The State of Childhood Obesity

Overview

Recent national data show that childhood obesity rates have stabilized at 17 percent over the past decade. Rates are declining among 2- to 5-year-olds, stable among 6- to 11-year-olds, and increasing among 12- to 19-year-olds. This shows signs of positive progress following a long period where rates had grown significantly among youth ages 2-19 when they more than tripled between the early 1970s and 2005 (from 5 percent to 17 percent).1

There are even signs that childhood obesity rates are starting to decline, particularly among young children and in communities that have taken comprehensive obesity-prevention approaches. Between 2010 and 2014, 31 states and three territories reported declines in obesity rates among toddlers (ages 2 to 4) whose families participate in the Special Supplemental Nutrition Program (SNAP) for Women, Infants, and Children (WIC) nutrition program for low-income families. The national obesity rate among children in the WIC program has also declined from a high of 15.9 percent in 2010 to 14.5 percent in 2014, the most recent year for which data are available.2 There are increasing examples of signs of progress — where areas have implemented a wide range of strategies to make healthy foods and beverages available in schools and communities, and have integrated physical activity into daily life — ranging from a 24.1 percent decline in obesity for children under 6 in Eastern Massachusetts to a 13.4 percent decline among kindergarten to fifthgraders in Kearney, Nebraska.3

Despite these positive trends, childhood obesity remains an American epidemic. More than 12 million U.S. children are obese — one out of every six children.4 Obese children have an increased risk of developing a range of health problems, including high blood pressure and high cholesterol, which are both risk factors for heart disease.5 Obesity can also cause sleep apnea, bone and joint problems, and chronic health conditions such as asthma and type 2 diabetes.6 Obese children are at increased risk of being bullied and suffering from depression, while a healthy diet and physical activity in childhood is associated with better mental health.7 More than 200,000 youth under the age of 20 have type 2 diabetes, and many more are at risk for developing diabetes.8 Obese children are also likely to grow up to be obese adults,9 at risk for all health problems associated with obesity.

Socioeconomic factors are also strongly correlated with childhood obesity. In fact, one recent study found that family income plays a larger role than race or ethnicity in predicting childhood obesity, and that the relationship between Black and Latino children and obesity disappeared after controlling for income.10

There are multiple factors that may explain why the United States has significant numbers of overweight and obese children. Like their adult counterparts, most children in the United States are not eating enough nutritious foods or getting sufficient physical activity: family and environmental factors are key. For example:

As with adults, environmental factors also play a role in childhood obesity. Some children have limited access to safe places to play, while others live in food deserts where there are few nearby places for their parents to buy affordable, healthy foods to serve their families. One study found that the odds of a child being obese or overweight increases by 20 percent to 60 percent if he or she lives in a neighborhood with unfavorable conditions such as poor housing, unsafe surroundings and/or limited access to sidewalks, parks and recreation centers.15 Unhealthy foods are heavily marketed to children, with Black youth exposed to a greater amount of unhealthy food marketing than White youth.16 Accordingly, efforts to prevent childhood obesity must address all of these factors.

Because kids are still growing, obesity is measured differently among children than adults. Instead of a simple BMI measurement, a child's BMI is compared to others of the same age and sex. Children with BMIs at the 95th percentile or above are considered obese, and those with a BMI between the 85th and 95th percentiles are considered overweight.

As with adult obesity rates, this report relies on multiple survey instruments to paint a complete picture of childhood obesity in America:

1. The National Health and Nutrition Examination Survey at CDC measures obesity rates among Americans ages two and older and is the primary source for national obesity data in this report of children ages 2 to 19. NHANES is particularly valuable in that it combines interviews with physical examinations and covers a wide age range of Americans. However, due to the delay between collection and reporting, the timeliness of its data can lag. The most recent NHANES obesity rates are from the 2013-2014 survey.

