Prevalence and trends in obesity and diabetes in the United States

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Prevalence and trends in obesity and diabetes in
the United States
Katherine M. Flegal, Ph.D.
Centers for Disease Control and
Prevention National Center for Health Statistics
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National Health and Nutrition
Examination Surveys
Survey
Dates
Ages
NHES I 1960-62 18-79 years NHES II 1963-65 6-11
years NHES III 1966-70 12-17 years NHANES
I 1971-75 1-74 years NHANES II 1976-80 6 mo.-74
years HHANES 1982-84 6 mo.-74 years NHANES
III 1988-94 2 mo. NHANES 1999- All ages
OP96025
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NHANES Mobile Exam Center
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Definitions of overweight and obesityfor adults

• Body mass index (BMI)
• Calculated as weight (kg)/ height (m) squared
• Overweight BMI ? 25 Obesity BMI ? 30
• 5 ft 9 in, Overweight 169 lbs,
• Obese 203 lbs
• 5 ft 4 in, Overweight 145 lbs,
• Obese 174 lbs.

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Age-adjusted Trends in Overweight
(BMI ? 25) United States
Prevalence ()
SOURCE CDC/NCHSNHES I, NHANES I, NHANES II,
NHANES III
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Age-adjusted Trends in Obesity
(BMI ? 30) United States
Prevalence ()
SOURCE CDC/NCHSNHES I, NHANES I, NHANES II,
NHANES III
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Prevalence of Overweight among U.S. Adults, BRFSS
1999
SourceMokdad A H, et al. Am Med Assoc
200028413
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Age-specific Prevalence of Overweight
(BMI ? 25) Men, United States
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Age-specific Prevalence of Overweight
(BMI ? 25) Women, United States
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Age-specific Prevalence of Obesity
(BMI ? 30) Men, United States
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Age-specific Prevalence of Obesity
(BMI ? 30) Women, United States
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Prevalence of Overweight (BMI ? 25)
by sex and race-ethnic group for ages 50-59 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Prevalence of obesity (BMI ? 30)
by sex and race-ethnic group, ages 50-59 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Trends in Prevalence of Diabetes Ages 40-74 Y
Prevalence ()
SOURCE CDC/NCHS NHANES II, HHANES NHANES
III Medical history or fasting plasma glucose
126 md/dL
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Diagnosed and UndiagnosedDiabetes, Ages 40-74
US 1988-94
Prevalence ()
Non-Hispanic black
Mexican-American
Non-Hispanic white
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Prevalence of Diabetes
by age and race-ethnic group for women
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Trends in Diagnosed Diabetes
United States 1960-95
Prevalence ()
65 y
45-64 y
SOURCE CDC/NCHS NHIS
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Diabetes Trends in the U.S., 1990-1998
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Estimating the prevalence of diabetes
Methodological issues

• Diagnosed diabetes
• Relies on self-reports of physician diagnosis
• Could increase because of improved diagnostic
  rates
• Incomplete picture of all diabetes
• Used by NHANES, NHIS and BRFSS

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Estimating the prevalence of diabetes
Methodological issues

• Total diabetes (diagnosed plus undiagnosed)
• Affected by any problems with self-reports
• Requires AM measurement of fasting plasma glucose
• Logistical problems in a survey environment
• Low response rates in NHANES II (baseline)
• National data only from NHANES

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Diagnosed diabetes by BMI
for women 60-79 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Diagnosed diabetes by BMI
and race-ethnic group for women 60-79 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Diagnosed diabetes by BMI
and race-ethnic group for women 60-79 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Diagnosed diabetes by BMI
and race-ethnic group for women 60-79 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Diagnosed diabetes by BMI
and race-ethnic group for women 60-79 y
Prevalence ()
SOURCE CDC/NCHS NHANES III
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Definition of overweight for children

• Based on new CDC growth charts for the United
  States (www.cdc.gov/growthcharts)
• Overweight BMI ? 95th percentile of sex-specific
  BMI-for-age chart

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Trends in Overweight for Children
(BMI ? 95th percentile) United States
Prevalence ()
SOURCE CDC/NCHSNHES Ii, NHES III, NHANES I,
NHANES II, NHANES III
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Schematic model of increased skewness
Percent of population

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BMI differences at selected percentilesBoys age
6 y NHANES III vs. NHES II
BMI Difference
90th
50th
SOURCE CDC/NCHS
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BMI differences at selected percentilesGirls age
9 y NHANES III vs. NHES II
BMI Difference
90th
50th
SOURCE CDC/NCHS
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The emergence of type 2 diabetes in North
American youth

• American Indians
• 1979 First case series in Pima Indians in
  Arizona
• 1988 First case series in First Nation youth in
  Canada
• Other ethnic groups
• 1980s Almost all cases in US pediatric centers
  are type 1
• 1990-1994 First case series of type 2 diagnosed
• 1996-1999 First publications
• 2000 Consensus statement

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Estimates from NHANES III, U.S., 1988-94
Adolescents aged 12-19 years
Fagot-Campagna A, in press, Diabetes Care
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American Diabetes Association consensus
statement on Type 2 diabetes in children

• Recommendations for screening children10 yrs
• Overweight (BMI85th percentile for age and sex)
• Plus 2 other risk factors
• Belonging to a minority group
• Family history of type 2 diabetes
• Insulin resistance (polycystic ovary syndrome,
  hypertension, dyslipidemia, acanthosis nigricans)

ADA consensus statement. Diabetes Care
200023381-9
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Summary

• Overweight and obesity are highly prevalent and
  increasing in the United States among both adults
  and children, in both men and women, among all
  age and race-ethnic groups
• The prevalence of diabetes is increasing among
  adults
• The prevalence of type 2 diabetes is low among
  children but appears to be increasing
• The relation of changes in obesity and overweight
  to changes in diabetes prevalence is complex