Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014

IMPORTANCE Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. DESIGN, SETTING, AND PARTICIPANTS Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. EXPOSURES Survey period. MAIN OUTCOMES AND MEASURES Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. RESULTS Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2%(95% CI, 5.8%-8.8%) in 1988-1994 to 13.9%(95% CI, 10.7%-17.7%) (P <.001) in 2003-2004 and then decreased to 9.4%(95% CI, 6.8%-12.6%) (P =.03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3%(95% CI, 9.4%-13.4%) in 1988-1994 to 19.6%(95% CI, 17.1%-22.4%) (P <.001) in 2007-2008, and then did not change (2013-2014: 17.4%[95% CI, 13.8%-21.4%]; P =.44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5%[95% CI, 8.8%-12.5%]) and 2013-2014 (20.6%[95% CI, 16.2%-25.6%]; P <.001) as did extreme obesity among children aged 6 to 11 years (3.6%[95% CI, 2.5%-5.0%] in 1988-1994 to 4.3%[95% CI, 3.0%-6.1%] in 2013-2014; P =.02) and adolescents aged 12 to 19 years (2.6%[95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P <.001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range,.09-.87). CONCLUSIONS AND RELEVANCE In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.