2. The WIC Participant and Program Characteristics (WIC PC), a USDA survey analyzed for obesity trends by CDC, is a report of the Special Supplemental Nutrition Program for Women, Infants, and Children on the results of its biennial census of families served by the program. The data it collects include height and weight information. Because the program provides assistance only to low-income mothers and children under the age of 5, this dataset is limited. However, because obesity disproportionately affects the poor, and early childhood is a critical time for obesity prevention, the dataset provides valuable information for evaluating the effectiveness of programs aimed at reducing obesity rates and health disparities.

3. The National Survey of Children's Health (NSCH) surveys parents of children ages 0 to 17 about all aspects of their children's health. An advantage of this survey is that it includes both national and state-by- state data, so obesity rates between states can be compared. The latest survey was conducted in 2016 and published in 2017. In addition, obesity rates are calculated based on parent-reported height and weight.

4. The Youth Risk Behavior Surveillance System (YRBSS) tracks high-risk health behaviors among students in grades 9-12, including unhealthy dietary behavior and physical inactivity. The survey also measures the prevalence of obesity by asking respondents about their height and weight. As in other surveys that use self-reported data to measure obesity rates, this survey likely underreports the true rates. The survey is conducted in odd-numbered years. The most recent public YRBSS obesity data are from the 2015 survey.

B. National Childhood Obesity Rates (NHANES)

Nationally, the childhood obesity rate is 17 percent. The rate varies among different age groups, with rates rising along with age. This same pattern is seen in both boys and girls. Recent national data show that childhood obesity rates have stabilized at 17 percent over the past decade. Rates are declining among 2- to 5-year-olds, stable among 6- to 11-year-olds, and increasing among 12- to 19-year-olds.

C. Early Childhood Obesity Rates (WIC)

Research has demonstrated that creating healthy eating patterns early on can help establish lifelong food preferences and habits.17 Given that more than one in 11 of all low-income children ages 2-5 are already overweight or obese,18 forming good eating behaviors at an early age is critical.19 Early childhood obesity rates have begun to level off and even decline. Nationally, the obesity rate among low-income 2- to 5-year-old children enrolled in the WIC program declined from 15.9 percent in 2010 to 14.5 percent in 2014.20 Among these children, a majority of states and all major racial/ethnic groups saw a reduction between 2010 and 2014 in the obesity rates.

CDC analyses cite that a set of initiatives have contributed to the recent reduction in obesity rates, including revisions to the WIC program's food package, providing WIC recipients with more healthy food options, and WIC efforts to promote and support breastfeeding.

View interactive data

D. Obesity Rates in Children Ages 10-17 (NSCH)

In 2016, nearly one-third (31.2 percent) of children ages 10-17 were either overweight or obese, according to the National Survey of Children's Health.23 At a state level, Utah had the lowest rate of overweight or obese children in this age group at 19.2 percent, while Tennessee had the highest rate at 37.7 percent.24

NSCH is based on a survey of parents in each state. The data are from parental reports, so they are not as reliable as measured data, but they are the only source of comparative state-by-state data for children in this age group. NSCH has typically been conducted and released every four years.

View interactive data

E. High School Obesity Rates (YRBSS)

According to the Youth Risk Behavior Surveillance System, 13.9 percent of high school students were obese, and an additional 16.0 percent were overweight in 2015. There was a significant increase in high school obesity rates between 1999 and 2015 (from 10.6 percent to 13.9 percent), but no significant change between 2013 and 2015.26 State obesity rates among high school students in 2015 ranged from a low of 10.3 percent in Montana to a high of 18.9 percent in Mississippi, with a median of 13.3 percent.27 The information from YRBSS is based on a survey of participating states and uses self-reported information. Male students had higher obesity rates than female students (16.8 percent vs. 10.8 percent). American Indian/Alaskan Native, Black and Hispanic students had higher rates than White and Asian students, as seen in the chart below.

View interactive data

Notes

1 Fryar CD, Carroll MD, Ogden CL, Prevalence of overweight and obesity among children and adolescents: United States, 1963-1965 through 2011-2012. Atlanta, GA: National Center for Health Statistics, 2014.

