Summary
This brief report examined obesity prevalence among US youth from 2011 to 2023 using National Health and Nutrition Examination Survey data. Obesity prevalence significantly increased overall, particularly among non-Hispanic Black children and adolescents. Findings highlighted worsening racial disparities and underscored an urgent need for targeted early childhood obesity prevention efforts.
Keywords: NHANES, paediatric obesity, prevalence, public health, trends
1 |. INTRODUCTION
Obesity among children and adolescents remains a major public health concern in the United States due to its strong association with adverse physical and psychosocial outcomes, including increased risk for chronic diseases such as Type 2 diabetes, cardiovascular disorders, and mental health conditions.1–3 Monitoring trends in obesity prevalence is critical for developing targeted public health interventions and policies aimed at mitigating its impact across younger populations. We aimed to assess the total and race-specific obesity prevalence changes in US youth through analysis of nationally representative data from 2011 to 2023.
2 |. METHODS
We analysed data from the National Health and Nutrition Examination Survey (NHANES), a national cross-sectional health survey, for its 2011–2012, 2013–2014, 2015–2016, 2017–2020, and 2021–2023 cycles.4 Due to the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) combined the 2017–2018 cycle with the 2019 to March 2020 cycle and began collecting data between August 2021 and August 2023 to maintain nationally representative data. The response rate was 69.5% in 2011–2012 and a sharp decline of 25.7% in 2021–2023.4 Standardized techniques and equipment were used to measure height and weight. 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, and we followed the STROBE reporting guideline.
Results were presented by age groups of 2–5, 6–11, 12–19, and 2–19 years. We followed the CDC growth chart to define obesity for US children and adolescents as BMI at or above the 95th percentile.5 Parents reported child race and ethnicity, and sex through a questionnaire.
To account for complex sample design in all analyses, we utilized NHANES sampling weight (mobile examination centre), stratification, and clustering when estimating prevalence of obesity and 95% confidence interval. Linear trends across all years were tested using a logistic regression.6 Statistical analyses were performed using R version 4.4.2, and statistical significance was p < 0.05.
3 |. RESULTS
The total study sample comprised 17 459 children and adolescents with a mean (SD) age of 9.92 (5.07) years (8866 [50.8%] boys and 8593 [49.2%] girls). The prevalence of obesity among youth aged 2–19 years grew from 16.9% (95% CI, 14.9%–18.9%) in 2011–2012 to 19.7% (95% CI, 18.0%–21.4%) in 2017–2020 and then to 21.1% (95% CI, 18.9%–23.3%) in 2021–2023 (Table 1 and Figure 1). Between the 2011–2012 and 2021–2023 periods, obesity prevalence significantly increased from 16.7% to 23.0% (p for trend ≤.001) among boys but not among girls (p for trend = .23) (Figure 1). Moreover, there were significant increasing trends in obesity prevalence among children aged 2–5 and 6–11 years, which were absent for adolescents aged 12–19 years.
TABLE 1.
