Introduction
Obesity prevalence among children and adolescents has risen sharply, yet there is
a limited understanding of the age-specific dynamics of obesity as there is no single
nationally representative cohort following children into young adulthood. Investigators
constructed a pooled data set of 5 nationally representative panels and modeled age-specific
obesity incidence from childhood into young adulthood.
Methods
This longitudinal prospective follow-up used 718,560 person-years of observation in
a pooled data set of 5 high-quality nationally representative panels—National Longitudinal
Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and
Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011—constructed
by the authors, covering 1980–2016. Differences in obesity incidence across birth
cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic
Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data
were analyzed from September 2018 to October 2021.
Results
Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06,
95% CI=1.05, 1.07); however, incidence was nonlinear, exhibiting an inverted “U”-shaped
pattern before 15 years of age and then rising from adolescence through 30 years.
Obesity incidence more than doubled between the cohorts born in 1957–1965 and those
born in 1974–1985 during adolescence. There was no significant change among those
born in 1991–1994 and 2003–2006 up to age 15 years. Compared with non-Hispanic White
children, non-Hispanic Black and Hispanic children had higher obesity incidence in
all study cohorts. The magnitude of these disparities on the relative scale remained
stable throughout the study period.
Conclusions
Although many children become obese before the age of 10, obesity incidence rises
from about 15 years into early adulthood, suggesting that interventions are required
at multiple developmental stages.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Do birth cohorts matter? Age-period-cohort analyses of the obesity epidemic in the United States.Soc Sci Med. 2009; 69: 1439-1448https://doi.org/10.1016/j.socscimed.2009.08.040
- Flexible age-period-cohort modelling illustrated using obesity prevalence data.BMC Med Res Methodol. 2020; 20: 16https://doi.org/10.1186/s12874-020-0904-8
- Age–period–cohort analyses of obesity prevalence in U.S. adults.Public Health. 2016; 141: 163-169https://doi.org/10.1016/j.puhe.2016.09.021
- What is a cohort effect? Comparison of three statistical methods for modeling cohort effects in obesity prevalence in the United States, 1971–2006.Soc Sci Med. 2010; 70: 1100-1108https://doi.org/10.1016/j.socscimed.2009.12.018
- Trends in obesity prevalence by race and Hispanic origin-1999-2000 to 2017-2018.JAMA. 2020; 324: 1208-1210https://doi.org/10.1001/jama.2020.14590
- Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014.JAMA. 2016; 315: 2292-2299https://doi.org/10.1001/jama.2016.6361
- Diabetes complications in childhood and adolescent onset type 2 diabetes-a review.J Diabetes Complications. 2016; 30: 951-957https://doi.org/10.1016/j.jdiacomp.2016.02.009
- The role of obesity in pediatric orthopedics.J Am Acad Orthop Surg Glob Res Rev. 2019; 3: e036https://doi.org/10.5435/JAAOSGlobal-D-19-00036
- Increased asthma risk and asthma-related health care complications associated with childhood obesity.Am J Epidemiol. 2013; 178: 1120-1128https://doi.org/10.1093/aje/kwt093
- Childhood obesity and obstructive sleep apnea syndrome.J Appl Physiol (1985). 2010; 108: 436-444https://doi.org/10.1152/japplphysiol.00689.2009
- Childhood overweight and obesity and the risk of depression across the lifespan.BMC Pediatr. 2020; 20: 25https://doi.org/10.1186/s12887-020-1930-8
- Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden.BMC Med. 2020; 18: 30https://doi.org/10.1186/s12916-020-1498-z
- Psychological consequences of childhood obesity: psychiatric comorbidity and prevention.Adolesc Health Med Ther. 2016; 7: 125-146https://doi.org/10.2147/AHMT.S101631
- Childhood obesity: causes and consequences.J Family Med Prim Care. 2015; 4: 187-192https://doi.org/10.4103/2249-4863.154628
- Psychological well-being and weight-related teasing in childhood obesity: a case–control study.Eat Weight Disord. 2020; 25: 751-759https://doi.org/10.1007/s40519-019-00683-y
- Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.Obes Rev. 2016; 17: 95-107https://doi.org/10.1111/obr.12334
- In, out, and fluctuating: obesity from adolescence to adulthood.Ann Epidemiol. 2020; 41: 14-20https://doi.org/10.1016/j.annepidem.2019.12.003
