Prevalence Of Obesity Among Adults And Youth: United States, 2011-2014

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NCHS Data Brief No. 219 November 2015Prevalence of Obesity Among Adults and Youth:United States, 2011–2014Cynthia L. Ogden, Ph.D.; Margaret D. Carroll, M.S.P.H.; Cheryl D. Fryar, M.S.P.H.;and Katherine M. Flegal, Ph.D.Key findingsData from the NationalHealth and NutritionExamination SurveyIn 2011–2014, theprevalence of obesity was justover 36% in adults and 17% inyouth. The prevalence of obesitywas higher in women (38.3%)than in men (34.3%). Amongall youth, no difference wasseen by sex.The prevalence of obesitywas higher among middle-aged(40.2%) and older (37.0%)adults than younger (32.3%)adults. Obesity is associated with health risks (1,2). Monitoring the prevalenceof obesity is relevant for public health programs that focus on reducingor preventing obesity. No significant changes were seen in either adult orchildhood obesity prevalence in the United States between 2003–2004 and2011–2012 (3). This report provides the most recent national data on obesityprevalence by sex, age, and race and Hispanic origin, using data for 2011–2014. Overall prevalence estimates from 1999–2000 through 2013–2014 arealso presented.Keyword: National Health and Nutrition Examination SurveyWhat was the prevalence of obesity among adults in2011–2014?The prevalence of obesity was 36.5% (crude estimate) among U.S. adultsduring 2011–2014. Overall, the prevalence of obesity among middle-agedFigure 1. Prevalence of obesity among adults aged 20 and over, by sex and age: United States,2011–201420 and over50The prevalence of obesitywas higher among nonHispanic white, non-Hispanicblack, and Hispanic adults andyouth than among non-HispanicAsian adults and youth. From 1999 through 2014,obesity prevalence increasedamong adults and youth.However, among youth,prevalence did not changefrom 2003–2004 5960 and over132.3 llMenWomenSignificantly different from those aged 20–39.Significantly different from women of the same age group.NOTES: Totals were age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59,and 60 and over. Crude estimates are 36.5% for all, 34.5% for men, and 38.5% for women.SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.12U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

NCHS Data Brief No. 219 November 2015adults aged 40–59 (40.2%) and older adults aged 60 and over (37.0%) was higher than amongyounger adults aged 20–39 (32.3%). No significant difference in prevalence was observedbetween middle-aged and older adults (Figure 1).Overall, the prevalence of obesity among women (38.3%) was higher than among men (34.3%).For adults aged 20–39 and 40–59, the prevalence of obesity was higher among women thanamong men, but the difference between older women and men aged 60 and over was notsignificant.Among both men and women, the prevalence of obesity followed a similar pattern by age. Menaged 40–59 (38.3%) had a higher prevalence of obesity than men aged 20–39 (30.3%). Womenaged 40–59 (42.1%) had a higher prevalence of obesity than women aged 20–39 (34.4%). Theprevalence of obesity among men and women aged 20–39 was lower than among men andwomen aged 60 and over, except the difference for men was not significant.Were there differences in the prevalence of obesity among adults by raceand Hispanic origin in 2011–2014?The prevalence of obesity was lowest among non-Hispanic Asian adults (11.7%), followed bynon-Hispanic white (34.5%), Hispanic (42.5%), and non-Hispanic black (48.1%) adults. Alldifferences were significant. The pattern among women was similar to the pattern in the overalladult population. The prevalence of obesity was 11.9% in non-Hispanic Asian, 35.5% in nonHispanic white, 45.7% in Hispanic, and 56.9% in non-Hispanic black women. The prevalenceFigure 2. Prevalence of obesity among adults aged 20 and over, by sex and race and Hispanic origin: United States,2011–2014Non-Hispanic whiteNon-Hispanic blackNon-Hispanic 2100AllMen11.9WomenSignificantly different from non-Hispanic Asian persons.Significantly different from non-Hispanic white persons.Significantly different from Hispanic persons.4Significantly different from women of the same race and Hispanic origin.NOTE: All estimates are age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over.SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.123 2

