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.
- Children who are overweight or obese are more likely to be obese as adults. Being overweight or obese can put children at a higher risk for health problems such as heart disease, hypertension, type 2 diabetes, stroke, cancer, asthma and osteoarthritis — during childhood and as they age.2,3
- Preventing obesity early can impact a child's lifetime trajectory. A study of more than 7,700 children found that a third of the children who were overweight in kindergarten were obese by eighth grade. When the children entered kindergarten, 12.4 percent were obese and another 14.9 percent were overweight; in eighth grade, 20.8 percent were obese and 17 percent were overweight. Overweight 5-year-olds were more than four times as likely as healthy weight children to become obese.4
Obesity is associated with higher healthcare needs and costs among children:
- Overweight and obesity in childhood is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit healthcare costs annually.5 An obese 10-year-old child who continues to gain weight throughout adulthood has lifetime medical costs that are $19,000 higher compared to a healthy-weight 10-year-old who maintains a normal weight throughout life.6
- A child who is obese for two consecutive years has a $194 higher outpatient visit expenditure, a $114 higher prescription drug expenditure and a $12 higher emergency room expenditure compared to a normal/underweight child during the same two years, based on a Medical Expenditure Panel Survey (2002-2005).7
- The average total annual health cost for a child treated for obesity under private insurance is $3,743, while the average health cost for all children covered by private insurance is $1,108.8
- Hospitalizations of children and youths with a diagnosis of obesity nearly doubled between 1999 and 2005, while total costs for children and youths with obesity-related hospitalizations increased from $125.9 million in 2001 to $237.6 million in 2005 (in 2005 dollars).9
Focusing on nutrition and physical activity early can help improve a child's future health — particularly among children from low-income families:
- Children who grow up in low-income families and neighborhoods are at higher risk for obesity and related health problems.10,11
- More than 15 million children (20.9 percent) experience food insecurity annually — where their family has limited access to adequate food and nutrition due to cost, proximity and/or other reasons.12,13
- Nearly half of infants and toddlers under 3-years-old live in low-income families; 24 percent live in poverty; and 6.6 percent of the U.S. population lives in deep poverty.14,15 (Low-income is defined as two times the federal poverty level (FPL); poverty is below FPL; deep poverty is earning less than $6,000 per year or raising a child on less than $7,600 per year.)
- Seventy percent of Black, 66 percent of Native American, 64 percent of Latino and 34 percent of White children under the age of three live in 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 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
- Nearly one-third (31.3 percent) of children ages 10 to 17 are overweight or obese [2011-2012, National Survey of Children's Health, phone surveys of parents in each state].33,34
- Rates ranged from a low of 9.9 percent in Oregon to a high of 21.7 percent in Mississippi.
- Seven out of 10 states with the highest rates are in the South. The obesity rate in the South (41.8 percent) was nearly three times the rate in the Northeast (14.6 percent). Rates in the Midwestern states were 22.2 percent and 21.5 percent in the West.
- Rates exceeded 15 percent in 19 states and were 20 percent or above in four states.
High School Students
- 13.9 percent of high school students are obese, and an additional 16.0 percent are overweight [2015, Youth Risk Behavior Surveillance System, 37 states participating, self-reported data].35
- In 2015, obesity rates ranged from a low of 10.3 percent in Montana to a high of 18.9 percent in Mississippi.
- Obesity rates exceeded 15 percent in eleven states, were between 10 and 15 percent in 26 states and no states were below 10 percent.
Percentage of High School Students Who Were Obese — Selected U.S. States Youth Risk Behavior Surveillance System, 201536
- Nationally, self-reported obesity among high school students has increased by 31.1 percent, from 10.6 percent in 1999 to 13.9 percent in 2015.37
- Rates are higher among males (16.8 percent) than females (10.8 percent).
- Rates vary by race/ethnicity: 16.8 percent among Blacks, 16.4 percent among Latinos, 15.9 percent among American Indian/Alaska Natives and 12.4 percent among Whites.
- Among females: Blacks have a rate of 15.2 percent, Latinas of 13.3 percent and Whites of 9.1 percent.
- Among males: Latinos have a rate of 19.4 percent, Blacks of 18.2 percent and Whites of 15.6 percent.
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