Health Objectives for the Nation Prevalence of Overweight Among Adolescents -- United States, 1988- 91

Among adults, overweight is associated with increased risk for death, coronary heart disease, diabetes mellitus, gallbladder disease, joint disease, and certain cancers (1), and overweight during adolescence is associated with increased risk for overweight as an adult (2). CDC's third National Health and Nutrition Examination Survey (NHANES III) provides data to monitor changes in the dietary, nutritional, and health status of the U.S. population (3) and to track progress toward achieving the year 2000 national health objectives, including those related to prevalence of overweight (4). This report presents findings from NHANES III, Phase 1 (1988-91), on the prevalence of overweight among U.S. adolescents (ages 12-19 years).

NHANES III used a stratified multistage probability design to obtain a sample of the civilian, noninstitutionalized U.S. population aged greater than or equal to 2 months. The survey comprised two 3-year nationally representative phases with oversampling of children aged 2 months-5 years, persons aged greater than or equal to 60 years, blacks, and persons of Mexican descent (5). Height and weight were measured as part of a standardized physical examination in a mobile examination center (3). Body mass index (BMI, kg/m2) was used as a measure of weight adjusted for height. For adolescents, overweight was defined in the year 2000 national health objectives (objective 2.3) using BMI cutoffs based on modified age- and sex-specific 85th percentile values of the second National Health and Nutrition Examination Survey (NHANES II) (1976-80) (4).

Of the 1849 persons aged 12-19 years selected for the survey, 1632 (88%) were interviewed; of those interviewed, 1519 (93%) underwent a standardized physical examination. Of those examined, 1490 (98%) had complete data for height and weight, resulting in an overall analytic response rate of 81% (1490/1849). Data were weighted to account for survey design and nonresponse.

During 1988-91, the prevalence of overweight for persons aged 12-19 years was 21%, an increase of 6% since NHANES II Table_1. Sex-specific prevalence of overweight was 20% for males and 22% for females. Reported by: Div of Health Examination Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: One national health objective for the year 2000 is that overweight prevalence not exceed 15% among adolescents aged 12-19 years (baseline: 15% for adolescents aged 12-19 years in 1976-80) (objective 2.3) (4). The findings in this report indicate that, since NHANES II, the prevalence of overweight among adolescents has increased; a similar increase was reported for adults (6). Because both national surveys employed standardized equipment and procedures to measure height and weight, the increase during 1988-91 probably does not reflect changes in methodology.

There is no generally accepted definition of overweight for adolescents (7). The definition used for the year 2000 national health objective (i.e., the 85th percentile from NHANES II) (4) has the advantage of comparability with the definition for adults. However, because of changes in body composition with growth, weight is a less reliable measure of fatness for children and adolescents than for adults (8), and this definition may classify some adolescents as overweight who do not have excess body fat. In addition, some adolescents change overweight classification with age; most overweight adults were not overweight children (2).

The increase in the prevalence of overweight among adolescents and adults is most likely associated with dietary energy intake exceeding caloric expenditure. Energy intake through food consumption and energy expenditure through physical activity cannot be measured as precisely as height and weight in population surveys. Although high-fat and high-calorie foods are abundant and readily available in the United States, survey data suggest that dramatic increases in energy intake alone do not account for the increased prevalence of overweight among adolescents (9). Declining levels of physical activity also may account for these changes. For example, levels of participation by high school students in physical education declined from 1984 to 1990 (10); other factors possibly associated with declines in physical activity include concerns about personal safety and changing parental work habits.

Changes in diet and activity levels are necessary for the U.S. population to reduce overweight; primary prevention of overweight should begin in childhood. The findings in this report can assist in tracking progress toward achieving public health goals aimed at reducing overweight among adolescents and adults. Subsequent analyses of NHANES III will be used to elucidate differences in overweight prevalence by socioeconomic status and race/ethnicity, identify population subgroups at risk for increased prevalence of overweight, and examine the relation between overweight and other health and nutrition variables.

References

1. Public Health Service. The Surgeon General's report on

nutrition and health, 1988. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-50210.

2. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr 1994;59:810-9.

3. NCHS. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994; DHHS publication no. (PHS)94-1308. (Vital and health statistics; series 1, no. 32).

4. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

5. Ezzati TM, Massey JT, Waksberg J, Chu A, Maurer KR. Sample design: Third National Health and Nutrition Examination Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992; DHHS publication no. (PHS)92-1387. (Vital and health statistics; series 2, no. 113)

6. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. JAMA 1994;272:205-11.

7. Flegal KM. Defining obesity in children and adolescents: epidemiologic approaches. Crit Rev Food Science Nutr 1993;33:307- 12.

8. Kuczmarski RJ. Trends in body composition for infants and children in the U.S. Crit Rev Food Sci Nutr 1993;33:375-87.

9. McDowell MA, Briefel RR, Alaimo K, et al. Energy and macronutrient intakes of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1994; DHHS publication no. (PHS)94-1250. (Advance data no. 255) 10. Heath GW, Pratt M, Warren CW, Kann L. Physical activity patterns in American high school students: results from the 1990 Youth Risk Behavior Survey. Arch Pediatr Adolesc Med 1994;148:1131- 6.

TABLE 1. Prevalence of overweight * among adolescents
-- United States, National Health and Nutrition Examination
Survey 1976-1980 (NHANES II), and 1988-1991 (NHANES III)
=================================================================
                                      Prevalence
                                   -----------------
Sex/Survey      Sample size        %      (95% CI +)
-----------------------------------------------------------------
Males
  NHANES II         1351           15     (12.9-16.7)
  NHANES III         717           20     (15.3-24.5)

Females
  NHANES II         1241           15     (12.1-17.3)
  NHANES III         739           22     (18.4-26.3)

Total
  NHANES II         2592           15     (13.1-16.4)
  NHANES III        1456           21     (17.5-24.6)
-----------------------------------------------------------------
* Defined as body mass index >=23.0 for males aged 12-14 years;
  >=24.3 for males aged 15-17 years; >=25.8 for males aged 18-19
  years, >=23.4 for females aged 12-14 years; >=24.8 for females
  aged 15-17 years; and >=25.7 for females aged 18-19 years.
+ Confidence interval; based on a t-statistic with 32 degrees of
  freedom for NHANES II and 23 degrees of freedom for NHANES III.
=================================================================

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