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 (NHANES) 1999–2002. The percent of overweight children (defined as BMI-for-age at or above the 95th percentile) continues to increase. Among children and teenagers ages six to nineteen, 16%-more than nine million are overweight according to the NHANES 1999–2002 data. This represents a 45% increase from the overweight estimates of 11% obtained from NHANES III (1988–94).

FIGURE 4.1 Prevalence of overweight* among children and teenagers by age group and selected period, 1963–2002 "Prevalence of Overweight among Children and Teenagers by Age Group and Selected Period—United States, 1963–2002," in "QuickStats: Prevalence of Overweight among Children and Teenagers, by Age Group and Selected Period—United States, 1963–2002," Morbidity and Mortality Weekly Report, vol. 54, no. 8, March 4, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, 2005, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a6.htm (accessed January 12, 2006)

TABLE 4.1 BMI percentile for children and teens BMI for Children and Teens, in BMI: Body Mass Index, Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, April 2003, http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm (accessed January 12, 2006)

TABLE 4.1
BMI percentile for children and teens
Age	BMI	Percentile
SOURCE: BMI for Children and Teens, in BMI: Body Mass Index, Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, April 2003, http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm (accessed January 12, 2006)
2 years	19.3	95th
4 years	17.8	95th
9 years	21.0	95th
13 years	25.1	95th

The 1999–2002 NHANES found that more than one-fifth of Mexican-American and non-Hispanic African-American children and teenagers were overweight. Mexican-American children ages six to eleven were more likely to be overweight (22%) than non-Hispanic black children (20%) and non-Hispanic white children (14%). Non-Hispanic African-American (21%) and Mexican-American adolescents (23%) ages twelve to nineteen were more likely to be overweight than non-Hispanic white adolescents (14%). In addition to the 16% of children and teens ages six to nineteen who were overweight in 1999–2002, another 15% were considered at risk of becoming overweight (a BMI-for-age between the 85th and 95th percentiles). The 1999–2002 NHANES findings of increasing percentages of overweight children and teens suggest the likelihood of yet another generation of overweight adults who may be at risk for subsequent overweight and obesity related health problems.

The prevalence of overweight children is highest among Mexican-origin boys (26.5%) and non-Hispanic African-American girls (22.8%). Nearly one-quarter of non-Hispanic African-American girls (23.6%) ages twelve to nineteen and Mexican-origin boys (24.7%) ages twelve to nineteen were overweight in 1999–2002. (See Table 4.2.)

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 breastfeeding. The state-specific data are used to FIGURE 4.2 Body mass index (BMI) percentiles by age, boys aged 2 to 20 years "Figure 2. Body Mass Index-For-Age Percentiles: Boys Aged 2 to 20 Years," in The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, U.S. Department of Health and Human Services, National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion, 2001, http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_1.htm (accessed January 12, 2006)FIGURE 4.3 Body mass index (BMI) percentiles by age, girls aged 2 to 20 years "Figure 3. Body Mass Index-For-Age Percentiles: Girls Aged 2 to 20 Years," in The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, U.S. Department of Health and Human Services, National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion, 2001, http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_1.htm (accessed January 12, 2006)TABLE: 4.2 Overweight children and adolescents ages 6-19, by demographic characteristics, selected years 1963–65 through 1999–2002 "Table 74. Overweight Among Children and Adolescents 6-19 Years of Age, According to Sex, Age, Race, and Hispanic Origin, and Poverty Status: United States, Selected Years 1963–65 through 1999–2002, "in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 9, 2006)identify common nutrition-related problems, identify high-risk groups, monitor trends, target resources for program planning, and evaluate the effectiveness of interventions—programs aimed at addressing nutritional deficiencies or problems. Table 4.3 shows the 2003 PedNSS state-specific prevalence data for these nutritional status indicators. Figure 4.4 shows how each of these indicators has improved since 1994 with the exception of the percent of children who are overweight.

