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There was a significant decrease in obesity among 2- to 5- year- old children (from 1. P. Obesity prevalence remains high and thus it is important to continue surveillance. Obesity and childhood obesity, in particular, are the focus of many public health efforts in the United States. New regulations have been implemented by the US Department of Agriculture for food packages in the Special Supplemental Nutrition Program for Women, Infants and Children,3 the Centers for Disease Control and Prevention (CDC) has funded state- and community- level interventions,4 and there have been numerous reports and recommendations issued by the Institute of Medicine,5 the US Surgeon General,6 and the White House. Although the prevalence of obesity in the United States is high, with one- third of adults and 1. Given the focus of public health efforts on obesity, surveillance of trends in obesity remains important. The purpose of this study is to provide the most recent national estimates of childhood obesity and analyze trends in childhood obesity between 2. In addition, as a follow- up to recently published estimates of adult obesity,1. Estimates of overweight prevalence are also presented but are not analyzed for trends because overweight prevalence showed no trends between 1. Analyses are based on measured values of weight and height from the 2. National Health and Nutrition Examination Survey (NHANES). Although each year represents a nationally representative sample, data are released every 2 years to ensure adequate sample size for analyses and protect confidentiality. The most recent data presented in this analysis are from 2. In 2. 01. 1- 2. 01. NHANES includes oversampling of different subpopulations, including specific race/Hispanic origin groups. In 2. 01. 1- 2. 01. Hispanics, non- Hispanic blacks, and non- Hispanic Asians were oversampled. Oversampling of non- Hispanic Asians is a new addition to the NHANES survey. In the collection of NHANES data, survey participants were asked to report their race and whether they were of Hispanic origin. Individuals who reported they were of Hispanic origin were categorized as Hispanic regardless of their race. ![]() Powerful, Intuitive, Ultrafast, Featherlight Antivirus Software. Hundreds of millions of computer users worldwide rely on Bitdefender Antivirus Solutions to stay safe. Oracle acquired Sun Microsystems in 2010, and since that time Oracle's hardware and software engineers have worked side-by-side to build fully integrated. If they were not of Hispanic origin, they were categorized into 4 different groups (non- Hispanic white, non- Hispanic black, non- Hispanic Asian, and other). All non- Hispanic individuals who reported more than 1 race group were included in the . In 2. 01. 1- 2. 01. The National Center for Health Statistics Research Ethics Review Board approved NHANES. Written parental permission was obtained for minors younger than 1. Children aged 7 to 1. ![]() Written consent was obtained for all adults aged 1. Weight status for individuals aged 2 years and older was defined with body mass index (BMI, measured as weight in kilograms divided by height in meters squared) rounded to 1 decimal place. In children and adolescents aged 2 to 1. BMI at or above the 9. CDC sex- specific BMI- for- age growth charts from 2. Overweight was defined as a BMI between the 8. The estimates are presented as greater than or equal to both the 8. Because there is no recommended definition of obesity in children younger than 2 years, excess weight was defined as a weight for recumbent length at or above the 9. CDC sex- specific weight for recumbent length growth charts, similar to what has been presented in previous analyses. The World Health Organization (WHO) growth standards have been recommended to monitor growth in children younger than 2 years in the United States. Consequently, the percentage of infants and toddlers at or above the 9. WHO weight for recumbent length growth standards. In adults aged 2. BMI greater than or equal to 3. Obesity was further divided into grade 1 (BMI 3. BMI 3. 5- 3. 9), and grade 3 (BMI. Overweight among adults was defined as a BMI greater than or equal to 2. The estimates are presented as BMI greater than or equal to 2. Prevalence estimates are presented with 9. CIs, which were constructed with the logit transformation. Differences in prevalence between male and female participants overall in 2. To test for race/Hispanic origin and age differences in 2. If this hypothesis was rejected, tests for differences between any 2 subgroups were conducted with t tests. Tests for differences by race/Hispanic origin were evaluated by comparing the 4 race/Hispanic origin groups described above. Tests for differences by age in children were evaluated with the following comparisons: aged 2 to 5 vs 6 to 1. Similarly, in adults comparisons