Prevalence of obesity in children and adolescents stratified by age and race and ethnicity from 2011 to 2023.a
| Allb |
Mexican American |
Non-Hispanic Black |
Non-Hispanic White |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of participants | Prevalence (95% CI) | p-valuec | No. of participants (%) | Prevalence (95% CI) | p-valuec | No. of participants (%) | Prevalence (95% CI) | p-valuec | No. of participants (%) | Prevalence (95% CI) | p-valuec | |
|
| ||||||||||||
| Age 2–5 years | <0.001 | 0.13 | 0.21 | 0.004 | ||||||||
| 2011–2012 | 883 | 8.30 (5.72–10.9) | 288 (32.6) | 16.7 (11.8–21.7) | 276 (31.3) | 11.3 (6.86–15.7) | 164 (18.6) | 3.37 (0.84–5.90)d | ||||
| 2013–2014 | 855 | 9.44 (6.84–12.0) | 269 (31.5) | 15.0 (11.3–18.7) | 212 (24.8) | 9.30 (5.52–13.1) | 231 (27.0) | 7.12 (3.33–10.9) | ||||
| 2015–2016 | 827 | 13.9 (11.6–16.1) | 247 (29.9) | 18.4 (14.1–22.6) | 209 (25.3) | 13.5 (6.89–20.1) | 242 (29.3) | 12.4 (7.94–16.9) | ||||
| 2017–2020 | 1154 | 12.6 (10.9–14.4) | 246 (21.3) | 20.7 (15.7–25.6) | 321 (27.8) | 12.5 (8.61–16.3) | 390 (33.8) | 9.94 (7.30–12.6) | ||||
| 2021–2023 | 515 | 14.8 (12.1–17.6) | 137 (26.6) | 20.0 (13.6–26.5) | 83 (16.1) | 18.6 (4.47–32.8) | 214 (41.6) | 12.2 (6.42–18.1) | ||||
| Age 6–11 years | 0.025 | 0.13 | 0.002 | 0.25 | ||||||||
| 2011–2012 | 1268 | 18.1 (14.6–21.5) | 397 (31.3) | 26.2 (22.4–30.0) | 365 (28.8) | 23.5 (17.5–29.6) | 300 (23.7) | 13.9 (7.10–20.6) | ||||
| 2013–2014 | 1307 | 17.5 (14.2–20.7) | 411 (31.4) | 23.6 (19.2–28.0) | 358 (27.4) | 18.9 (14.9–23.0) | 343 (26.2) | 14.3 (9.94–18.6) | ||||
| 2015–2016 | 1269 | 18.4 (15.0–21.7) | 461 (36.3) | 27.1 (22.8–31.3) | 271 (21.4) | 20.9 (16.4–25.3) | 350 (27.6) | 13.7 (10.8–16.6) | ||||
| 2017–2020 | 1770 | 20.9 (18.2–23.6) | 459 (25.9) | 27.6 (23.0–32.1) | 489 (27.6) | 26.4 (21.7–31.2) | 504 (28.5) | 17.4 (13.3–21.4) | ||||
| 2021–2023 | 864 | 22.5 (18.8–26.2) | 247 (28.6) | 30.7 (23.9–37.6) | 126 (14.6) | 38.8 (29.7–48.0) | 347 (40.2) | 17.1 (13.1–21.1) | ||||
| Age 12–19 years | 0.23 | 0.35 | 0.037 | 0.92 | ||||||||
| 2011–2012 | 1204 | 20.4 (17.1–23.6) | 350 (29.1) | 22.6 (17.7–27.5) | 367 (30.5) | 22.3 (15.7–28.8) | 264 (21.9) | 19.3 (14.1–24.4) | ||||
| 2013–2014 | 1361 | 20.6 (16.3–24.9) | 463 (34.0) | 23.0 (18.6–27.3) | 332 (24.4) | 23.3 (16.8–29.8) | 345 (25.3) | 19.6 (11.5–27.7) | ||||
| 2015–2016 | 1244 | 20.7 (16.8–24.6) | 418 (33.6) | 28.7 (24.8–32.5) | 287 (23.1) | 27.0 (19.4–34.7) | 333 (26.8) | 15.0 (11.1–19.0) | ||||
| 2017–2020 | 1825 | 22.1 (19.7–24.6) | 438 (24.0) | 27.7 (22.6–32.9) | 460 (25.2) | 29.1 (24.9–33.3) | 577 (31.6) | 19.0 (14.9–23.0) | ||||
| 2021–2023 | 1113 | 22.7 (19.4–26.0) | 353 (31.7) | 26.3 (17.8–34.7) | 156 (14.0) | 37.5 (22.2–52.9) | 432 (38.8) | 19.6 (15.5–23.7) | ||||
| Age 2–19 years | 0.002 | 0.057 | 0.002 | 0.091 | ||||||||
| 2011–2012 | 3355 | 16.9 (14.9–18.9) | 1035 (30.8) | 22.4 (20.4–24.4)e | 1008 (30.0) | 20.2 (16.7–23.7)f | 728 (21.7) | 14.1 (10.7–17.4)e,f | ||||
| 2013–2014 | 3523 | 17.2 (15.0–19.3) | 1143 (32.4) | 21.3 (18.2–24.5)e | 902 (25.6) | 18.8 (15.8–21.9) | 919 (26.1) | 15.3 (12.0–18.6)e | ||||
| 2015–2016 | 3340 | 18.5 (16.0–20.9) | 1126 (33.7) | 25.8 (22.8–28.8)e | 767 (23.0) | 22.0 (16.7–27.4)f | 925 (27.7) | 14.1 (12.0–16.1)e,f | ||||
| 2017–2020 | 4749 | 19.7 (18.0–21.4) | 1143 (24.1) | 26.2 (22.5–29.8)e | 1270 (26.7) | 24.8 (21.8–27.8)f | 1471 (31.0) | 16.6 (13.7– 19.4)e,f | ||||
| 2021–2023 | 2492 | 21.1 (18.9–23.3) | 737 (29.6) | 26.6 (21.1–32.0)e,g | 365 (14.6) | 33.9 (24.0–43.8)f,g | 993 (39.8) | 17.3 (15.1–19.4)e,f | ||||
Data are from the National Health and Nutrition Examination Survey; all estimates except sample sizes were weighted (mobile examination centre weights). The values in the no. of participants columns for each race and ethnicity do not sum to the values in the no. of participants column under All because Asian individuals and those of more than 1 race and ethnicity were not included as subgroups because of the low sample sizes.
