Childhood Obesity Trends

Childhood obesity rates have remained at around 17 percent for the past decade.1

The federal government has several sources that track different obesity rates, including a National Health and Nutrition Evaluation Survey, and three major studies that track national trends as well as different childhood obesity rates in U.S. states.

Children and the Importance of Maintaining a Healthy Weight

Good nutrition and physical activity are particularly important for infants, toddlers and young children who need an adequate intake of key nutrients while their brains and bodies are rapidly developing. The foundations for lifelong, healthy eating and physical activity begin in these formative years. A child's health is even impacted by the mother's underlying health before and during pregnancy — where a mother's obesity and diabetes puts the child at increased risk for a range of health concerns.

Obesity is associated with higher healthcare needs and costs among children:

Focusing on nutrition and physical activity early can help improve a child's future health — particularly among children from low-income families:

Obesity and Adverse Childhood Experiences (ACEs) and Toxic Stress

Stress and trauma in childhood can harm and alter a child's body and brain. Adverse childhood experiences, adverse family experiences and toxic stress can dramatically increase a child's likelihood of becoming obese and for developing many obesity-related illnesses.

Adverse Family Experiences

Around one-third (30.5 percent) of children experienced two or more adverse family experiences, including 1) divorce or separation; 2) death; 3) incarceration of a parent or guardian; 4) living with anyone who was mentally ill, suicidal or severely depressed; 5) living with anyone who had an alcohol or drug problem; 6) witnessing any violence in the household; 7) being the victim of violence or witnessing violence in the neighborhood; 8) suffering racial discrimination; and 9) having a caregiver who often found it hard to get by on the family's income.16,17

Youth ages 10 to 17 who have experienced two or more adverse family experiences have an 80 percent higher chance of obesity than children who do not experience such events, according to an analysis of the 2011?2012 National Survey of Children's Health (NSCH).18 The strongest association between adverse family experiences and obesity was among White children, and there was no reported association among Black children.

Toxic Stress

Toxic stress occurs when children experience not just one traumatic event but rather are exposed to repeated and ongoing traumas, such as physical, sexual or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, repeated exposure to violence in the home or in their neighborhood and/or the accumulated burden and stress of family economic hardship.19 More than half of U.S. public school students live in poverty, which can contribute to toxic stress as well as to obesity.20,21

Adverse Childhood Experiences

More than half of children experience an adverse event during childhood — and many experience multiple co-occurring adverse events.22,23 The most commonly reported ACEs were physical abuse (28.3 percent), substance abuse in the household (26.9 percent), sexual abuse (24.7 percent for girls and 16 percent for boys) and parent divorce or separation (23.3 percent).24 More than one-quarter (27 percent) of children experience at least two ACEs, 14 percent experience three and 7 percent experience four or more. The more ACEs experienced, the higher likelihood for increased negative outcomes. The prevalence of ACEs in creases with a child's age, except for economic hardship, which is reported relatively equally for children of all ages.

Children with four or more ACEs had a 220 percent greater risk of heart disease than children experiencing no ACEs. They had a 240 percent greater risk of stroke, and 160 percent greater risk of diabetes. An ACE score of 6 or more could lower life expectancy by two decades.25 Adults who were abused as children have higher incidences of heart disease, chronic lung disease, cancer and liver disease; and are more likely to be smokers or obese.26,27

Research also shows that support from caring adults and protective systems can help buttress or reduce the negative effects that toxic stress, ACEs and other adverse family experiences can have on a child. Programs and services that help give parents and caregivers additional resources, skills and support can help them in turn provide safe, stable and nurturing environments for their children.28

WIC Participants Ages 2 to 4

Obesity among young children from low-income families has declined in recent years. The latest data from the Centers for Disease Control and Prevention show that 14.5 percent of 2- to 4-year-olds enrolled in WIC (the Special Supplemental Nutrition Program for Women, Infants and Children) were obese in 2014, down from 15.9 percent in 2010.29

From 2010 to 2014, rates significantly decreased in 31 states (Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, Wyoming) and three territories (Guam, Northern Mariana Islands, Puerto Rico); significantly increased in four states (Nebraska, North Carolina, Ohio, West Virginia); and remained stable in Alabama, Arkansas, Delaware, the District of Columbia, Hawaii, Idaho, Illinois, Maine, Mississippi, Montana, New Hampshire, North Dakota, Pennsylvania, Rhode Island, South Dakota, and Vermont.

