a Adapted from ref. 13.

In NHANES I the overweight prevalence was 7.1, 6.3, and 3.8% in low-, medium-, and high-SES non-Hispanic white girls, compared with 8.2, 14.8, and 1.9% in non-Hispanic black girls; in 1999-2002 these figures became 17.9, 10.6, and 10.6% vs 24.5, 18.7, and 38.0%, respectively. Although the prevalence for overweight remains higher among African American than among Caucasian children, the highest rates of increase in overweight were found in the highest SES groups for both racial/ethnic groups. The disproportionate protection that once was conferred by being within the higher SES category is eroding among all racial/ethnic groups. Although the cause for this weakening secular trend remains uncertain, these findings should be considered when predicting future trends in obesity prevalence and guide the development of programs and governmental policies designed for obesity prevention and management.

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