Nutrition Diet and Weight Issues among Children and Adolescents - How Many Children And Teens Are Overweight?

The most accurate data about the prevalence of overweight among children and adolescents come from the Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey. Table 4.2 displays the prevalence of overweight by age, gender, race, and ethnicity from 1988 to 1994. The prevalence of overweight was highest among Mexican-American boys aged six to eleven and lowest among non-Hispanic white girls aged twelve to nineteen. From the 1960s through the 1990s the percentage of overweight children aged six to eleven more than tripled from 4 percent to 13 percent and the percentage of overweight adolescents nearly tripled from 5 percent to 14 percent. (See Figure 4.4.)

By 1999–2000 about 15 percent of all children (six to eleven years of age) and adolescents (twelve to nineteen years of age) were now overweight. (See Figure 2.1 in Chapter 2.) The increase in overweight prevalence is highest among non-Hispanic black and Mexican-origin adolescents. More than 25 percent of non-Hispanic black girls ages twelve to nineteen and more than 27 percent of Mexican-origin boys ages six to eleven were overweight in 1999–2000. (See Table 4.3.)

The CDC also performs regular surveillance of the nutritional status of low-income children in federally funded maternal and child health programs. The Pediatric Nutrition Surveillance System (PedNSS) gathers and analyzes data about birth weight, short stature, underweight, overweight, anemia (iron deficiency), and breast-feeding. FIGURE 4.4
Trends in overweight: Body mass index (BMI)<95th percentile, selected periods 1963–70 through 1999 FIGURE 4.5
Infant and child health advances and concerns, percent change 1992 to 2001 The state-specific data are used to identify common nutrition-related problems, identify high-risk groups, monitor trends, target resources for program planning, and evaluate the effectiveness of interventions—programs TABLE 4.3
Overweight children and adolescents 6–19 years of age, according to sex, age, race, and Hispanic origin, selected years 1963–65 through 1999–2000
[Data are based on physical examinations of a sample of the civilian noninstitutionalized population]

Age, sex, race, and Hispanic origin1	1963–65 1966–702	1971–74	1976–803	1988–944	1999–20004
6–11 years of age	Percent of population (standard error)
Both sexes5	4.2	4.0	6.5	11.3 (1.0)	15.3 (1.7)
Boys	4.0	4.3	6.6	11.6 (1.3)	16.0 (2.3)
Not Hispanic or Latino:
White only	6.1	10.7	(2.0)	*11.9 (3.0)
Black or African American only	—	—	6.8	12.3 (1.4)	17.6 (2.8)
Mexican	—	—	13.3	17.5 (2.4)	27.3 (3.1)
Girls6	4.5	3.6	6.4	11.0 (1.4)	14.5 (2.4)
Not Hispanic or Latino:
White only	—	—	5.2	*9.8 (2.0)	*12.0 (3.6)
Black or African American only	—	—	11.2	17.0 (1.6)	22.1 (3.3)
Mexican	—	—	9.8	15.3 (2.5)	19.6 (3.1)
12–19 years of age
Both sexes5	4.6	6.1	5.0	10.5 (0.9)	15.5 (1.2)
Boys	4.5	6.1	4.8	11.3 (1.3)	15.5 (1.6)
Not Hispanic or Latino:
White only	—	—	3.8	11.6 (1.9)	13.0 (2.5)
Black or African American only.	—	—	6.1	10.7 (1.4)	20.5 (2.6)
Mexican	—	—	7.7	14.1 (1.8)	27.5 (3.0)
Girls6	4.7	6.2	5.3	9.7 (1.1)	15.5 (1.6)
Not Hispanic or Latino:
White only	—	—	4.6	8.9 (1.7)	12.2 (2.1)
Black or African American only	—	—	10.7	16.3 (2.1)	25.7 (2.6)
Mexican	—	—	8.8	*13.4 (3.1)	19.4 (2.8)
*Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20–30 percent.
—Data not available.
1Persons of Mexican origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The two non-Hispanic race categories shown in the table conform to 1997 Standards. The 1999–2000 race-specific estimates are for persons who reported only one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999–2000 estimates can be seen by comparing 1999–2000 data tabulated according to the two Standards: Estimates based on the 1977 Standards of the percent of the children 6–11 years who were overweight are: 0.1 percentage points higher for white males; 0.5 percentage points lower for black males; 0.4 percentage points lower for white females; and 0.1 percentage points higher for black females than estimates based on the 1997 Standards. Estimates based on the 1977 Standards of the percent of adolescents 12–19 years of age who were overweight are: 0.2 percentage points lower for white males; 0.2 percentage points higher for black males; 0.2 percentage points higher for white females; and 0.9 percentage points higher for black females than estimates based on the 1997 Standards.
2Data for 1963–65 are for children 6–11 years of age; data for 1966–70 are for adolescents 12–17 years of age, not 12–19 years.
3Data for Mexicans are for 1982–84.
4Standard errors of estimates for 1988–94 and 1999–2000 are shown. 1999–2000 estimates are based on a smaller sample size than estimates for earlier time periods and therefore are subject to greater sampling error.
5Includes persons of all races and Hispanic origins, not just those shown separately.
6Excludes pregnant women starting with 1971–74. Pregnancy status not available for 1963–65 and 1966–70.
Notes: Overweight is defined as body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts: United States. Advance data from vital and health statistics; no 314. Hyattsville, Maryland: National Center for Health Statistics. 2000. Age is at time of examination at mobile examination center. Crude rates, not age-adjusted rates, are shown. Some data for 1976–80, 1988–94, and 1999–2000 have been revised and differ from the previous edition of Health, United States.
SOURCE: "Table 69. Overweight children and adolescents 6–19 years of age, according to sex, age, race, and Hispanic origin: United States, selected years 1963–65 and 1999–2000," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/hus.htm [accessed January 2, 2004]

