Update: Prevalence of Overweight Among Children, Adolescents, and Adults -- United States, 1988-1994

Overweight and obese adults are at increased risk for morbidity and mortality associated with many acute and chronic medical conditions, including hypertension, dyslipidemia, coronary heart disease, diabetes mellitus, gallbladder disease, respiratory disease, some types of cancer, gout, and arthritis (1). In addition, overweight during childhood and adolescence is associated with overweight during adulthood (2), and previous reports have documented an increase in the prevalence of overweight among children, adolescents, and adults from 1976-1980 to 1988-1991 (3,4). This report presents data from CDC's Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994) to provide the most recent national estimates of overweight among children (aged 6-11 years), adolescents (aged 12-17 years), and adults (aged greater than or equal to 20 years) * in the United States. The findings indicate that the prevalence of overweight in the United States has continued to increase.

NHANES III was a stratified, multistage, probability cluster sample representative of the U.S. civilian, noninstitutionalized population. The survey was designed as a 6-year survey, with Phase 1 conducted from 1988 through 1991 and Phase 2 from 1991 through 1994. Estimates are presented from both phases combined because individual phase estimates may be more variable than the 6-year estimates (5). Stature and weight were measured as part of a standardized physical examination in a mobile examination center (6). Body mass index (BMI, kg/m (superscript 2)) was used as a measure of weight adjusted for stature. Children and adolescents were categorized as overweight when their BMIs were at or above sex- and age-specific 95th percentile BMI cutoff points calculated at 6-month age intervals, derived respectively from the second and third National Health Examination Surveys (NHES II, 1963-1965, and III, 1966-1970) (3). Adults were classified as overweight when BMI was greater than or equal to 27.8 for men and greater than or equal to 27.3 for women (85th percentiles from NHANES II for ages 20-29 years) (4). A more conservative definition of overweight was used for children and adolescents compared with adults to account for growth spurts and other physiologic changes.

The findings from NHANES III indicate that substantial proportions of children, adolescents, and adults in the United States were overweight (Table_1). Approximately 14% of children and 12% of adolescents were overweight. Among adults, approximately 33% of men and 36% of women were overweight (Table_2). Among women, 34% of non-Hispanic whites, 52% of non-Hispanic blacks, and 50% of Mexican Americans were overweight. ** Racial/ethnic group-specific variation among men was less than that among women.

Reported by: Div of Health Examination Statistics, National Center for Health Statistics; Div of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Previous reports based on NHANES III Phase 1 data indicated that the prevalence of overweight had increased from 1976-1980 to 1988-1991 (from 7.6% to 10.9% for children, 5.7% to 10.8% for adolescents, and 25.4% to 33.3% for adults) and that the prevalence of overweight was higher among blacks than among whites (3,4). The findings in this report for NHANES III 6-year estimates indicate generally higher prevalence estimates than NHANES III, Phase 1, suggesting that the prevalence of overweight in the United States has continued to increase. Although estimates are subject to sampling variability, increases occurred in all sex and racial/ethnic subgroups among adults and, with one exception, among children and adolescents. For example, among adults, overweight prevalence increased 3.3 percentage points for men and 3.6 percentage points for women between Phase 1 and Phase 2 of NHANES III. The increasing trend in the prevalence of overweight is consistent with findings from CDC's Behavioral Risk Factor Surveillance System (BRFSS), which indicate that, during 1987-1993, the age-adjusted prevalence of overweight based on self-report increased by 0.9% per year for adults (7). These findings underscore the sustained increase in prevalence of overweight by a different methodology.

The increase in the prevalence of overweight is a result of a positive shift in energy balance in which energy intake from food exceeds energy expenditure in physical activity. Median energy intake for adults increased from NHANES II (1976-1980) to NHANES III (1988-1994), and in most population subgroups, from Phase 1 to Phase 2 of NHANES III (CDC, unpublished data, 1997). Nationally representative data for physical activity among children and adolescents have not been collected with comparable methods across surveys through the 1980s and 1990s. However, for adults, data from the National Health Interview Survey (NHIS) and the BRFSS document stable or constant levels of participation in leisure-time physical activity among adults from the mid-1980s through the early 1990s (8). Changes that result in decreased energy expenditures may have occurred in other types of physical activity, including transportation patterns, household work, and time spent in inactivity (e.g., watching television and playing electronic games). Results from Phase 1 of NHANES III also documented a high prevalence of inactivity in the United States and that rates of inactivity were greater for women than men and for non-Hispanic blacks and Mexican Americans than non-Hispanic whites (9).

Overweight is an important nutrition-related condition in the United States. Because most methods for achieving weight loss are unsuccessful over time (10), prevention continues to be the most viable option for controlling overweight. Reversing the trend in overweight will require changes in individual behavior and the elimination of societal barriers to healthy choices.

References

1. Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993;119: 655-60.

2. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 years. Am J Clin Nutr 1994;59:810-9.

3. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149:1085-91.

4. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among U.S. adults: the National Health and Nutrition Examination surveys, 1960 to 1991. JAMA 1994;272:205-11.

5. National Center for Health Statistics. NHANES III reference manuals and reports {CD-ROM}. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1996.

6. National Center for Health Statistics. Plan and operation of the third National Health and Nu-trition Examination Survey, 1988-94. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994; DHHS publication no. (PHS)94-1308. (Vital and health statistics; series 1, no. 32).

7. Galuska DA, Serdula M, Pamuk E, Siegel PZ, Byers T. Trends in overweight among U.S. adults from 1987 to 1993: a multistate telephone survey. Am J Public Health 1996;86:1729-35.

8. US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, 1996.

9. Crespo CJ, Sempos CT, Heath G, Keteyian SJ. The prevalence of leisure time physical activity among U.S. adults: results from the Third National Health and Nutrition Examination Survey. Arch Intern Med 1995;156:93-8.

10. NIH Technology Assessment Conference Panel. Methods for voluntary weight loss and control. Ann Intern Med 1993;119:764-70.

Data for 18- and 19-year-olds are not included in estimates for either adolescents or adults to allow for comparison with previously published results (which did not include 18- and 19-year-olds) from NHANES surveys. ** Numbers for other racial/ethnic groups were too small for meaningful analysis.

TABLE 1. Number and percentage of children (aged 6-11 years) and adolescents (aged 12-17 years) who
were overweight *, by sex and race/ethnicity + -- United States, Third National Health and Nutrition
Examination Survey (NHANES III), 1988-1994
========================================================================================================
                                       Children                       Adolescents &
                           --------------------------------    ----------------------------------
Characteristic              No.       (%)      (95% CI @)       No.      (%)        (95% CI)
--------------------------------------------------------------------------------------------------------
Male
 White, non-Hispanic         446     (13.2)   ( 8.7%-17.6%)      281     (11.6)   ( 7.6%-15.6%)
 Black, non-Hispanic         584     (14.7)   (11.2%-18.3%)      412     (12.5)   ( 9.2%-15.8%)
 Mexican American            565     (18.8)   (14.6%-23.0%)      406     (15.0)   (10.8%-19.1%)
 Total                      1673     (14.7)   (11.5%-17.9%)     1154     (12.3)   ( 9.3%-15.3%)

Female
 White, non-Hispanic         428     (11.9)   ( 7.2%-16.5%)      342     ( 9.6)   ( 5.5%-13.6%)
 Black, non-Hispanic         538     (17.9)   (14.5%-21.2%)      447     (16.3)   (11.9%-20.8%)
 Mexican American            581     (15.8)   (10.3%-21.3%)      412     (14.0)   ( 6.8%-21.2%)
 Total                      1606     (12.5)   ( 9.4%-15.7%)     1274     (10.7)   ( 7.7%-13.7%)
Total **                    3279     (13.7)   (11.4%-15.9%)     2428     (11.5)   ( 9.0%-14.0%)
--------------------------------------------------------------------------------------------------------
*  Overweight is defined as body mass index (BMI) (kg/m^2) at or above sex- and age-specific 95th
   percentile BMI cutoff points calculated at 6-month age intervals, derived respectively from National
   Health Examination Survey cycles 2 and 3.
+  Numbers for other racial/ethnic groups were too small for meaningful analysis.
&  Excludes pregnant femals and one person with an outlier sample weight.
** Total estimates include racial/ethnic groups not shown.
========================================================================================================

TABLE 2. Number and percentage of adults (aged >=20 years) who
were overweight *, by sex and race/ethnicity + -- United
States, Third National Health and Nutrition Examination Survey
(NHANES III), 1988-1994
=================================================================
                            No.       (%)       (95% CI &)
-----------------------------------------------------------------
Men
 White, non-Hispanic       3,285      (33.7)   (31.9%-35.4%)
 Black, non-Hispanic       2,112      (33.3)   (31.2%-35.1%)
 Mexican American          2,250      (36.4)   (33.2%-39.1%)
 Total                     7,933      (33.3)   (31.5%-34.8%)
Women @
 White, non-Hispanic       3,755      (33.5)   (31.3%-35.5%)
 Black, non-Hispanic       2,490      (52.3)   (48.9%-55.2%)
 Mexican American          2,128      (50.1)   (47.6%-52.3%)
 Total                     8,748      (36.4)   (34.5%-38.0%)

Total **                  16,681      (34.9)   (33.6%-36.1%)
-----------------------------------------------------------------
*  Overweight is defined as body mass index (kg/m^2) >=27.8 for
   men and >=27.3 for women (85th percentiles from NHANES II for
   ages 20-29 years). The prevalence of overweight among persons
   aged 18-19 years, using these criteria, is 15.3% for males
   and 19.2% for females.
+  Numbers for other racial/ethnic groups were too small for
   meaningful analysis.
&  Confidence interval.
@  Excludes pregnant women.
** Total estimates include racial/ethnic groups not shown.
=================================================================

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