Abstract
Obesity was first identified as an issue of significant public policy concern in the late 1990s, after which US obesity rates continued to grow. Now, more than one-third of adult Americans are obese or extremely obese while a further one-third or more are overweight; in addition, one-third of American children are at least overweight, and about one-sixth are obese. In this chapter we document the obesity status of the nation and its genesis over the past 50 years. We review various concepts and measures of obesity, including the conventional BMI and alternatives. Then, using the BMI, we review the patterns of US obesity for adults and children over time, disaggregated spatially and among various sociodemographic groups.
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Notes
- 1.
This section draws heavily on (and in places verbatim) the paper by MacEwan et al. (2015) which discusses various concepts and measures of obesity, details many aspects of the links between obesity and health outcomes, and explores the issues surrounding the use of the BMI as a measure of obesity and the potential consequences of doing so.
- 2.
More precisely, in 1959–1962, among all American adults 46.5% (50.2% of men and 42.9% of women) had BMI ≥ 25 and 14.1% (11.3% of men and 16.8% of women) had BMI ≥ 30; in 2011–2014, among all American adults 68.9% (71.7% of men and 66.1% of women) had BMI ≥ 25 and 36.0% (33.9% of men and 37.9% of women) had BMI ≥ 30.
- 3.
Adult height for males and females increased between 1952 and 2014. Males gained an inch in height and females gained slightly less than an inch. Holding body weight constant while increasing height would imply a decrease in BMI and hence in the prevalence of obesity and overweight. However, the large gains in body weight more than offset any increase in height.
- 4.
We see this more concretely in how the percentiles of the distribution have changed over time (see Table A2.5). In 1959–1962, the median BMI, or 50th percentile of the BMI distribution was 24.4 kg/m2, which increased to 27.6 kg/m2 in 2011–2014 (a 13% increase in median BMI). Many of the lower percentiles also increased over time but not as much as the median. The higher percentiles, however, increased much more: the 95th percentile of the BMI distribution grew 23% (from 33.9 to 41.9 kg/m2) and the 85th percentile BMI grew 19% (from 29.6 to 35.2 kg/m2). This means that everyone was getting larger but those in the upper percentiles with the greatest BMI were getting larger at a faster rate.
- 5.
Income is sometimes measured in relation to poverty thresholds, which are annual dollar amounts by family size and composition estimated by the US Census Bureau. The ratio of family income to the poverty threshold is called the poverty-to-income ratio (PIR). For example, if a family has a value of PIR = 2, its income is 200% of the poverty threshold.
- 6.
Jackson et al. (2009) measured percentage body fat of young men and women (aged 17–35 years) using dual-energy X-ray absorptiometry (DXA-BF%). For the same BMI of non-Hispanic white women, the DXA-BF% of African American women was 1.76 percentage points lower, but higher for Hispanic (1.65%), Asian (2.65%), and Asian-Indian (5.98%) women. For the same BMI of non-Hispanic white men, DXA-BF% of African American men was 4.59 percentage points lower and 4.29 percentage points higher for Asian-Indian men. Jackson et al. (2009) conclude that using the recommended BMI cutoff scores to define overweight and obesity systematically overestimated overweight and obesity prevalence for African American men and women, and underestimated prevalence for Asian-Indian men and women, Asian women, and Hispanic women.
- 7.
In the case of children, overweight and obesity is defined as BMI at or above sex- and age-specific 85th and 95th percentiles from the 2000 CDC Growth Charts (see Kuczmarski et al. 2002). Earlier studies referred to children with BMI between the 85th and 95th percentiles as “at risk of overweight” and those at or above the 95th percentile as “overweight.” Current usage of the word “overweight,” however, now refers to those previously known as “at risk of overweight,” and the term “obese” now refers to children who were formerly labeled as “overweight.”
- 8.
Nutrition concerns are complex. Some two billion people are estimated to be suffering from “hidden hunger,” caused by micronutrient deficiencies of one form or another (see, e.g., Lele 2015; International Food Policy Research Institute 2014).
- 9.
The WHO website http://www.who.int/gho/ncd/risk_factors/overweight/en/ that shows linked maps and histograms of prevalence is particularly interesting: http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/obesity/atlas.html.
- 10.
- 11.
