Cynthia

Obesity and diet among US

adolescents

Ogden, PhD, MRP

NHANES Analysis Branch Chief

NCHS Conference, August, 2015

National Center for Health Statistics

Division of Health and Nutrition Examination Surveys

-

Prevalence of obesity in the US, 2011-2012

• 16.9% of children & teens 2-19 years

• 34.9% of adults ≥20 years

Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011 2012; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA 2014

2014 -

90+ million obese individuals in the US

78.6

12.7 0

10

20

30

40

50

60

70

80

Mill

ion

s o

f p

eo

ple

Adults, 20+ years

Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011 2012; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA

DATA SOURCE

National Health and Nutrition Examination Survey (NHANES)

Complex multi-stage probability sample of the US civilian non-

institutionalized population, all estimates have confidence intervals

Approximately 5,000 people surveyed each year

Survey Periods

Survey Dates Ages

NHES I 1960-62 18-79 years

NHES II 1963-65 6-11 years

NHES III 1966-70 12-17 years

NHANES I 1971-75 1-74 years

NHANES II 1976-80 6 mo.-74 years

NHANES 1982-84 6 mo.-74 years

NHANES III 1988-94 2 mo. +

Note: NHES, National Health Examination Survey

Continuous NHANES, All ages

Dates

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

2011-2012

Anthropometry

Dietary information collected in interviews

DEFINITION OF OBESITY IN YOUTH

Obesity cut points for children and teens

• BMI (kg/m2) proxy for body fat

• No set risk-based cutoffs exist

• BMI varies with age and sex

• Statistical definition of obesity

‒ Based on BMI-for-age

‒ Comparison to a reference population

- -

Reference population: CDC growth charts

• Overweight ‒ OBMI-for-age 85th-<95th percentile

• Obesity ‒ BMI for age ≥ 95th percentile

In US, sex specific CDC growth charts are reference

CDC growth charts

• Data from US national surveys

• By definition: ‒ 5% of youth each sex*age in 1960, 70, 80s were obese

OBESITY PREVALENCE: ADOLESCENTS 12-19 YEARS

25

20.5 20.3 20.7 20

15

10

5

0 Total Males Females

Pe

rce

nt

-

One in 5 adolescents obese

SOURCE: CDC/NCHS, NHANES 2011 2012, Ogden et al. JAMA 2014

OBESITY TRENDS: ADOLESCENTS 12-19 YEARS

25

Males Females

20

Po

un

ds

he

avie

r

15

10

5

0

17 pounds heavier

18 pounds heavier 18 pounds heavier

16 pounds heavier

14 pounds

heavier

16 pounds heavier

14 years 16 years 18 years

-

American teens on average ~16 pounds heavier in 2007-2010 than in early 1970s

Sources: CDC/NCHS: National Health and Nutrition Examination Survey; www.cdc.gov/nchs/data/ad/ad347.pdf; http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf (NHESI, NHESII, 2007 2010)

-

- -

Mean Median1976 80 21.2 20.6

Pe

rce

nta

ge

15

10

5

0 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

Obese cut off in adults (BMI=30)

2003 06 23.5 22.0

- -

The distribution of BMI among adolescents shifted slightly to the right and became more skewed between 1976-80 and 2003-2006

Sources: US National Health and Nutrition Examination Survey II 1976 1980; US National Health and Nutrition Examination Survey 2003 2006; Ogden et al. 2011 Epidemiology of Obesity in Children and Adolescents; Springer Series on Epidemiology and Public Health Volume 2, pp 69-93

Increase in obesity among teens in 1980s, 1990s and early 2000s

30

25

Pe

rce

nt

20

15

10

5

0

SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys; http://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm

Trends in obesity prevalence among youth 2-19 years,

30

25

20

15

10

5

0

by age, US, 2003-2004 to 2011-2012 1

2-5 years 6-11 years 12-19 years

20.5 18.8 17.8

19.6 18.4

17.4

15.1 18.1 18 17.7

13.9 12.1

10.7 10.1 8.4

2003-2004 2005-2006 2007-2008 2009-2010 2011-2012

1 p=.03 for linear trend SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys; Ogden et al. 2014 JAMA

DISPARITIES IN OBESITY PREVALENCE AMONG US TEENS

-

Perc

ent

non-Hispanic white non-Hispanic black non-Hispanic Asian Hispanic

30

23.9 25 22.6 22.7 22.1

19.6 20

15

10

5

0

18.3

20.9 21.4

11.1

14.8

7.3

21.3

Total Males Females

SOURCE: CDC/NCHS, NHANES 2011 2012, Ogden et al. JAMA 2014

Prevalence of obesity by race/Hispanic origin, 12-19 years, 2011-2012

HOW DOES THE US COMPARE TO CANADA?

