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Ogden CL, Carroll MD, Curtin, LR Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008. JAMA 2010; 303 : 242-249

Ogden CL, Carroll MD, Curtin, LR Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008. JAMA 2010; 303 : 242-249

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 current as of September 1, 2010.Online article and related content http://jama.ama-assn.org/cgi/content/full/303/3/242 . 2010;303(3):242-249 (doi:10.1001/jama.2009.2012)
Cynthia L. Ogden; Margaret D. Carroll; Lester R. Curtin; et al.
Adolescents, 2007-2008Prevalence of High Body Mass Index in US Children and
Supplementary material
Topic collections
Health, Other; Statistics and Research MethodsPediatrics; Adolescent Medicine; Pediatrics, Other; Public Health; Obesity; Public
the same issueRelated Articles published in
Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity
 at Duke University on September 1, 2010www.jama.comDownloaded from 
Prevalence of High Body Mass Indexin US Children and Adolescents, 2007-2008
Cynthia L. Ogden, PhDMargaret D. Carroll, MSPHLester R. Curtin, PhDMolly M. Lamb, PhDKatherine M. Flegal, PhD
(BMI)among children and ad-olescents continues to bea public health concernin the United States. Children withhigh BMI often become obeseadults,
and obese adults are at riskfor many chronic conditions such asdiabetes, cardiovascular disease,and certain cancers.
High BMI inchildren may also have immediateconsequences, such as elevated lipidconcentrations and blood pressure.
Since 1980, the prevalence of BMIfor age at or above the 95th percentile(sometimes termed “obese”) hastripled among school-age childrenand adolescents, and it remains highat approximately 17%.
However,the prevalence of BMI for age at orabove the 95th percentile amongchildren and adolescents showed nosignificant changes between 1999and 2006 for both boys and girls oramong non-Hispanic white, non-Hispanic black, and Mexican Ameri-can individuals.
Usingdatafrom2007-2008,thisar-ticle provides the most recent esti-matesofhighBMIamongchildrenandadolescentsaged2through19yearsandhigh weight for recumbent lengthamong infants and toddlers. In addi-tion,trendsinprevalencebetween1999and 2008 are analyzed.
Analyses are based on data from theNational Health and NutritionExamination Survey (NHANES), acomplex, multistage probabilitysample of the US civilian, noninstitu-tionalized population.
The surveywas conducted by the National Cen-ter for Health Statistics (NCHS) of the Centers for Disease Control andPrevention (CDC) and was reviewedand approved by the NCHS institu-tional review board. Parents providedinformed written consent for chil-dren younger than 18 years, and chil-dren aged 7 years and older providedassent. Standardized protocols andcalibrated equipment were used toobtain measurements of height andweight.
See also pp 235 and 275.
Author Affiliations:
National Center for Health Sta-tistics, Centers for Disease Control and Prevention,Hyattsville, Maryland.
Corresponding Author:
Cynthia L. Ogden, PhD, Na-tional Center for Health Statistics, 3311 Toledo Rd,Room 4414, Hyattsville, MD 20782 (cogden@cdc.gov).
The prevalence of high body mass index (BMI) among children and ado-lescents in the United States appeared to plateau between 1999 and 2006.
To provide the most recent estimates of high BMI among children andadolescentsandhighweightforrecumbentlengthamonginfantsandtoddlersandtoanalyze trends in prevalence between 1999 and 2008.
Design, Setting, and Participants
The National Health and Nutrition Examina-tion Survey 2007-2008, a representative sample of the US population with measuredheights and weights on 3281 children and adolescents (2 through 19 years of age)and 719 infants and toddlers (birth to 2 years of age).
95thpercentile of the Centers for Disease Control and Prevention growth charts) amonginfants and toddlers.Prevalenceofhigh BMIamong children and adolescents definedat 3 levels: BMI for age at or above the 97th percentile, at or above the 95th percen-tile, and at or above the 85th percentile of the BMI-for-age growth charts. Analysesof trends by age, sex, and race/ethnicity from 1999-2000 to 2007-2008.
In 2007-2008, 9.5% of infants and toddlers (95% confidence interval [CI],7.3%-11.7%) were at or above the 95th percentile of the weight-for-recumbent-lengthgrowthcharts.Amongchildrenandadolescentsaged2through19years,11.9%(95%CI,9.8%-13.9%)wereatorabovethe97thpercentileoftheBMI-for-agegrowthcharts; 16.9% (95% CI, 14.1%-19.6%) were at or above the 95th percentile; and31.7%(95%CI,29.2%-34.1%)wereatorabovethe85thpercentileofBMIforage.Prevalence estimates differed by age and by race/ethnic group. Trend analyses indi-cate no significant trend between 1999-2000 and 2007-2008 except at the highestBMI cut point (BMI for age
97th percentile) among all 6- through 19-year-old boys(odds ratio [OR], 1.52; 95% CI, 1.17-2.01) and among non-Hispanic white boys ofthe same age (OR, 1.87; 95% CI, 1.22-2.94).
Nostatisticallysignificantlineartrendsinhighweightforrecumbentlengthor high BMI were found over the time periods 1999-2000, 2001-2002, 2003-2004,2005-2006, and 2007-2008 among girls and boys except among the very heaviest6- through 19-year-old boys.
 JAMA. 2010;303(3):242-249
January 20, 2010—Vol 303, No. 3
©2010 American Medical Association. All rights reserved.
 at Duke University on September 1, 2010www.jama.comDownloaded from 
Excess weight in infants and tod-dlers is defined