aimed at addressing nutritional deficiencies or problems. Table 4.4 shows the 2001 PedNSS state-specific prevalence data for these nutritional status indicators. Figure 4.5 shows how each of these indicators has improved since 1992 with the exception of the percent of children who are overweight.

The 2001 PedNSS considered records for more than five million children from birth to age five, from thirty-nine states, the District of Columbia, Puerto Rico, American Samoa, and six tribal governments. In the 2001 PedNSS, 40 percent of records were from non-Hispanic white children, 32 percent from Hispanic children, 22 percent from non-Hispanic black children, 3 percent from Asian or Pacific Islander children, 1 percent Alaska Native children, and 2 percent from children of all other or unspecified races and ethnicities.

PedNSS data revealed that the prevalence of underweight (low weight-for-length/BMI-for-age) in this population was just 5.4 percent, very close to the expected rate of 5 percent, but slightly higher than the 3.8 percent prevalence rate for U.S. children of the same ages. The overall prevalence of underweight decreased from 6.9 percent in 1992 to 5.4 percent in 2001. In contrast, the overall prevalence of overweight TABLE 4.4
State-specific prevalence of selected nutritional indicators of children aged < 5 years, Pediatric Nutrition Surveillance System, 2001

Contributor	LBW1	HBW2	Short stature3	Overweight4	Anemia5	Ever breastfed	Breastfed at 6 months
American Samoa	na	na	9.6	16.1	49.9	na	na
Arizona	8.1	7.9	7.9	11.9	19.6	na	na
Arkansas	9.7	7.1	7.7	11.2	10.4	10.3	10.3
California	6.7	9.1	5.0	16.6	13.5	na	na
Cheyenne River Sioux (SD)	6.1	10.8	3.0	17.6	13.7	34.2	na
Chickasaw Nation (OK)	7.8	10.1	7.3	10.9	16.4	53.0	15.4
Colorado	9.0	4.9	8.4	8.5	7.1	69.7	25.4
Connecticut	9.0	7.9	6.2	18.7	10.4	49.3	23.4
District of Columbia	12.4	6.0	7.6	12.3	20.4	41.8	23.6
Florida	9.3	7.3	4.6	12.9	16.2	60.2	23.2
Georgia	9.9	6.7	7.1	11.3	12.7	46.9	16.1
Hawaii	9.4	7.7	7.5	10.4	11.6	65.3	25.8
Idaho	7.4	7.7	6.4	10.7	10.0	78.5	32.0
Illinois	9.3	7.4	8.4	14.7	12.7	48.4	18.5
Indiana	9.0	7.7	6.6	12.3	17.3	48.8	18.7
InterTribal Council (AZ)	7.0	9.3	6.4	21.4	11.8	63.9	26.1
Iowa	7.8	9.6	5.5	13.2	9.6	54.1	22.6
Kansas	8.1	7.1	7.0	11.1	10.7	61.0	20.8
Kentucky	9.5	7.9	5.0	14.4	12.3	na	na
Louisiana	12.2	5.6	10.2	12.1	14.5	20.4	0.5
Maine	6.8	12.0	7.7	14.3	9.9	50.7	21.3
Maryland	11.1	6.5	8.6	13.1	22.9	49.6	22.0
Michigan	9.7	8.5	7.7	12.2	13.8	44.8	12.2
Minnesota	7.7	10.0	4.3	13.1	9.6	na	na
Missouri	8.9	7.6	6.5	11.6	16.8	47.3	28.5
Navajo Nation (AZ)	7.3	7.6	5.8	13.3	6.2	na	na
Nebraska	7.9	7.7	6.5	11.9	13.0	56.2	20.9
Nevada	8.1	7.4	7.8	11.7	11.2	56.8	29.2
New Hampshire	9.5	10.4	7.9	14.6	16.2	52.4	20.0
