Changes in the distribution of body mass index of adults and children in the US population

BACKGROUND: National survey data show increases in mean body mass index (BMI) and in the prevalence of overweight and obesity for adults and children in the United States, indicating a change in the distribution of BMI. OBJECTIVE: To apply graphical methods to describe changes in the distribution of BMI. DESIGN: BMI values from the third National Health and Nutrition Examination Survey (NHANES III: 1988-94) were compared with data from earlier cross-sectional nationally representative surveys for adults 29-74y of age and for children and adolescents 6-17 y of age. Tukey mean-difference plots were used to investigate the changes in the distributions of BMI within sex-age groups. RESULTS: Mean-difference blots allow qualitative visual comparisons of the distributions of BMI between surveys. For ail sex-age groups, there was increasing skewness with a greater shift in the upper part of the distribution so that, within each group, the heaviest subgroup was heavier in NHANES III than in prior surveys. For the youngest children, the lower part of the distribution showed virtually no change. With increasing age the whole distribution tended to shift upward slightly, suggesting an increase in BMI across the entire population. CONCLUSIONS: These changes in the distribution of BMI suggest the combination of both profound environmental determinants and a population with a high degree of susceptibility. The reasons for the increasing prevalence of obesity should be sought in part by seeking to understand the factors causing increases in the population as a whole.