Notably, six of the nine most obese countries in Fig. 2.11 are English-speaking (the United States, New Zealand, Australia, Canada, the United Kingdom, and Ireland, and all former British colonies) and a seventh is Mexico. These countries share a common cultural heritage and some genetics as well as language, and are closely connected in trade, all of which might facilitate the adoption of similar eating patterns and foods associated with obesity. However, this observation is speculative and the issue is left for future research.
References
Anderson, P.M., K.F. Butcher, and P.B. Levine. 2003. “Maternal Employment and Overweight Children.” Journal of Health Economics 22: 477–504.
Baum, C.L., and C.J. Ruhm. 2009. “Age, Socioeconomic Status and Obesity Growth.” Journal of Health Economics 28(3): 635–648.
Boney, C.M., A. Verma, R. Tucker, and B.R. Vohr. 2005. “Metabolic Syndrome in Childhood: Association with Birth Weight, Maternal Obesity and Gestational Diabetes Mellitus.” Pediatrics 115(3): e290–e296.
Burkhauser, R. V., and J. Cawley. 2008. “Beyond BMI: The Value of More Accurate Measures of Fatness and Obesity in Social Science Research.” Journal of Health Economics 27: 519–529.
Chan, D. C., Gerald F. Watts, P.H.R. Barrett, and V. Burke. 2003. “Waist Circumference, Waist-to-Hip Ratio and Body Mass Index as Predictors of Adipose Tissue Compartments in Men.” Quarterly Journal of Medicine 96: 441–447.
Chang, V.W., and D.S. Lauderdale. 2005. “Income Disparities in Body Mass Index and Obesity in the United States, 1971–2002.” Archives of Internal Medicine 165: 2122–2128.
De Onis, M., M. Blössner, and E. Borghi. 2010. “Global Prevalence and Trends of Overweight and Obesity Among Preschool Children.” American Journal of Clinical Nutrition 92: 1257–1264.
Deckelbaum, R.J., and C.L. Williams. 2001. “Childhood Obesity: The Health Issue.” Obesity 9(S11): 239S–243S.
Després, J.-P., S. Moorjani, P. J. Lupien, A. Tremblay, A. Nadeau, and C. Bouchard. 1990. “Regional Distribution of Body Fat, Plasma Lipoproteins, and Cardiovascular Disease.” Arteriosclerosis, Thrombosis, and Vascular Biology 10(4): 497–511.
Ebbeling, C.B., D.B. Pawlak, and D.S. Ludwig. 2002. “Childhood Obesity: Public-Health Crisis, Common Sense Cure.” The Lancet 360: 473–482.
Eknoyan, G. 2008. “Adolphe Quetelet (1796–1874)—The Average Man and Indices of Obesity.” Nephrology Dialysis Transplantation 23: 47–51.
Ezzati, M. 2016. “Trends in Adult Body-Mass Index in 200 Countries from 1975 to 2014: A Pooled Analysis of 1698 Population-Based Measurement Studies with 19.2 Million Participants.” The Lancet 397: 1377–1396.
Finkelstein, E.A., and L. Zuckerman. 2008. The Fattening of America: How the Economy Makes Us Fat, If It Matters, and What to Do About It. Hoboken, NJ: John Wiley & Sons Inc.
Finkelstein, E.A., C. Zhen, M. Bilger, J. Nonnemaker, A.M. Farooqui, and J.E. Todd. 2012. “Implications of a Sugar-Sweetened Beverage (SSB) Tax When Substitutions to Non-Beverage Items are Considered.” Journal of Health Economics 32: 219–239.
Flegal, K.M., and R.P. Troiano. 2000. “Changes in the Distribution of Body Mass Index of Adults and Children in the U.S. Population.” International Journal of Obesity Related Metabolic Disorders 24(7): 807–818.
Flegal, K.M., B.K. Kit, H. Orpana, and B.I. Graubard. 2013. “Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories.” Journal of the American Medical Association 309(1): 71–82.
Frankenfield, D. C., W. A. Rowe, R. N. Cooney, J. S. Smith, and D. Becker. 2001. “Limits of Body Mass Index to Detect Obesity and Predict Body Composition.” Nutrition 17: 26–29.