TABLE: 4.2
Overweight children and adolescents ages 6-19, by demographic characteristics, selected years 1963–65 through 1999–2002
[Data are based on physical examinations of a sample of the civilian noninstitutionalized population]
Sex, age, race and Hispanic orgina, and poverty status	1963–65 1966–70b	1971–74	1976–80c	1988–94	1999–2002
Notes: — = Data not available. Overweight is defined as body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 Centers for Disease Control and Prevention growth charts. Age is at time of examination at mobile examination center. Crude rates, not age-adjusted rates, are shown.
aPersons 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 1999–2002 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.
bData 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
cData for Mexicans are for 1982–84.
dIncludes persons of all races and Hispanic origins, not just those shown separately
eExcludes pregnant women starting with 1971–74. Pregnancy status not available for 1963–65 and 1966–70.
fPoverty status is based on family income and family size. Poor persons are defined as below the poverty threshold. Near poor persons have incomes of 100 percent to less than 200 percent of the poverty threshold. Nonpoor persons have incomes of 200 percent or greater than the poverty threshold. Persons with unknown poverty status are excluded.
gEstimates are considered unreliable.
SOURCE: "Table 74. Overweight Among Children and Adolescents 6-19 Years of Age, According to Sex, Age, Race, and Hispanic Origin, and Poverty Status: United States, Selected Years 1963–65 through 1999–2002, "in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, December 8, 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf#chartbookontrendsinthe (accessed January 9, 2006)
6-11 years of age	Percent of population
Both sexesd	4.2	4.0	6.5	11.3	15.8
Boys	4.0	4.3g	6.6	11.6	16.9
Not Hispanic or Latino:
White only	—	—	6.1	10.7	14.0
Black or African American only	—	—	6.8	12.3	17.0
Mexican	—	—	13.3	17.5	26.5
Girlse	4.5	3.6g	6.4	11.0	14.7
Not Hispanic or Latino:
White only	—	—	5.2	*9.8	13.1
Black or African American only	—	—	11.2	17.0	22.8
Mexican	—	—	9.8	15.3	17.1
Poverty status:f
Poor	—	—	—	11.4	19.1
Near poor	—	—	—	11.1	16.4
Nonpoor	—	—	—	11.1	14.3
12-19 years of age
Both sexesd	4.6	6.1	5.0	10.5	16.1
Boys	4.5	6.1	4.8	11.3	16.7
Not Hispanic or Latino:
White only	—	—	3.8	11.6	14.6
Black or African American only	—	—	6.1	10.7	18.7
Mexican	—	—	7.7	14.1	24.7
Girlse	4.7	6.2	5.3	9.7	15.4
Not Hispanic or Latino:
White only	—	—	4.6	8.9	12.7
Black or African American only	—	—	10.7	16.3	23.6
Mexican	—	—	8.8	13.4g	19.9
Poverty status:f
Poor	—	—	—	15.8	19.9
Near poor	—	—	—	11.2	15.2
Nonpoor	—	—	—	7.9	14.9

The 2003 PedNSS considered records for more than five million children from birth to age five, from thirty-six states, the District of Columbia, Puerto Rico, American Samoa, and six tribal governments. In the 2003 PedNSS, 39% of records were from non-Hispanic white children, 33% from Hispanic children, 21% from non-Hispanic black children, 4% from Asian or Pacific Islander children, 1% from Native American or Alaska Native children, and 2% 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 5.2%, very close to the expected rate of 5%, but slightly higher than the 3.8% prevalence TABLE 4.3 State-specific prevalence of selected nutritional indicators of children aged <5 years, 2003 B. Polhamus et al., "Table 1. State-Specific Prevalence of Selected Nutritional Indicators of Children Aged <5 Years, 2003 Pediatric Nutrition Surveillance System," in Pediatric Nutrition Surveillance 2003 Report, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/pednss/pdfs/PedNSS_2003_Summary.pdf (accessed January 12, 2006)rate for U.S. children of the same ages. The overall prevalence of underweight decreased from 6.2% in 1994 to 5.2% in 2003. In contrast, the overall prevalence of overweight (high weight-for-length/BMI-for-age) in children aged two to five was 14.7%. The highest rates were among Hispanic children (19.4%) and Native American or Alaska Native (18%) and the lowest rates were among African-American (12%) and white (12.3%) children. (See Figure 4.5.) Overweight has increased among all racial and ethnic groups from 10.9% in 1994 to 14.7% in 2003. The relative increase in overweight was 35% from 1994 to 2003. In addition, the prevalence of at risk of overweight in children age two or older (in the 85th to 95th percentile BMI-for-age) increased from 13.9% in 1994 to 15.7% in 2003.