In 2014, rates among WIC preschoolers exceeded 15 percent in 18 states and ranged from a low of 8.2 percent in Utah and a high of 20.0 percent in Virginia. Racial and ethnic differences remain significant: 16.6 percent of American Indian/Alaska Natives, 16.1 percent of Latinos, 15.5 percent of Native Hawaiian/Pacific, 14 percent of Whites, 11.2 percent of Blacks and 10.1 percent of Asians were obese, in 2014.

In 2007, USDA published interim nutritional changes to the WIC program, updating standards to align closely to the National Academies of Medicine (NAM, formerly the Institute of Medicine) and the Dietary Guidelines for Americans — which had been the first major change in more than 30 years. Changes expanded access to healthy fruits and vegetables; whole grains; and low-fat dairy for women, infants and children; and gave states and local WIC programs more flexibility to meet the national and cultural needs of WIC participants.30 The final rules were published in March of 2014.

The WIC program is one of the longest running nutrition support programs in the country. It provides nutrition support to low-income pregnant, postpartum and breastfeeding women, infants and children up to age 5 who are at risk for inadequate nutrition.31 WIC participation in states ranged from a low of 0.12 percent in Wyoming to a high of 16.5 percent in California, in 2014.32

Children Ages 10 to 17

High School Students

Percentage of High School Students Who Were Obese — Selected U.S. States Youth Risk Behavior Surveillance System, 201536

Notes

1 Ogden CL, et al. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief, No. 219, 2015 (accessed April 2016).

2 Freedman DS, et al. The relation of childhood BMI to adult adiposity: The Bogalusa Heart Study. Pediatrics, 115(1): 22-27, 2005.

3 The Writing Group for the SEARCH for Diabetes in Youth Study, et al. Incidence of diabetes in youth in the United States. JAMA, 297(24): 2716-2724, 2007.

4 Cunningham SA, Kramer MR, Narayan V. Incidence of childhood obesity in the United States. N England J of Med, 370: 403-411, 2014.

5 Trasande L and Chatterjee S. The impact of obesity on health service utilization and costs in childhood. Obesity, 17(9):1749- 1754, 2009.

6 Finkelstein EA, Graham WC, Malhotra R. Lifetime direct medical costs of childhood obesity. Pediatrics, 133: 854-862, 2014 (accessed May 2016).

7 Trasande L and Chatterjee S, 1749-1754, 2009.

8 Marder W and Chang S. Childhood Obesity: Costs, Treatment Patterns, Disparities in Care, and Prevalent Medical Conditions. Thomson MedStat Research Brief, 2005 (accessed May 2016).

9 Trasande L, Liu Y, Fryer G, et al. Effects of childhood obesity on hospital care and costs, 1999-2005. Health Affairs, 28(4): w751-w760, 2009.

10 Lees K. Children in Poor Neighborhoods at Great Risk of Obesity. Science World Report June 20, 2014 (accessed October 2014).

11 Centers for Disease Control and Prevention. Obesity among low-income, preschool-aged children — United States, 2008-2011. Morbidity and Mortality Weekly Report, 62(31): 629-634, 2013 (accessed October 2014).

12 Feeding America. Map the Meal Gap. Chicago, IL: Feeding America, 2016. (accessed May 2016).

13 Child Food Insecurity in the United States. In Feeding America, 2016 (accessed May 2016).

14 Jiang Y, Ekono M, and Skinner C. Basic Facts About Low-Income Children: Children Under 3 Years, 2014. New York, NY: National Center for Children in Poverty, 2014 (accessed May 2016).

