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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)
JAMA
 
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
eTableCorrection
Citations
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
Permissions
 at Duke University on September 1, 2010www.jama.comDownloaded from 
 
ORIGINAL CONTRIBUTION
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
H
IGH BODY MASS INDEX
(BMI)among children and ad-olescents continues to bea public health concernin the United States. Children withhigh BMI often become obeseadults,
1
and obese adults are at riskfor many chronic conditions such asdiabetes, cardiovascular disease,and certain cancers.
2
High BMI inchildren may also have immediateconsequences, such as elevated lipidconcentrations and blood pressure.
3
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%.
4-6
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.
6
Usingdatafrom2007-2008,thisar-ticle provides the most recent esti-matesofhighBMIamongchildrenandadolescentsaged2through19yearsandhigh weight for recumbent lengthamong infants and toddlers. In addi-tion,trendsinprevalencebetween1999and 2008 are analyzed.
METHODS
Analyses are based on data from theNational Health and NutritionExamination Survey (NHANES), acomplex, multistage probabilitysample of the US civilian, noninstitu-tionalized population.
7
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).
Context
The prevalence of high body mass index (BMI) among children and ado-lescents in the United States appeared to plateau between 1999 and 2006.
Objectives
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).
MainOutcomeMeasures
Prevalenceofhighweightforrecumbentlength(
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.
Results
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).
Conclusion
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
www.jama.com
242
JAMA,
January 20, 2010—Vol 303, No. 3
(Reprinted)
©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
8
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.
9
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.”
10,11
A more recent expert committee rec-ommended that these groups of chil-dren be labeled “obese” and “over-weight,” respectively.
12
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
30)
2
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.
4-6,13
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
t
tests with a Bonferroni correc-tion based on 4 comparisons (4 race/ ethnic groups); thus, a
P
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
P
values forthe Satterthwaite adjusted
F
statisticfrom models that contain time periodas a continuous variable are presentedinthetext.ABonferronicorrectionwasmade based on 6 different compari-sons(2sexesand3race/ethnicgroups);thus,a
P
valueof.05dividedby6,.008,is considered significant.Analysis of trends was slightly dif-ferentfordifferentagegroupsgivendif-
HIGH BMI IN US CHILDREN AND ADOLESCENTS
©2010 American Medical Association. All rights reserved.
(Reprinted) JAMA,
January 20, 2010—Vol 303, No. 3
243
 at Duke University on September 1, 2010www.jama.comDownloaded from 

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