Freedman, D.S., and G. Perry. 2000. “Body Composition and Health Status Among Children and Adolescents.” Preventative Medicine 31(2): S34–S53.
Gallagher, D., S. B. Heymsfield, M. Heo, S. A. Jebb, P. R. Murgatroyd, and Y. Sakamoto. 2000. “Healthy Percentage Body Fat Ranges: An Approach for Developing Guidelines Based on Body Mass Index.” American Journal of Clinical Nutrition 72: 694–701.
Gelber, R. P., J. Michael Gaziano, J. Orav, J. E. Manson, J. E. Buring, and T. Kurth. 2008. “Measures of Obesity and Cardiovascular Risk Among Men and Women.” Journal of the American College of Cardiology 52(8): 605–615.
Jackson, A.S., K.J. Ellis, B.K. McFarlin, M.H. Sailors, and M.S. Bray. 2009. “Body Mass Index Bias in Defining Obesity of Diverse Young Adults: The Training Intervention and Genetics of Exercise Response (TIGER) Study.” British Journal of Nutrition 102(7): 1084–1090.
Janssen, I., P.T. Katzmarzyk, and R. Ross. 2004. “Waist Circumference and Not Body Mass Index Explains Obesity-Related Health Risk.” American Journal of Clinical Nutrition 79: 379–384.
Jones-Smith, J.C., P. Gordon-Larsen, A. Siddiqi, and B.M. Popkin. 2011. “Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys from 37 Developing Countries, 1989–2007.” American Journal of Epidemiology 173: 667–675.
Jones-Smith, J.C., P. Gordon-Larsen, A. Siddiqi, and B.M. Popkin. 2012. “Is the Burden of Overweight Shifting to the Poor Across the Globe? Time Trends Among Women in 39 Low- and Middle-Income Countries (1991–2008).” International Journal of Obesity 36: 1114–1120.
Keys, A., F. Fidanza, M. J. Karvonen, N. Kimura, and H. L. Taylor. 1972. “Indices of Relative Weight and Obesity.” Journal of Chronic Disease 25(6–7): 329–343.
Kuczmarski, R.J., C.L. Ogden, S.S. Guo, L.M. Grummer-Strawn, K.M. Flegal, Z. Mei, R. Wei, L.R. Curtin, A.F. Roche, and C.L. Johnson. 2002. “CDC Growth Charts for the United States: Methods and Development.” Vital Health Stat 11(246): 1–190. Available at: http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf.
Lele, U. 2015. “The Growing Obesity Epidemic Needs as Much Attention as Undernutrition in Sustainable Development Goals.” Global Nutrition Report, July 3rd, 2015. Available at: http://globalnutritionreport.org/2015/07/03/the-growing-obesity-epidemic-needs-as-much-attention-as-undernutrition-in-sustainable-development-goals/.
Litwin, S.E. 2008. “Which Measures of Obesity Best Predict Cardiovascular Risk?.” Journal of the American College of Cardiology 52(8): 616–619.
MacEwan, J.P., A.D. Smith, and J.M. Alston. 2015. “Quantifying Obesity in Economic Research: How Misleading Is the Body Mass Index?” Working Paper. University of California, Davis, Department of Agricultural and Resource Economics.
Ogden, C.L., M.S. Carroll, B.K. Kit, and K.M. Flegal. 2014. “Prevalence of Childhood and Adult Obesity in the United States, 2011–2012.” Journal of the American Medical Association 311(8): 806–814. Available at: http://jama.jamanetwork.com/article.aspx?articleid=1832542#Methods.
Pi-Sunyer, and F. Xavier. 1998. “Obesity,” in M.E Shils, J.A. Olson, M. Shike, and A.C. Ross eds. Modern Nutrition in Health and Disease. Baltimore, MD: Williams & Wilkins, pp. 1395–1418.
Ruhm, C.J. 2007. “Current and Future Prevalence of Obesity and Severe Obesity in the United States.” Forum for Health Economics and Policy 10(2). Available at: http://www.bepress.com/fhep/10/2/6/.
Sassi, F., M. Devaux, M. Cecchini, and E. Rusticelli. 2009. The Obesity Epidemic: Analysis of Past and Projected Future Trends in Selected OECD Countries. OECD Health Working Paper No. 45. Paris: OECD Publishing.