as weight at or abovethe 95th percentile of the sex-specific2000 CDC weight-for-recumbent-length growth charts (which are inde-pendentofage).Excessweightamongchildren and adolescents aged 2through 19 years is defined based onBMI in relation to the 2000 CDC sex-specific BMI-for-age growth charts.
Bodymassindexiscalculatedasweightin kilograms divided by height in me-ters squared, rounded to 1 decimalplace.There have been recent changes inthe nomenclature for specific levels of high BMI for age in children. In the1980s and 1990s, expert committeesrecommended that children and ado-lescents aged 2 through 19 years at orabovethe95thpercentileofBMIforagebe labeled “overweight” and childrenbetweenthe85thand95thpercentilesbe labeled “at risk for overweight.”
A more recent expert committee rec-ommended that these groups of chil-dren be labeled “obese” and “over-weight,” respectively.
In this article, we present estimatesforinfantsandtoddlersatorabovethe95th percentile of weight for recum-bent length and for children and ado-lescentsat3levelsofhighBMI:BMIforageatorabovethe97th,atorabovethe95th, and at or above the 85th percen-tiles.Forchildrenandadolescents,be-cause of recent changes in terminol-ogyandbecausewepresentanestimatefor at or above the 97th percentile,which does not have a recommendedlabel, we use the phrase “high BMI” torefertoall3BMI-for-agecutpoints.Be-cause the 95th percentiles of BMI forage among 18- and 19-year-old fe-malesand19-year-oldmalesareabove30, a teenager could be consideredobese by the adult definition but nothaveahighBMIbasedonthe95thper-centile of BMI for age. Consequently,the percentage of adolescents (12-19yearsofage)atorabovetheadultdefi-nition of obesity (BMI
was alsoestimated.Participants reported their race andethnicity after being shown a list thatincludedanopen-endedresponse.Par-ticipants aged 16 years and olderreported their own race and ethnicity,andforchildrenyoungerthan16years,a family member reported race andethnicity.Forthepurposesofthisanaly-sis, race/ethnic groups were catego-rized as non-Hispanic white, non-Hispanic black, total Hispanic, andMexican American. Prevalence esti-mates are shown for both total His-panicindividualsandMexicanAmeri-can individuals. Mexican Americanindividuals have been oversampledsince1999-2000,sotrendanalyseswereperformedonthetotalpopulation,non-Hispanic white, non-Hispanic black,and Mexican American race/ethnicgroups.TotalHispanicindividualswerenot oversampled prior to 2007-2008.Analyses of the total populationincluded an “other” group of primar-ilyAsianindividuals,butthisgroupdidnothavesufficientsamplesizetobeana-lyzed separately.Examination response rates forNHANES 2007-2008 were similar toprior surveys.
In 2007-2008, theoverall unweighted examinationresponse rate for children and adoles-centswas82.1%,calculatedasthenum-ber of examined children and adoles-cents divided by the total numberselected to participate in the sample.Lessthan1%ofexaminedchildrenwereexcluded from the analysis because of missing data for weight or height (orrecumbentlengthforchildrenyoungerthan2years).Thisreportincludesdatafor3281childrenandadolescents(2-19years of age) and 719 infants and tod-dlers(birthto2yearsofage)from2007-2008. The sample size is smaller thanthat in 2005-2006 (n=4207) becauseadolescents were oversampled only inNHANES 1999-2006.NHANES was designed to detect a10% difference between proportionswith80%power,adesigneffectof1.5,andasamplesizeofapproximately420.Totestforsmallerdifferenceswiththesame power, a larger sample size isneeded. For example, to test a changefrom15%to10%(a5%difference)re-quires a sample size of approximately1150.Becausetrendanalysescombineseveraltimeperiods,thestatisticaltestfor trends requires fewer sample per-sons per time period. Sufficient powerexists when combining the survey pe-riods to detect a change of 5%.Statistical analyses were done usingSAS (version 9.2; SAS Institute Inc,Cary, North Carolina) and SUDAAN(version 10; Research Triangle Insti-tute, Research Triangle Park, NorthCarolina).Allanalyses excludedpreg-nantfemales.Sampleweightswereusedto account for differential nonre-sponse and noncoverage and to adjustfor planned oversampling of somegroups. Standard errors were esti-mated with SUDAAN using Taylor se-ries linearization, a design-based ap-proach.Differencesbetweenagegroupsand race/ethnic groups were testedusing logistic regression models. Be-cause significant interactions werefound between sex and race/ethnicgroup, sex-specific models were run.Overall and within each race/ethnicgroup, differences by sex were testedusing
tests with a Bonferroni correc-tion based on 4 comparisons (4 race/ ethnic groups); thus, a
value of .05divided by 4, .0125, is considered sig-nificant.Lineartrendsweretestedover5timeperiods(1999-2000,2001-2002,2003-2004, 2005-2006, and 2007-2008)using time period as both a continu-ous and a categorical variable in logis-ticregressionmodels.Timeperiodwasanalyzedasacategoricalvariabletoex-amine the possibility that 1 or 2 timeperiods were leading to any differ-encesthatwerefoundsignificantwhentimeperiodwasanalyzedasacontinu-ous variable. Odds ratios (ORs) asso-ciated with the trends and
values forthe Satterthwaite adjusted
statisticfrom models that contain time periodas a continuous variable are presentedinthetext.ABonferronicorrectionwasmade based on 6 different compari-sons(2sexesand3race/ethnicgroups);thus,a
valueof.05dividedby6,.008,is considered significant.Analysis of trends was slightly dif-ferentfordifferentagegroupsgivendif-
©2010 American Medical Association. All rights reserved.
(Reprinted) JAMA,
January 20, 2010—Vol 303, No. 3
 at Duke University on September 1, 2010www.jama.comDownloaded from 

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