were made between aged 2. P values for test results are shown in the text but not the tables. Adjustments were not made for multiple comparisons. Trends in the unadjusted prevalence of high weight for recumbent length or obesity from 2. Trends were analyzed separately for infants, children, and adults because of different definitions. P values for trends, along with the absolute change in obesity prevalence between 2. Trends in high weight for recumbent length or obesity were also tested in logistic regression models adjusted for age and race/Hispanic origin with the Satterwaite adjusted F statistic. We found a significant interaction between survey period and age among youth and adult women, so we conducted sex- and age- specific logistic regression models of obesity adjusted for race/Hispanic origin (results shown in the Supplement). Survey period was treated as a continuous variable. Analyses were conducted with SAS version 9. SUDAAN version 1. All analyses used NHANES examination sample weights that adjust for nonresponse, noncoverage, and unequal probabilities of selection. Standard errors were estimated with Taylor series linearization to take into account the complex sample design. Pregnant females were excluded from all analyses. Obesity estimates for total adults aged 2. US Census by the direct method, using the age groups 2. Crude estimates of obesity among all adults are also presented. More than half of these (5. Of the 9. 12. 0 respondents, 1. Hispanic Asian. Detailed sample sizes by sex, age, and race/Hispanic origin are shown in Table 1. The prevalence of high weight for recumbent length among infants and toddlers from birth to aged 2 years was 8. CI, 5. 8%- 1. 1. 1%) (Table 2). There was a significant difference between boys and girls; 5% of boys (9. CI, 3. 5%- 7. 0%) and 1. CI, 7. 3%- 1. 7. 4%) had high weight for recumbent length (P. There were no significant differences between the race/Hispanic origin groups (P. When WHO growth charts were used to define excess weight for recumbent length, 7. CI, 4. 9%- 1. 0. 3%) of infants and toddlers had high weight for recumbent length (Table 2). In 2. 01. 1- 2. 01. CI, 2. 9. 1%- 3. 4. CI, 1. 4. 9%- 1. 9. Table 3). In 2. 01. P. The prevalence of obesity was lower in non- Hispanic Asian youth (8. CI, 5. 7%- 1. 2. 7%) than in youth who were non- Hispanic white (1. CI, 1. 0. 8%- 1. 8. P. The prevalence of obesity was also lower among non- Hispanic white youth compared with non- Hispanic black youth (P. There was no difference in prevalence between non- Hispanic black youth and Hispanic youth (P. More than 8% (8. 4%; 9. CI, 5. 9%- 1. 1. 6%) of 2- to 5- year- olds were obese compared with 1. CI, 1. 4. 5%- 2. 1. P. There was no difference in obesity prevalence between 6- to 1. P. Additional information on the unweighted number of participants with high weight for recumbent length or who were obese is detailed in e. Table 1 in the Supplement. The percentage of adolescents aged 1. BMI greater than or equal to 3. CI, 1. 0. 9%- 1. 7. Age- adjusted and crude prevalence estimates of overweight and obesity among adults by sex, age, and race/Hispanic origin are shown in Tables 4 and 5. The age- adjusted estimates indicate that more than two- thirds (6. CI, 6. 5. 2%- 7. 1. CI, 3. 2. 0%- 3. 7. CI, 5. 2%- 7. 7%) were extremely obese (grade 3 obesity) in 2. There were significant differences by sex, age, and race/Hispanic origin. For example, the prevalence of grade 3 obesity differed by sex (P. The prevalence of grade 3 obesity also varied by race/Hispanic origin (P. Among infants and toddlers from birth to aged 2 years, there was no significant change in high weight for length prevalence (. Among children and adolescents aged 2 to 1. Among adults, there was no significant change in obesity prevalence in the total population (+2. P. In these analyses, the only significant trends were found in women aged 6. P. Among girls aged 2 to 5 years, there was a 5. P. In sex and race/Hispanic origin adjusted analyses of trends, results were similar to those in the unadjusted analyses (e. Table 3 in the Supplement). Tests for an interaction between survey period and age found an interaction in children (P. The overall prevalence of obesity among youth remained unchanged compared with that in 2. Similarly, there was no significant change in obesity prevalence among adults between 2. In subgroup analyses, the prevalence of obesity among children aged 2 to 5 years decreased from 1. Because these age subgroup analyses and tests for significance did not adjust for multiple comparisons, these results should be interpreted with caution. Newly available estimates of obesity among non- Hispanic Asians show that almost 9% of non- Hispanic Asian youth and 1. Hispanic Asian adults were obese according to BMI cut points. BMI, however, is not a perfect measure of body fat. It is highly correlated with body fat