2 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. MMWR Morb Mortal Wkly Rep 2016;65:1256-1260. doi: http://dx.doi.org/10.15585/mmwr.mm6545a2.

3 Robert Wood Johnson Foundation. Signs of Progress. http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html. Accessed June 14, 2017.

4 Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Updated June 4, 2015. Accessed July 18, 2017.

5 Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Updated June 4, 2015. Accessed July 18, 2017.

6 Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Updated June 4, 2015. Accessed July 18, 2017.

7 Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Updated June 4, 2015. Accessed July 18, 2017.

8 American Diabetes Association. Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/. Accessed June 13, 2017.

9 The NS, Suchindran C, North KE, Popkin BM, Gordon-Larsen P. Association of adolescent obesity with risk of severe obesity in adulthood. JAMA. 2010;304(18):2042-2047.

10 Rogers R, Eagle TF, Sheetz A. The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: lessons from Massachusetts. Child Obes. 2015;11(6):691-5. doi:10.1089/chi.2015.0029.

11 Steinberger J, Daniels SR, Hagberg N. Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association. Circulation. 2016;134(12):e1-e20.

12 Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened beverage consumption among U.S. youth, 2011-2014. NCHS data brief, no 271. Hyattsville, MD: National Center for Health Statistics. 2017.

13 Centers for Disease Control and Prevention. Trends in the prevalence of physical activity and sedentary behaviors national YRBS: 1991—2015. https://www.cdc.gov/ healthyyouth/data/yrbs/pdf/trends/2015_us_physical_trend_yrbs.pdf. Accessed May 17, 2017.

14 American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013; 131:183-188.

15 Singh GK, Siahpush M, Kogan MD. Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health Aff. 2010;29(3):503-512. doi:10.1377/ hlthaff.2009.0730.

16 Fleming-Milici F, Harris JL. Television food advertising viewed by preschoolers, children and adolescents: contributors to differences in exposure for black and white youth in the United States. Pediatr Obes. 2016 Dec 15. doi:10.1111/ijpo.12203.

17 Perez-Escamilla R, Segura-Perez S, Lott M, on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Guidelines for Health Professionals. Durham, NC: Healthy Eating Research, 2017. Available at http://healthyeatingresearch.org. Accessed April 24, 2017.

18 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. MMWR Morb Mortal Wkly Rep 2016;65:1256-1260. doi: http://dx.doi.org/10.15585/mmwr.mm6545a2.

19 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.

20 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. MMWR Morb Mortal Wkly Rep 2016;65:1256-1260. doi: http://dx.doi.org/10.15585/mmwr.mm6545a2.

21 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. MMWR Morb Mortal Wkly Rep 2016;65:1256-1260. doi: http://dx.doi.org/10.15585/mmwr.mm6545a2.

22 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. MMWR Morb Mortal Wkly Rep 2016;65:1256-1260. doi: http://dx.doi.org/10.15585/mmwr.mm6545a2.

23 Child and Adolescent Health Measurement Initiative. 2016 National Survey of Children's Health. Data Resource Center for Child and Adolescent Health website. http://www.childhealthdata.org/browse/survey/results?q=4568&r=1. accessed September 2017.

24 Child and Adolescent Health Measurement Initiative. 2016 National Survey of Children's Health. Data Resource Center for Child and Adolescent Health website. http://www.childhealthdata.org/browse/survey/results?q=4568&r=1. accessed September 2017.

25 Data query from the Child and Adolescent Health Measurement Initiative?s Data Resource Center for Child and Adolescent Health website. Indicator 1.4: Childhood weight status in 4 categories, age 10-17 years; all states. http://www.nschdata.org/browse/survey/allstates?q=2462. Accessed May 26, 2017.

26 Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2015. MMWR Surveill Summ. 2016;65(No. SS- 6):1-174. doi:http://dx.doi.org/10.15585/ mmwr.ss6506a1.

27 Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2015. MMWR Surveill Summ. 2016;65(No. SS- 6):1-174. doi:http://dx.doi.org/10.15585/ mmwr.ss6506a1.