Prevalence of childhood obesity in the United States 1999 to 2018: a 20-year analysis

Abstract

Introduction: Obesity is a public health crisis in the United States. Childhood obesity is associated with multiple comorbidities in adulthood, including metabolic syndrome, cardiovascular diseases, and premature death. This study estimated the prevalence of obesity and severe obesity in United States children and adolescents. Methods: From the United States National Health and Nutrition Examination Survey from 1999 to 2018, 35907 children aged 2 to 19 years with body mass index (BMI) data were included. Prevalence of obesity and severe obesity, defined as BMI ≥95th percentile and ≥120% of 95th percentile of United States Centers for Disease Control and Prevention growth charts, respectively. Trends in prevalence of obesity and subgroup analyses according to age-group, sex, ethnicity, language used in interview, household education level, and household income level, were analysed. Data analysis was performed using the R statistical package “survey” (version 3.6.3). Results: The prevalence of obesity and severe obesity increased from 14.7 (95% confidence interval [CI]=12.9%-17.0%) to 19.2 (17.2%-21.0%) and 3.9 (2.9%-5.0%) to 6.1 (4.8%-8.0%) in 1999 to 2018, respectively (P=0.001 and P=0.014 for obesity and severe obesity, respectively). In 2017 to 2018, the prevalence of obesity among children from Spanish-speaking households was 24.4 (22.4%-27.0%), higher than children from English-speaking households (P=0.027). Children from households with high education level and high-income level had a lower prevalence of obesity compared with those with low education level and low-income level (P=0.003 and P=0.002 for education level and income level, respectively). Conclusion: The prevalence of childhood obesity in America kept increasing during the period 1999 to 2018 despite various public health initiatives. The problem is worse in children with lower socioeconomic status, and in children from Spanish-speaking households. Public health interventions are urgently needed to halt the rising trend of childhood obesity, and measures specifically catering to children from Spanish-speaking families should be put in place. Acknowledgement: HL Li was a research intern under the Research Internship Scheme (RIS)