New Jersey	9.0	7.4	6.2	16.8	19.3	53.7	32.7
New Mexico	8.9	5.3	8.2	9.4	4.7	na	na
North Carolina	9.4	7.5	5.3	12.3	11.7	49.8	16.4
North Dakota	6.5	11.3	4.1	11.4	8.6	54.4	22.2
Ohio	10.0	6.8	6.2	11.1	16.2	36.6	14.7
Oregon	5.6	23.4	5.9	14.0	11.5	na	na
Pennsylvania	10.2	7.4	6.0	11.9	15.5	39.1	13.4
Puerto Rico	11.5	3.1	8.5	22.2	10.2	48.2	19.5
Rosebud Sioux (SD)	8.1	12.6	3.3	18.9	17.2	58.7	na
South Carolina	11.8	6.2	11.6	11.9	11.3	na	na
South Dakota	7.5	9.8	5.8	12.2	7.0	49.9	22.6
Standing Rock (ND)	6.2	8.5	2.5	18.9	7.0	39.3	na
Tennessee	10.4	6.4	5.1	11.0	8.3	na	na
Utah	8.5	6.0	6.7	7.6	10.5	77.2	39.9
Vermont	7.3	10.8	5.2	13.0	10.1	65.3	28.6
Washington	6.6	10.9	4.8	12.9	9.3	79.6	34.8
West Virginia	9.2	7.8	4.5	12.0	6.2	38.9	15.9
Wisconsin	8.3	8.9	5.6	11.3	13.1	53.4	21.4
Wyoming	11.1	4.5	7.9	8.1	8.8	53.9	21.5
Nation	9.0	7.9	6.4	13.4	13.3	50.9	20.8
1Low birthweight: < 2,500 grams.
2High birthweight: > 4,000 grams.
3Short stature: Based on the 2000 Centers for Disease Control (CDC) growth reference, < 5th percentile length-for-age for children younger than age 2 and height-for-age for children aged 2 or older.
4Overweight: Based on the 2000 CDC growth reference for children age 2 and older, body mass index-for-age ≥ 95th percentile.
5Anemia: Based on 1998 CDC Morbidity and Mortality Weekly Report Recommendations to Prevent and Control Iron Deficiency in the United States, altitude adjusted, children aged 6 months or older included in the analysis.
SOURCE: "B. Polhamus, K. Dalenius, D. Thompson, K. Scanlon, E. Borland, B. Smith, and L. Grummer-Strawn, "Table 1. State-specific prevalence of selected nutritional indicators of children aged <5 years, 2001 Pediatric Nutrition Surveillance System," in Pediatric Surveillance 2001 Report, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA, 2003 [Online] http://www.cdc.gov/nccdphp/dnpa/pednss.htm [accessed January 12, 2004]

(high weight-for-length/BMI-for-age) in children from birth to age five was 13.1 percent, and 13.4 percent for children aged two to five. The highest rates were among American Indian or Alaska Native (17.4 percent) and Hispanic children (17.4 percent) and the lowest rate was among black children (11.1 percent). (See Figure 4.6.) Overweight has increased among all racial and ethnic groups, with the greatest increase among white children—between 1992 and 2001 overweight increased more than 27 percent. (See Figure 4.7.) Although the PedNSS trends are consistent with U.S. trends of increasing overweight in children, the prevalence of overweight and risk of overweight is lower in U.S. children than in this population.

FIGURE 4.6
Prevalence of overweight and risk of overweight* among children aged 2 to 5 years, by race and ethnicity