- Measurement and long-term health risks of child and adolescent fatness.Int J Obes Relat Metab Disord. 1997; 21: 507-526https://doi.org/10.1038/sj.ijo.0800454
- Do obese children become obese adults? A review of the literature.Prev Med. 1993; 22: 167-177https://doi.org/10.1006/pmed.1993.1014
- Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study.Metabolism. 1996; 45: 235-240https://doi.org/10.1016/s0026-0495(96)90060-8
- Entrenched obesity in childhood: findings from a national cohort study.Ann Epidemiol. 2017; 27: 435-441https://doi.org/10.1016/j.annepidem.2017.05.016
- The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies.Diabetes Res Clin Pract. 2010; 89: 309-319https://doi.org/10.1016/j.diabres.2010.04.012
- The duration of obesity and the risk of type 2 diabetes.Public Health Nutr. 2011; 14: 119-126https://doi.org/10.1017/S1368980010001813
- Weight histories and mortality among finnish adults: the role of duration and peak body mass index.Epidemiology. 2014; 25: 707-710https://doi.org/10.1097/EDE.0000000000000147
- Modeling obesity histories in cohort analyses of health and mortality.Epidemiology. 2013; 24: 158-166https://doi.org/10.1097/EDE.0b013e3182770217
- Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis.Obes Rev. 2016; 17: 56-67https://doi.org/10.1111/obr.12316
- Incidence of childhood obesity in the United States.N Engl J Med. 2014; 370: 403-411https://doi.org/10.1056/NEJMoa1309753
- Dynamics of obesity and chronic health conditions among children and youth.JAMA. 2010; 303: 623-630https://doi.org/10.1001/jama.2010.104
- Objectively assessed associations between physical activity and body composition in middle-school girls: the Trial of Activity for Adolescent Girls.Am J Epidemiol. 2007; 166: 1298-1305https://doi.org/10.1093/aje/kwm202
- Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study.J Pediatr. 2007; 150: 18-25https://doi.org/10.1016/j.jpeds.2006.09.039
- Influence of the home environment on the development of obesity in children.Pediatrics. 1999; 103: e85https://doi.org/10.1542/peds.103.6.e85
- Childhood obesity incidence in the United States: a systematic review [published correction appears in Child Obes. 2016;12(3):226].Child Obes. 2016; 12: 1-11https://doi.org/10.1089/chi.2015.0055
- Cohort profile: the National Longitudinal Survey of Youth 1979 (NLSY79).Int J Epidemiol. 2019; 48 (–22e): 22https://doi.org/10.1093/ije/dyy133
- National longitudinal survey of youth 1997 (NLSY97).National Opinion Research Center, Chicago, ILNovember 2000https://www.bls.gov/nls/nlsy97/other-documentation/technical-sampling-report/nlsy97-technical-sampling-report.pdfDate accessed: September 1, 2021
- Cohort profile: the National Longitudinal Study of Adolescent to Adult Health (Add Health).Int J Epidemiol. 2019; 48 (–1415k): 1415https://doi.org/10.1093/ije/dyz115
- Early childhood longitudinal study, kindergarten class of 1998–99 (ECLS-K): combined User’s manual for the ECLS-K eighth-grade and K-8 full sample data files and electronic Codebooks (NCES 2009-004).National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, Washington, DCFebruary 2009https://nces.ed.gov/ecls/data/ECLSK_K8_Manual_part1.pdf(Accessed September 1, 2021)Date accessed: September 1, 2021
- Early childhood longitudinal study, kindergarten class of 2010–11 (ECLS-K: 2011). User’s manual for the ECLS-K: 2011 kindergarten data file and electronic Codebook, public version (NCES 2015-074).National Center for Education Statistics, U.S. Department of Education., Washington, DCApril 2015https://nces.ed.gov/pubs2015/2015074.pdf(Accessed September 1, 2021)Date accessed: September 1, 2021
- National Longitudinal Survey of Youth 1979 Cohort, 1981–2016 (rounds 3–27).Center for Human Resource Research, U.S. Bureau of Labor Statistics, Washington, DC2019
- National Longitudinal Survey of Youth 1997 Cohort, 1997–2015 (rounds 1–23).Center for Human Resource Research, U.S. Bureau of Labor Statistics, Washington, DC2019
- The National Longitudinal Study of Adolescent to Adult Health: study design.Add Health, 2022http://www.cpc.unc.edu/projects/addhealth/designDate accessed: January 27, 2022
- Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data.Ann Intern Med. 2015; 163: 245-253https://doi.org/10.7326/M14-1753
CDC growth charts. Centers for Disease Control and Prevention, National Center for Health Statistics. https://www.cdc.gov/growthcharts/cdc_charts.htm. Updated December 7, 2016. Accessed September 1, 2021.