Segal, L.M., A. Martin, and J. Rayburn. 2016. The State of Obesity Policy: Better Policies for a Healthier America. Issue Report. Princeton, NJ: Robert Wood Johnson Foundation Trust for America’s Health, September. Available at: http://stateofobesity.org/files/stateofobesity2015.pdf.
Sturm R. 2003. “Increases in Clinically Severe Obesity in the United States, 1986–2000.” Archives of Internal Medicine 163:2146–2148.
Subramanian, S., J.M. Perkins, and K.T. Khan. 2009. “Do Burdens of Underweight and Overweight Coexist Among Lower Socioeconomic Groups in India?.” The American Journal of Clinical Nutrition 90(2): 369–376.
United Nations, Food and Agriculture Organization (FAO). 2015. “The State of Food Insecurity in the World 2015.” Available at: http://www.fao.org/hunger/key-messages/en/.
United Nations, World Health Organization (WHO). 2015. “Obesity and Overweight” Fact Sheet No. 311, Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/.
Wang, Y., and M.A. Beydoun. 2007. “The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis.” Epidemiologic Reviews 29: 6–28.
Wang, Y., and H. Lim. 2012. “The Global Childhood Obesity Epidemic and the Association Between Socio-Economic Status and Childhood Obesity.” International Review of Psychiatry 24(3): 176–188.
Wang, Y., E. B. Rimm, M. J. Stampfer, W. C. Willet, and F. B. Hu. 2005. “Comparison of Abdominal Adiposity and Overall Obesity in Predicting Risk of Type 2 Diabetes Among Men.” American Journal of Clinical Nutrition 81(3): 555–563.
Weiss, R., and S. Caprio. 2005. “The Metabolic Consequences of Childhood Obesity.” Best Practice and Research Clinical Endocrinology and Metabolism 19(3): 405–419.
WHO. 1995. “Physical Status: The Use and Interpretation of Anthropometry”. WHO Expert Committe on Physical Status, WHO Technical Report Series 854. Available at http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.
Zhang, Q., and Y. Wang. 2004. “Trends in the Association between Obesity and Socioeconomic Status in U.S. Adults: 1971 to 2000.” Obesity Research 12(10): 1622–1632.
Zhu, S., Z. Wang, S. Heshka, M. Heo, M.S. Faith, and S.B. Heymsfield. 2002. “Waist Circumference and Obesity-Associated Risk Factors Among Whites in the Third National Health and Nutrition Examination Survey: Clinical Action Thresholds.” The American Journal of Clinical Nutrition 76(4): 743–749.
Finkelstein, E., O.A. Khavjou, H. Thompson, J.G. Trogdon, L. Pan, B. Sherry, and W. Dietz. 2012. “Obesity and Severe Obesity Forecasts Through 2030.” American Journal of Preventative Medicine 42(6): 563–570.
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Appendix
Appendix
Source: Authors’ calculations based on 1959–62 National Health Examination Survey, NHANES I–III and continuous NHANESNotes: Density estimated with an Epanechnikov kernel function with 50 evaluation points. Data are weighted with sampling weights to be nationally representative
Distributions of BMI in the United States for those aged 18 years and older by gender
Source: Authors’ calculations based on 1959–62 National Health Examination Survey, NHANES I–III and continuous NHANES. The relationship between BMI and the poverty-to-income ratio is characterized by a kernel-weighted local polynomial smoother Notes: PIR is reported family income relative to poverty thresholds for a family of a particular size and age as determined by Census. PIR top-coded at 5 to be consistent across surveys. Data are weighted with sampling weights to be nationally representative
Smoothed scatterplot between PIR and BMI for US adults aged 18 years and older
Source: Authors’ calculations based on 1959–62 National Health Examination Survey, NHANES I–III and continuous NHANES.Notes: Density estimated with an Epanechnikov kernel function with 50 evaluation points. Data are weighted with sampling weights to be nationally representative
Distributions of BMI in the United States for adults aged 18 years and older by race-ethnicity
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Alston, J.M., Okrent, A.M. (2017). Obesity in America. In: The Effects of Farm and Food Policy on Obesity in the United States. Palgrave Studies in Agricultural Economics and Food Policy. Palgrave Macmillan, New York. https://doi.org/10.1057/978-1-137-47831-3_2
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