NCHS Data Brief No. 219 November 2015of obesity was lower in non-Hispanic Asian (11.2%) men compared with non-Hispanic white(33.6%), non-Hispanic black (37.5%), and Hispanic (39.0%) men. No difference in obesityprevalence was observed between non-Hispanic black and non-Hispanic white men, nor was therea difference between non-Hispanic black and Hispanic men (Figure 2).The only differences by sex were found among non-Hispanic black and Hispanic adults. Theprevalence of obesity among non-Hispanic black women was 56.9% compared with 37.5%in non-Hispanic black men. The prevalence of obesity was 45.7% among Hispanic womencompared with 39.0% in Hispanic men.What was the prevalence of obesity among youth aged 2–19 years in2011–2014?The prevalence of obesity among U.S. youth was 17.0% in 2011–2014. Overall, the prevalenceof obesity among preschool-aged children (2–5 years) (8.9%) was lower than among school-agedchildren (6–11 years) (17.5%) and adolescents (12–19 years) (20.5%). The same pattern was seenin both males and females (Figure 3).Figure 3. Prevalence of obesity among youth aged 2–19 years, by sex and age: United States, 2011–20142–19 years302–5 years6–11 years12–19 17.115109.28.98.650AllMalesSignificantly different from those aged 2–5 years.SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.1 3 Females21.0

NCHS Data Brief No. 219 November 2015Were there differences in the prevalence of obesity among youth aged 2–19years by race and Hispanic origin in 2011–2014?The prevalence of obesity among non-Hispanic Asian youth (8.6%) was lower than amongnon-Hispanic white (14.7%), non-Hispanic black (19.5%), and Hispanic (21.9%) youth. Theprevalence of obesity among non-Hispanic white youth was lower than in non-Hispanic blackand Hispanic youth, but no significant difference was observed between non-Hispanic black andHispanic youth.The pattern among females was similar to the pattern in the overall population, except theprevalence was not significantly different in non-Hispanic white females compared with nonHispanic black females. The prevalence of obesity was 5.3% in non-Hispanic Asian, 15.1% innon-Hispanic white, 20.7% in non-Hispanic black, and 21.4% in Hispanic females.Among males, the prevalence of obesity was lower in non-Hispanic Asian (11.8%) malescompared with non-Hispanic black (18.4%) and Hispanic (22.4%) males, but no significantdifference was seen between non-Hispanic Asian (11.8%) and non-Hispanic white (14.3%)males. Differences between non-Hispanic white, non-Hispanic black, and Hispanic males werestatistically significant (Figure 4).The only difference by sex was found among non-Hispanic Asian youth—the prevalence was11.8% in non-Hispanic Asian males and 5.3% in non-Hispanic Asian females.Figure 4. Prevalence of obesity among youth aged 2–19 years, by sex and race and Hispanic origin: United States,2011–2014Non-Hispanic white30Non-Hispanic blackNon-Hispanic sSignificantly different from non-Hispanic Asian persons.Significantly different from non-Hispanic white persons.Significantly different from females of the same race and Hispanic origin.4Significantly different from non-Hispanic black persons.SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.123 4 Females21.4

NCHS Data Brief No. 219 November 2015What are the trends in adult and childhood obesity?From 1999–2000 through 2013–2014, a significant increase in obesity was observed in bothadults and youth. Between 2003–2004 and 2013–2014, however, no change in prevalence wasseen among youth. No change in obesity prevalence among youth was noted between 2011–2012and 2013–2014, and the observed change in adults between 2011–2012 and 2013–2014 was notsignificant (Figure 5).Figure 5. Trends in obesity prevalence among adults aged 20 and over (age-adjusted) and youth aged 2–19 years:United States, 1999–2000 through 1999–20002001–20022003–20042005–2006Survey yearsSignificant increasing linear trend from 1999–2000 through 2013–2014.Test for linear trend for 2003–2004 through 2013–2014 not significant (p 0.05).NOTE: All adult estimates are age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over.SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.12SummaryMore than one-third of adults and 17% of youth in the United States were obese in 2011–2014.The prevalence of obesity was higher among women than among men overall and higher amongnon-Hispanic black and Hispanic adults compared with other racial and Hispanic origin groups.Among youth, no difference in obesity prevalence was seen between males and females, exceptamong non-Hispanic Asian youth.Obesity prevalence was lower among non-Hispanic Asian adults compared with other racial andHispanic origin groups. No difference in obesity prevalence was observed between non-Hispanicblack and Hispanic men. However, the prevalence was higher among non-Hispanic black womencompared with Hispanic women. Among youth, the prevalence of obesity was lowest among nonHispanic Asian youth, but no significant difference in prevalence was seen between non-Hispanicwhite and non-Hispanic Asian males. Among males, the prevalence of obesity was lower among 5