- Discrete-time methods for the analysis of event histories.Sociol Methodol. 1982; 13: 61-98https://doi.org/10.2307/270718
- On the variances of asymptotically normal estimators from complex surveys.Int Stat Rev. 1983; 51: 279-292https://doi.org/10.2307/1402588
Korn EL, Graubard BI. Analysis of Health Surveys. New York, NY: John Wiley & Sons, 2011. Vol 323. https://onlinelibrary.wiley.com/doi/book/10.1002/9781118032619. Accessed April 27, 2021.
- Incidences of obesity and extreme obesity among U.S. adults: findings from the 2009 Behavioral Risk Factor Surveillance System.Popul Health Metr. 2011; 9: 56https://doi.org/10.1186/1478-7954-9-56
- Changes in body mass during elementary and middle school in a national cohort of kindergarteners.Pediatrics. 2011; 128: e1411-e1417https://doi.org/10.1542/peds.2011-0114
- Adolescent obesity and puberty: the “perfect storm.Ann N Y Acad Sci. 2008; 1135: 265-279https://doi.org/10.1196/annals.1429.009
- Environmental influences on childhood obesity: ethnic and cultural influences in context.Physiol Behav. 2008; 94: 61-70https://doi.org/10.1016/j.physbeh.2007.11.019
- Racial and ethnic disparities in early childhood obesity.Pediatrics. 2018; 141e20170865https://doi.org/10.1542/peds.2017-0865
- The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity.Prev Med. 2016; 91: 103-109https://doi.org/10.1016/j.ypmed.2016.07.009
- Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America's Health and the Obesity Society.Diabetes Care. 2008; 31: 2211-2221https://doi.org/10.2337/dc08-9024
- Female overweight and obesity in adolescence: developmental trends and ethnic differences in prevalence, incidence, and remission.J Youth Adolesc. 2012; 41: 76-85https://doi.org/10.1007/s10964-011-9664-4
- Incidence and remission rates of overweight among children aged 5 to 13 years in a district-wide school surveillance system.Am J Public Health. 2005; 95: 1588-1594https://doi.org/10.2105/AJPH.2004.054015
- Hispanic and black U.S. children's paths to high adolescent obesity prevalence.Pediatr Obes. 2012; 7: 423-435https://doi.org/10.1111/j.2047-6310.2012.00080.x
- Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health.Am J Clin Nutr. 2004; 80: 569-575https://doi.org/10.1093/ajcn/80.3.569
Child Trends. Immigrant children. Bethesda, MD: Child Trends. https://www.childtrends.org/indicators/immigrant-children. Published 2018. Accessed November, 2018.
- Disparities in obesity and overweight prevalence among U.S. immigrant children and adolescents by generational status.J Community Health. 2009; 34: 271-281https://doi.org/10.1007/s10900-009-9148-6
- Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component.BMC Endocr Disord. 2020; 20: 52https://doi.org/10.1186/s12902-020-0526-5
- Reducing racial/ethnic disparities in childhood obesity: the role of early life risk factors.JAMA Pediatr. 2013; 167: 731-738https://doi.org/10.1001/jamapediatrics.2013.85
Article Info
Identification
Copyright
© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
