Trends in Obesity Prevalence Among Children and Adolescents Aged 2 to 19 Years in the US From 2011 to 2020

Obesity among youth is a major public health concern in the US.^1,2 Childhood obesity is associated with cardiometabolic comorbidities throughout life.³ This study aimed to examine changes in obesity prevalence among US youth using the most recently released nationally representative data from 2011 to 2020.

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey representing the US population, for 2011 to 2012, 2013 to 2014, 2015 to 2016, and 2017 to 2020.⁴ The 2017 to 2020 data set consisted of data from 2017 until the COVID-19 pandemic in March 2020 that ended data collection for the 2019 to 2020 period. Combining the results of operations from 2019 to March 2020 and 2017 to 2018, the data maintained a nationally representative estimate. The response rate was 69.5% in 2011 to 2012 and declined to 46.9% in 2017 to 2020.⁴ Weight and height were measured using standardized techniques and equipment. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. The Pennington Biomedical Research Center Institutional Review Board deemed this study as non–human participant research. The study followed the STROBE reporting guideline.

Data were categorized by age group: 2 to 5 years, 6 to 11 years, 12 to 19 years, and 2 to 19 years. Obesity for children and adolescents was defined as BMI for age at or above the 95th percentile based on the Centers for Disease Control and Prevention growth chart.⁵ Parents reported child race and ethnicity and sex.

We estimated prevalence of obesity and 95% CIs using NHANES sampling weights (mobile examination center [MEC]), stratification, and clustering to account for complex sample design in all analyses. Linear trends across all years were tested using logistic regression.⁶ Statistical significance was P < .05. Statistical analyses were performed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp) and SAS, version 9.4 (SAS Institute Inc).

The study included 14 967 children and adolescents (mean [SD] age, 9.81 [5.07] years; 7613 [50.9%] boys and 7354 [49.1%] girls). Among youth aged 2 to 19 years, the prevalence of obesity increased from 16.9% (95% CI, 14.9%-18.9%) in 2011 to 2012 to 19.7% (95% CI, 18.0%-21.5%) in 2017 to 2020 (Table and Figure). Overall, obesity increased from 16.7% to 20.9% for boys (P for trend = .0084) but not for girls (P for trend = .35) between the 2011 to 2012 and 2017 to 2020 periods (Figure). As shown in the Table, the prevalence of obesity also increased significantly in children aged 2 to 5 years but not in children aged 6 to 11 years or adolescents aged 12 to 19 years.

Among all participants, there were significant increased trends for obesity from the 2011 to 2012 to the 2017 to 2020 periods for Mexican American (22.4% to 26.2%; P for trend = .03) and non-Hispanic Black (20.2% to 24.8%; P for trend = .02) individuals but not for non-Hispanic White (P for trend = .33) individuals overall. There was a significant increase for non-Hispanic White 2- to 5-year-old children (P for trend = .001; 2011-2012: 3.4 [0.8-6.0], 2013-2014: 7.1 [3.3-11.0], 2015-2016: 12.4 [7.8-17.0], 2017-2020: 9.9 [7.3-12.6]) but for no other specific race or ethnicity by age group.

Between 2011 to 2012 and 2017 to 2020, obesity increased for children aged 2 to 5 years and 2 to 19 years and for Mexican American and non-Hispanic Black children. A limitation of the study is the decreased response rates for NHANES. Moreover, there was a small sample size and low cases of obesity when we stratified data among different ages and races and ethnicities. Because of the significant increase in obesity, there is an urgent need for identification of antecedents and correlates of adiposity and cardiometabolic risk for early obesity prevention.

Accepted for Publication: April 24, 2022.

Published Online: July 25, 2022. doi:10.1001/jamapediatrics.2022.2052

Correction: This article was corrected on October 23, 2023, to correct pervasive errors resulting from the removal of weights during the final analyses to include race and ethnicity as a covariate. The corrected analyses resulted in changes to many of the prevalence rates reported in the text, Table, and Figure.

Corresponding Author: Amanda E. Staiano, PhD, Pediatric Obesity and Health Behavior Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808 (amanda.staiano@pbrc.edu).

Author Contributions: Dr Staiano 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: Staiano.

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

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Staiano.

Statistical analysis: Hu.

Administrative, technical, or material support: Staiano.

Supervision: Staiano.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was partially supported by a NORC Center grant (P30DK072476) from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases and grant U54 GM104940 from the NIH/National Institute of General Medicine Sciences, which funds the Louisiana Clinical and Translational Science Center.

Role of the Funder/Sponsor: The NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.