Includes all self-reported race and ethnicity groups.
The linear trends were conducted using 2-year cycles except for 2017–2020 and 2021–2023.
The number of individuals with obesity was fewer than 10.
Values for the prevalence difference of obesity between Mexican American and non-Hispanic White individuals were significant at p < 0.05.
Values for the prevalence difference of obesity between non-Hispanic Black and non-Hispanic White individuals were significant at p < 0.05.
Values for the prevalence difference of obesity between Mexican American and non-Hispanic Black individuals were significant at p < 0.05.
FIGURE 1.
Prevalence of obesity in US youth aged 2–19 years stratified by sex from 2011 to 2023.
Among different races and ethnicities, a significant increase in the prevalence of obesity from the 2011–2012 to the 2021–2023 survey cycles was only found among non-Hispanic Black (20.2%–33.9%; p for trend = 0.002) individuals but not among Mexican American (p for trend = 0.057) or non-Hispanic White (p for trend = 0.091) individuals. There were also significant increasing obesity trends within the 6–11 and 12–19 years age groups for non-Hispanic Black participants and within the 2–5 years age group for non-Hispanic White participants.
4 |. DISCUSSION
Obesity prevalence increased for children aged 2–19 years between 2011–2012 and 2017–2020, but the United States faced an even greater increase during 2021–2023, especially for non-Hispanic Black individuals. While a recent study assessed the overall trends in obesity prevalence among children and adolescents,3 our findings contribute race-specific trends in obesity prevalence. Two major limitations of the study are the declining response rates for NHANES after 2020 and the resulting small sample sizes for the stratified data analysis. Nevertheless, this study signals an urgent need for early obesity prevention during childhood.
FUNDING INFORMATION
This work was partially supported by a NORC 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. The NIH had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, preparation, review or approval of the manuscript, and decision to submit the manuscript for publication.
Footnotes
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
REFERENCES
- 1.Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA. 2018;319(16):1723–1725. doi: 10.1001/jama.2018.3060 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hu K, Staiano AE. Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatr. 2022;176(10):1037–1039. doi: 10.1001/jamapediatrics.2022.2052 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Emmerich SD, Fryar CD, Stierman B, Gu Q, Afful J, Ogden CL. Trends in obesity-related measures among US children, adolescents, and adults. JAMA. 2025;333(12): 1082–1084. doi: 10.1001/jama.2024.27676 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Centers for Disease Control and Prevention National Center for Health Statistics. National Health and Nutrition Examination Survey. Centers for Disease Control and Prevention; 2024. Accessed October 7, 2024. https://www.cdc.gov/nchs/nhanes/index.html [Google Scholar]
- 5.Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat. 2002;246:1–190. [PubMed] [Google Scholar]
- 6.Ingram DD, Malec DJ, Makuc DM, et al. National Center for Health Statistics guidelines for analysis of trends. Vital Health Stat. 2018;2(179):1–71. [PubMed] [Google Scholar]