NCHS Data Brief No. 219 November 2015non-Hispanic black compared with Hispanic youth. However, among females, no difference inprevalence was observed between non-Hispanic black and Hispanic youth.Trends in obesity prevalence show no increase among youth since 2003–2004, but trends doshow increases in both adults and youth from 1999–2000 through 2013–2014. No significantdifferences between 2011–2012 and 2013–2014 were seen in either youth or adults.Obesity is defined using cut points of body mass index (BMI). BMI does not measure bodyfat directly, and the relationship between BMI and body fat varies by sex, age, and race andHispanic origin (4,5). Morbidity and mortality risk may vary between different racial andHispanic origin groups at the same BMI. Some studies suggest that among some Asiansubgroups, health and mortality risks may begin at a lower BMI compared with other racialand Hispanic origin groups (6–8).The definition of obesity is based on BMI for both youth and adults, but the definitions are notdirectly comparable. Among adults, there is a set cut point based on health risk, while amongchildren the definition is statistical and is based on a comparison to a reference population (9).The prevalence of obesity among U.S. adults remains higher than the Healthy People 2020 goalof 30.5% (10). Although the overall prevalence of childhood obesity is higher than the HealthyPeople 2020 goal of 14.5%, the prevalence of obesity among children aged 2–5 years is below thegoal of 9.4%.DefinitionsNon-Hispanic Asian: Primarily comprises persons of Chinese, Asian Indian, Korean, Filipino,Vietnamese, and Japanese descent.Obesity: BMI was calculated as weight in kilograms divided by height in meters squared, roundedto one decimal place. Obesity in adults was defined as a BMI of greater than or equal to 30.Obesity in youth was defined as a BMI of greater than or equal to the age- and sex-specific 95thpercentile of the 2000 CDC growth charts (9).Data source and methodsData from the National Health and Nutrition Examination Surveys (NHANES) for survey years1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012, and2013–2014 were used for these analyses. Data from NHANES 2011–2014 (4 years of data) wereused to test differences between demographic subgroups, thus increasing the sample size and theability to detect a difference in the prevalence. In testing for trends in obesity, eight 2-year cycleswere used: 1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012,and 2013–2014. Because previous research found no increase in obesity prevalence from 2003–2004 through 2011–2012 (3), analyses of linear trends were also conducted between 2003–2004and 2013–2014.NHANES is a cross-sectional survey designed to monitor the health and nutritional status of thecivilian noninstitutionalized U.S. population (11). The survey consists of interviews conductedin participants’ homes and standardized physical examinations conducted in mobile examinationcenters. 6