but does not account for differences in distribution of body fat or differences between race/Hispanic origin groups, sex, and age. Different sex, age, and race/ethnicity groups may have different body fat at the same BMI. For example, some research suggests that Asians may have more body fat than whites, especially at lower BMIs. Risk of morbidity and mortality may not be completely captured by BMI. Given concerns that health risks begin at a lower BMI among Asians compared with others, some Asian countries have adopted lower cut points of BMI to define overweight or obesity,2. WHO has recommended continuing to use the standard cutoffs for international comparisons, a WHO expert committee has recommended lower cutoffs for Asians as points for . Overall, among infants and toddlers from birth to aged 2 years, 8. CDC weight for recumbent length growth charts, whereas 7. WHO growth charts. For all groups (sex and race/Hispanic origin), the estimates were slightly higher with the CDC growth charts than WHO growth standards. The 2 sets of growth charts differ in that the CDC charts represent a growth reference based on the general US population in the 1. WHO growth standards, on the other hand, represent growth of children in select settings around the world with optimal feeding practices, among other factors. Recent decreases in the prevalence of obesity have been reported in some populations of youth in the United States. Between 2. 00. 8 and 2. US Virgin Islands. The absolute decreases ranged from 0. Similarly, between 2. Massachusetts. 2. The decrease we observed among preschool- aged children is consistent with the decreases observed in low- income children in the United States overall and in some states individually. Analyses of trends in obesity prevalence among middle and high school students have shown mixed results. Among public middle school students in New York City, a recent analysis found a decrease in obesity prevalence between 2. Other researchers using a school- based survey found an increase in obesity prevalence among US adolescents between 2. In addition, data from the Youth Risk Behavior Surveillance System showed an increase in the prevalence of obesity between 1. NHANES results among middle school. In this analysis, we selected 2. Hispanic origin. For example, analyses of childhood obesity trends between 1. In the current analysis, trend tests were conducted on different age groups. When multiple statistical tests are undertaken, by chance some tests will be statistically significant (eg, 5% of the time using . In some cases, adjustments are made to account for these multiple comparisons, and a P value lower than . In the current analysis, adjustments were not made for multiple comparisons, but the P value is presented. Obesity prevalence remains high and thus it is important to continue surveillance. Corresponding Author: Cynthia L. Ogden, Ph. D, National Center for Health Statistics, Centers for Disease Control and Prevention, 3. Toledo Rd, Room 4. Hyattsville, MD 2. Author Contributions: Dr Ogden had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ogden, Flegal. Analysis and interpretation of data: Ogden, Carroll, Kit, Flegal. Drafting of the manuscript: Ogden. Critical revision of the manuscript for important intellectual content: Ogden, Carroll, Kit, Flegal. Statistical analysis: Carroll, Kit. Study supervision: Ogden. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Role of the Sponsors: All data used in this study were collected by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). The CDC reviewed and approved this article before submission. Disclaimer: The findings and conclusions in this article are those of the authors and not necessarily those of the CDC. RR- 7): 1- 2. 6. Pub. Med. 6. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2. Ogden. . 2. 01. 2; (8. Pub. Med. 8. Flegal. Pub. Med. Article. Ogden. . 2. 01. 2; 3. Pub. Med. Article. Ogden. . 2. 01. 3; (1. Pub. Med. 14. Ogden. Pub. Med. 15. Kuczmarski. Pub. Med. 16. Grummer- Strawn. RR- 9): 1- 1. 5. Pub. Med. 17. Wolter. . Introduction to Variance Estimation. Analysis of Complex Surveys. Chichester, UK: John Wiley; 1. Ahima. . 2. 01. 3; 3. Pub. Med. Article. Flegal. . 2. 01. 0; 9. Pub. Med. Article. Flegal. . 2. 00. 9; 8. Pub. Med. Article. Deurenberg. . 2. 00. Pub. Med. Article. Baumgartner. . 1. Pub. Med. Article. Chu. . 2. 00. 5; 6(4): 2. Pub. Med. Article. WHO Expert Consultation. Pub. Med. Article. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/Height- for- Age, Weight- for- Age, Weight- for- Length, Weight- for- Height and Body Mass Index- for- Age: Methods and Development. Geneva, Switzerland: WHO; 2. Centers for Disease Control and Prevention (CDC). Pub. Med. 28. Wen. Pub. Med. Article. Centers for Disease Control and Prevention (CDC). Pub. Med. 30. Iannotti. Pub. Med. 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