TABLE 4.3
State-specific prevalence of selected nutritional indicators of children aged 5 years, 2003
[In percent]
Contributor	Low birthweighta	High birthweighta	Ever breastfed	Breastfed 6 months	Anemiac	Short statured	Overweighte
aLow birthweight: <2,500 grams
bHigh birthweight: >4,000 grams.
cAnemia: Based on Centers for Disease Control and Prevention recommendations to prevent and control iron deficiency in the United States. Children aged 1 to 2 years: Hb < 11.0 g/dL or Hct < 32.9%; children aged 2 to 5 years: Hb < 11.1 g/dLor Hct < 33.0%. Altitude adjusted, children aged 6 months or older included in the analysis.
dShort stature: Based on the 2000 Centers for Disease Control and Prevention growth reference, <5 percentile length-for-age for children younger than 2 years of age or height-for-age for children aged 2 years or older.
eOverweight: Based on the 2000 Centers for Disease Control and Prevention growth reference for children aged 2 years or older, BMI-for-age >95th percentile
fNational PedNSS = National Pediatric Nutrition Surveillance System.
SOURCE: B. Polhamus et al., "Table 1. State-Specific Prevalence of Selected Nutritional Indicators of Children Aged <5 Years, 2003 Pediatric Nutrition Surveillance System," in Pediatric Nutrition Surveillance 2003 Report, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/pednss/pdfs/PedNSS_2003_Summary.pdf (accessed January 12, 2006)
Alabama	na	na	na	na	22.7	6.9	14.7
Arkansas	9.5	6.7	43.2	10.1	11.3	7.3	12.2
California	7.1	8.6	na	na	13.7	4.9	17.6
Cheyenne River Sioux (SD)	9.4	8.7	43.1	na	11.3	4.0	17.5
Chickasaw Nation (OK)	8.7	9.1	56.1	13.3	17.9	6.9	12.0
Colorado	10.2	4.9	70.1	26.9	7.8	7.9	9.4
District of Columbia	11.9	5.8	48.5	26.4	21.0	7.2	13.3
Florida	9.6	6.6	62.1	25.2	14.8	4.6	13.4
Georgia	10.0	6.4	49.3	16.3	13.4	7.2	12.4
Hawaii	10.1	7.4	53.8	11.7	10.4	7.1	10.1
Idaho	6.9	7.5	na	na	12.8	6.7	11.1
Illinois	9.1	7.2	55.4	19.4	10.9	7.1	14.0
Indiana	9.0	7.3	52.5	21.5	15.3	6.5	13.7
Inter Tribal Council (AZ)	6.3	9.0	na	na	12.3	6.8	20.9
Iowa	7.1	9.0	55.7	27.5	10.1	5.9	13.6
Kansas	8.4	7.0	61.7	19.6	10.9	6.9	12.6
Kentucky	9.6	7.4	na	na	11.5	7.4	17.2
Louisiana	11.9	5.5	25.4	2.4	14.9	9.3	13.3
Maine	7.8	11.4	52.0	24.6	12.9	7.6	16.0
Michigan	9.4	8.3	48.0	14.7	13.1	6.9	12.9
Minnesota	7.4	10.0	na	na	9.8	4.2	13.2
Missouri	9.1	6.9	47.7	32.4	16.2	6.9	13.3
Montana	7.9	8.4	74.7	30.8	8.8	4.9	11.0
Navajo Nation (AZ)	6.7	7.0	75.2	32.9	8.3	5.3	14.4
Nebraska	8.0	7.7	63.1	22.4	13.6	6.1	13.4
Nevada	8.4	7.2	52.4	20.8	10.4	8.1	13.6
New Hampshire	7.8	10.8	59.2	18.7	13.8	6.8	15.6
New Jersey	9.1	7.2	56.3	36.1	16.9	6.4	17.9
New York	7.6	8.0	64.1	32.9	14.1	4.4	16.8
North Dakota	7.0	10.7	56.9	21.0	7.7	4.2	11.4
Ohio	10.2	6.7	38.9	16.1	14.2	6.1	11.6
Oregon	5.6	19.7	na	na	11.3	6.0	14.7
Pennsylvania	10.3	7.2	35.6	14.2	15.3	6.1	12.4
Puerto Rico	11.6	2.9	50.3	14.0	8.3	9.0	24.0
Rosebud Sioux (SD)	7.4	9.5	57.2	29.3	17.8	3.2	17.3
South Carolina	12.5	6.1	na	na	10.9	13.2	12.4
South Dakota	8.0	9.4	55.9	22.0	7.6	6.1	13.6
Standing Rock Sioux (ND)	7.3	6.2	38.2	na	8.0	1.9	20.1
Tennessee	10.4	6.1	na	na	7.1	5.2	12.0
Utah	8.0	6.3	76.0	41.9	9.9	7.5	8.6
Vermont	8.2	9.9	63.7	34.7	9.0	5.1	13.1
West Virginia	9.7	6.6	42.1	12.0	6.6	4.8	13.2
Wisconsin	8.3	8.5	58.2	23.8	12.2	5.2	13.0
Wyoming	10.7	4.2	60.0	22.8	10.3	8.7	9.5
National PedNSSf	9.1	7.3	53.2	21.5	12.8	6.2	14.7

FIGURE 4.4 Changes in infant and child health status, 1994–2003 B. Polhamus et al., "Figure 9. Changes in Infant and Child Health Status, 1994–2003," in Pediatric Nutrition Surveillance 2003 Report, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/pednss/pdfs/PedNSS_2003_Summary.pdf (accessed January 12, 2006)

FIGURE 4.5 Prevalence of overweight and risk of overweight* among children aged 2 to 5 years, by race and ethnicity, 2003 B. Polhamus et al., "Figure 6. Prevalence of Overweight and at Risk of Overweight among Children Aged 2 to 5 Years, by Race and Ethnicity," in Pediatric Nutrition Surveillance 2003 Report, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/pednss/pdfs/PedNSS_2003_Summary.pdf (accessed January 12, 2006)