NCHS Data Brief No. 219 November 2015The NHANES sample is selected through a complex, multistage probability design. In 2011–2012and 2013–2014, non-Hispanic black, non-Hispanic Asian, and Hispanic persons, among othergroups, were oversampled to obtain reliable estimates for these population subgroups. Race- andHispanic origin-specific estimates reflect individuals reporting only one race; those reportingmore than one race are included in the total but are not reported separately.Examination sample weights, which account for the differential probabilities of selection,nonresponse, and noncoverage, were incorporated into the estimation process. All varianceestimates accounted for the complex survey design by using Taylor series linearization. Pregnantfemales were excluded from analyses.Prevalence estimates for the adult population aged 20 and over were age-adjusted using the directmethod to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over.Differences between groups were tested using a univariate t statistic at the p 0.05 significancelevel. All differences reported are statistically significant unless otherwise indicated. Adjustmentswere not made for multiple comparisons. Statistical analyses were conducted using the SASSystem for Windows, release 9.3 (SAS Institute Inc., Cary, N.C.) and SUDAAN, release 11.1(RTI International, Research Triangle Park, N.C.).About the authorsCynthia L. Ogden, Margaret D. Carroll, Cheryl D. Fryar, and Katherine M. Flegal are with CDC’sNational Center for Health Statistics, Division of Health and Nutrition Examination Surveys.References1. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesityin adults—The evidence report. Obes Res 6 Suppl 2:51S–209S. 1998.2. U.S. Department of Health and Human Services, Office of the Surgeon General. The surgeongeneral’s vision for a healthy and fit nation. Rockville, MD: 2010.3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in theUnited States, 2011–2012. JAMA 311(8):806–14. 2014.4. Flegal KM, Ogden CL, Yanovski JA, Freedman DS, Shepherd JA, Graubard BI, Borrud LG.High adiposity and high body mass index-for-age in US children and adolescents overall and byrace-ethnic group. Am J Clin Nutr 91(4):1020–6. 2010.5. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and fromeach other in their body mass index/body fat per cent relationship. Obes Rev 3(3):141–6. 2002.6. Nguyen TT, Adair LS, Suchindran CM, He K, Popkin BM. The association between bodymass index and hypertension is different between East and Southeast Asians. Am J Clin Nutr89(6):1905–12. 2009.7. Jafar TH, Islam M, Poulter N, Hatcher J, Schmid CH, Levey AS, Chaturvedi N. Childrenin South Asia have higher body mass-adjusted blood pressure levels than white children in theUnited States: A comparative study. Circulation 111(10):1291–7. 2005. 7

U.S. DEPARTMENT OFHEALTH & HUMAN SERVICESFIRST CLASS MAILPOSTAGE & FEES PAIDCDC/NCHSPERMIT NO. G-284Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo Road, Room 5419Hyattsville, MD 20782–2064OFFICIAL BUSINESSPENALTY FOR PRIVATE USE, 300For more NCHS Data Briefs, htm.NCHS Data Brief No. 219 November 20158. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, etal. Association between body-mass index and risk of death in more than 1million Asians. N Engl J Med 364(8):719–29. 2011.9. Ogden CL, Flegal KM. Changes in terminology for childhoodoverweight and obesity. National health statistics reports; no 25. Hyattsville,MD: National Center for Health Statistics. 2010.10. U.S. Department of Health and Human Services, Office of DiseasePrevention and Health Promotion. Healthy People 2020 topics andobjectives: Nutrition and weight status. Washington, DC. Available ctives/topic/nutrition-andweight-status?topicid 29.11. Johnson CL, Dohrmann SM, Burt VL, Mohadjer LK. National Healthand Nutrition Examination Survey: Sample design, 2011–2014. NationalCenter for Health Statistics. Vital Health Stat 2(162). 2014.Suggested citationOgden CL, Carroll MD, Fryar CD, FlegalKM. Prevalence of obesity among adultsand youth: United States, 2011–2014. NCHSdata brief, no 219. Hyattsville, MD: NationalCenter for Health Statistics. 2015.Copyright informationAll material appearing in this report is inthe public domain and may be reproducedor copied without permission; citation as tosource, however, is appreciated.National Center for HealthStatisticsCharles J. Rothwell, M.S., M.B.A., DirectorNathaniel Schenker, Ph.D., Deputy DirectorJennifer H. Madans, Ph.D., AssociateDirector for ScienceDivision of Health and NutritionExamination SurveysKathryn S. Porter, M.D., M.S., DirectorRyne Paulose-Ram, Ph.D., AssociateDirector for ScienceFor e-mail updates on NCHS publicationreleases, subscribe online at:http://www.cdc.gov/nchs/govdelivery.htm.For questions or general information aboutNCHS:Tel: 1–800–CDC–INFO (1–800–232–4636) TTY:1–888–232–6348Internet: http://www.cdc.gov/nchsOnline request form: http://www.cdc.gov/cdc-info/ISSN 1941–4927 Print ed.ISSN 1941–4935 Online ed.DHHS Publication No. 2016–1209CS260465

childhood obesity prevalence in the United States between 2003-2004 and 2011-2012 (3). This report provides the most recent national data on obesity prevalence by sex, age, and race and Hispanic origin, using data for 2011- 2014. Overall prevalence estimates from 1999-2000 through 2013-2014 are also presented.

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