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Question  In 2013-2016, were there differences in obesity and severe obesity prevalence by demographics and urbanization level among US children and adolescents?

Findings  In this cross-sectional analysis that included 6863 children and adolescents aged 2 to 19 years, differences in obesity and severe obesity prevalence by age, race and Hispanic origin, and household education were found. Differences in obesity by urbanization levels were not significant, but the prevalence of severe obesity was significantly higher in non–metropolitan statistical areas (MSAs) (9.4%) than in large MSAs (5.1%).

Meaning  Differences in age, race and Hispanic origin, or education of household head were not related to the difference in severe obesity by urbanization.

Abstract

Importance  Differences in childhood obesity by demographics and urbanization have been reported.

Objective  To present data on obesity and severe obesity among US youth by demographics and urbanization and to investigate trends by urbanization.

Design, Setting, and Participants  Measured weight and height among youth aged 2 to 19 years in the 2001-2016 National Health and Nutrition Examination Surveys, which are serial, cross-sectional, nationally representative surveys of the civilian, noninstitutionalized population.

Exposures  Sex, age, race and Hispanic origin, education of household head, and urbanization, as assessed by metropolitan statistical areas (MSAs; large: ≥ 1 million population).

Main Outcomes and Measures  Prevalence of obesity (body mass index [BMI] ≥95th percentile of US Centers for Disease Control and Prevention [CDC] growth charts) and severe obesity (BMI ≥120% of 95th percentile) by subgroups in 2013-2016 and trends by urbanization between 2001-2004 and 2013-2016.

Results  Complete data on weight, height, and urbanization were available for 6863 children and adolescents (mean age, 11 years; female, 49%). In 2013-2016, the prevalence among youth aged 2 to 19 years was 17.8% (95% CI, 16.1%-19.6%) for obesity and 5.8% (95% CI, 4.8%-6.9%) for severe obesity. Prevalence of obesity in large MSAs (17.1% [95% CI, 14.9%-19.5%]), medium or small MSAs (17.2% [95% CI, 14.5%-20.2%]) and non-MSAs (21.7% [95% CI, 16.1%-28.1%]) were not significantly different from each other (range of pairwise comparisons P = .09-.96). Severe obesity was significantly higher in non-MSAs (9.4% [95% CI, 5.7%-14.4%]) compared with large MSAs (5.1% [95% CI, 4.1%-6.2%]; P = .02). In adjusted analyses, obesity and severe obesity significantly increased with greater age and lower education of household head, and severe obesity increased with lower level of urbanization. Compared with non-Hispanic white youth, obesity and severe obesity prevalence were significantly higher among non-Hispanic black and Hispanic youth. Severe obesity, but not obesity, was significantly lower among non-Hispanic Asian youth than among non-Hispanic white youth. There were no significant linear or quadratic trends in obesity or severe obesity prevalence from 2001-2004 to 2013-2016 for any urbanization category (P range = .07-.83).

Conclusions and Relevance  In 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.

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Article Information

Corresponding Author: Cynthia L. Ogden, PhD, National Center for Health Statistics, US Centers for Disease Control and Prevention, 3311 Toledo Rd, Hyattsville, MD 20782 (cogden@cdc.gov).

Accepted for Publication: April 3, 2018.

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.

Concept and design: Ogden, Hales.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ogden.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Fryar, Hales, Carroll, Aoki, Freedman.

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 Funder/Sponsor: The National Center for Health Statistics (NCHS) and the US Centers for Disease Control and Prevention (CDC) had a role in the design and conduct of the National Health and Nutrition Examination Surveys and in the collection and management of the data and the clearance of the manuscript; however, the NCHS and the CDC had no role in the preparation of the manuscript; or in the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this report are those of the authors and not necessarily the official position of the CDC.

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