15 Understanding Poverty. In Urban Institute (accessed May 2016).

16 Heerman WJ, Krishnaswami S, Barkin SL, et al. Adverse family experience during childhood and adolescent obesity. Obesity 24(3): 696-702, 2016 (accessed May 2016).

17 Bramlett MD and Radel LF. Adverse family experiences among children in nonparental care, 2011-2012. National Health Statistics Reports; no. 74. Hyattsville, MD: National Center for Health Statistics, 2014 (accessed May 2016).

18 Mathew DB and Radel LF. Adverse family experiences among children in nonparental care, 2011-2012. National Health Statistics Reports, 74. 2014 (accessed July 216).

19 Suitts S. A New Majority — Low Income Students Now a Majority in the Nation's Public Schools. Atlanta, GA: Southern Education Foundation, 2015 (accessed March 2016).

20 Central Iowa ACEs 360 Steering Committee. Adverse childhood experience in Iowa: a new way of understanding lifelong health. Findings from the 2012 Behavioral Risk Factor Surveillance System. In Iowa ACEs 360, 2013 (accessed September 2014).

21 National Scientific Council on the Developing Child. The Science of Early Childhood Development. Closing the Gap Between What We Know and What We Do. Cambridge, MA: Harvard University, Center on the Developing Child, 2007 (accessed May 2016).

22 Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American J of Prev Med, 14(4): 245- 258, 1998.

23 Injury Prevention and Control: Division of Violence Prevention. Adverse Childhood Experiences (ACEs). In Centers for Disease Control and Prevention (accessed September 2014).

24 Middlebrooks JS and Audage NC. The Effects of Childhood Stress on Health across the Lifespan. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2008 (accessed October 2014).

25 Brown DW, Anda RF, Tiemeier H, et al. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med 37(5): 389-396, 2009.

26 Central Iowa ACEs 360 Steering Committee. Adverse childhood experience in Iowa: a new way of understanding lifelong health. Findings from the 2012 Behavioral Risk Factor Surveillance System. In Iowa ACEs 360, 2013 (accessed May 2016).

27 Central Iowa ACEs 360 Steering Committee, 2013.

28 Core Meanings of the Strengthening Families Protective Factors. In Center for the Study of Social Policy, 2015 (accessed August 2015).

29 Pan L, Freedman DS, Sharma AJ, et al. Trends in Obesity Among Participants Aged 2-4 Years in the Special Supplemental Nutrition Program for Women, Infants, and Children - United States, 2000-2014. Morbidity and Mortality Weekly Report (MMWR) 2016;65:1256-1260. DOI.

30 USDA Finalizes Changes to the WIC Programs, Expanding Access to Healthy Fruits and Vegetables, Whole Grains, and Low-Fat Dairy for Women, Infants, and Children. In U.S. Department of Agriculture, Food and Nutrition Service, 2014 (accessed July 2016).

31 Nutrition Program Facts: WIC — The Special Supplemental Nutrition Program for Women, Infants and Children. In U.S. Department of Agriculture, Food and Nutrition Service (accessed July 2015).

32 Thorn B, Tadler C, Huret N, et al., No. AG?3198?C?11?0010, 2015.

33 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The Health and Well-Being of Children: A Portrait of States and the Nation, 2011-2012. Rockville, Maryland: U.S. Department of Health and Human Services, 2014 (accessed May 2016).

34 http://stateofobesity.org/children1017/

35 Kann L, et al., 1-174, 2016.

36 High School YRBS. Youth Online. In Centers for Disease Control and Prevention (accessed June 2016).

37 High School YRBS. 1999-2015 Results: Obesity Totals. In Centers for Disease Control and Prevention (accessed June 2016).