- -

- -

Pe

rce

nt

Canada US30

20 17.5

16.6

1312.4

10

5.6 5

0

1976 80 US 2001 4 US 2009 12 US 1978/79 Canada 2004 Canada 2009 13 Canada

1 - - - -

-

Trends in childhood obesity prevalence, Canada and the United States, ages 3-19 years

Notes: Pregnant girls are excluded. Statistically significant difference compared to Canada p<.001 Sources: CDC/NCHS, National Health and Nutrition Examination Surveys, 1976 1980, 2001 2004, 2009 2012; Canada Health Survey 1978/79, Canadian Community Health Survey Nutrition 2004, Canadian Health Measures Surveys, 2009 2013; Carroll et al NCHS Data Brief 2015

- -

Prevalence of childhood obesity, by age, 3-19 years, Canada (2009-2013) and

the United States (2009-2012)

Notes: Pregnant girls are excluded. 1Statistically significant difference compared to Canada p<.001. Sources: CDC/NCHS, National Health and Nutrition Examination Survey, 2009 2012; Canadian Health Measures Survey 2009 2013. Carroll et al NCHS Data Brief 2015

- - -

Prevalence of childhood obesity, by sex and age, 3-19 years, Canada (2009-2013) and the

United States (2009-2012)

Notes: Pregnant girls are excluded.1Statistically significant difference compared to Canada p<.001 2Use with caution (coefficient of variation 16.6% 33.3%, For the Canadian Health Measures Survey). Sources: CDC/NCHS, National Health and Nutrition Examination Survey, 2009 2012; Canadian Health Measures Survey 2009 2013; Carroll et al NCHS Data Brief 2015

- - -

Prevalence of childhood obesity, non-Hispanic whites, by sex and age, 3-19 years, Canada (2009-2013) and

the United States (2009-2012)

Notes: Pregnant girls are excluded. 1Statistically significant difference compared to Canada p<.001 2Use with caution (coefficient of variation 16.6% 33.3%). Sources: CDC/NCHS, National Health and Nutrition Examination Survey, 2009 2012; Canadian Health Measures Survey 2009 2013; Carroll et al NCHS Data Brief 2015

DIET

Per capita availability of calories

SOURCE: http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx#26675

-

Trends in mean kilocalories, 12-19 years 3000

2500

2000

Kca

l/d

ay

1000

1500 Male

Female

500

0

2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011 2012

http://www.cdc.gov/nchs/data/databriefs/db113.htm; http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/1112/Table_1_NIN_GEN_11.pdf; NHANES/WWEIA

50

41 40

34 32

30 30

20

10

0 non-Hispanic white non-Hispanic black non-Hispanic Asian Hispanic

Pe

rce

nt

-

Non-Hispanic white adolescents consume more than 40% of calories away from home

NHANES/WWEIA 2011 2012; http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/1112/Table_10_AWY_RAC_11.pdf

Figure 2. Mean percent of kilocalories from added sugars among children and adolescents aged 2-19 years, by sex and age group: United States, 2005-2008

20

16.31

15 i--~ ...... ------.... ~~~

c ~ 10 <l) a_

5

'Significantly different from females, p < 0.05. 2$ ignificant linear trend by age. p < 0.05.

13.52

Male

• Total

17.5

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008.

2- 5 years • 6-11 years • 12- 19 years

16.6 15.5

13.12

Female

http://www.cdc.gov/nchs/data/databriefs/db87.htm

-

On average male teens consume 278 kcal a day from sugar sweetened beverages – almost 2 cans of cola

300 278

Me

an k

cal p

er

day

250

200

150

100

50

0

175

Male female

Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2009 2010; kit et al 2013 AJCN; http://ajcn.nutrition.org/content/98/1/180/T1.expansion.html

30 26

25

20 18

15

10

5

0 Males Females

-

One quarter of adolescent males consume pizza on a given day

NHANES/WWEIA 2007 2010; http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/DBrief/11_consumption_of_pizza_0710.pdf

nt

obesity and diet Adolesce

• Obesity ‒ One in 5 teens

‒ Disparities, prevalence lowest among Asian Americans

‒ Trends: since 1980 large increases

‒ NHANES 2013-2014 will help clarify recent trends

• 2 year data are limited for subgroup analysis

• Diet ‒ Not much change in calories recently

‒ High consumption of added sugars, SSB, pizza

The findings and conclusions in this presentation are those of the author and not necessarily of CDC

DISCLAIMER

Katherine Flegal, PhD Brian Kit, MD Margaret Carroll, MSPH

THANK YOU TO MY COLLEAGUES