Overweight and Obesity

Overweight and obesity in children, as in adults, are assessed based on Body Mass Index (BMI), or the ratio of weight to height. For children, the standards for overweight and obesity are relative; that is, they are based on the child’s percentile rank compared to others of the same age and sex. Children whose BMI falls between the 85th and 95th percentile on national growth charts for their age and sex are considered to be overweight, and those whose BMI falls at or above the 95th percentile are considered to be obese. The NSCH asked parents for the height and weight of their children, from which the BMI was calculated and weight status assessed based on age and sex for children aged 10–17 years. Overall, 31.3 percent of children met the criteria for overweight or obesity based on their parent-reported weight and height. Children living in rural areas were significantly more likely than urban children to be overweight or obese. More than 35 percent of children in both large and small rural areas had a BMI at or above the 85th percentile for their age and sex, compared to 30.1 percent of urban children.

Boys were significantly more likely than girls to be overweight or obese in urban areas, though there was no difference in rates in large and small rural areas. Among both sexes, children living in rural areas were more likely to be overweight or obese than their urban counterparts. Among boys, 33.8 percent of those in urban areas were overweight or obese, compared to 40.1 percent of boys in small rural and 38.4 percent in large rural areas. For girls, 26.2 percent of those in urban areas were overweight or obese, compared to 36.2 percent of those in small rural and 32.4 percent in large rural areas.

In all locations, children with lower household incomes were significantly more likely to be overweight or obese than those with higher incomes. The rate of overweight and obesity among children in households with incomes below 100 percent of the Federal Poverty Level (FPL) was approximately twice that of children with household incomes of 400 percent or more of the FPL. For example, among children in large rural areas, 51.8 percent of those in poverty were overweight or obese, compared to 24.5 percent of those with household incomes of 400 percent or more of the FPL. Within each income group there were few differences by location with no clear patterns presenting themselves. For instance, among the lowest income households, children in urban areas were significantly less likely to be overweight or obese than children in large rural areas (43.6 versus 51.8 percent, respectively), but rates did not vary significantly from those in small rural areas.

In urban and large rural areas, non-Hispanic Black and Hispanic children were more likely than non-Hispanic White children to be overweight or obese. Less than one-quarter of non-Hispanic White children in urban areas and 31.7 percent of those in large rural areas were overweight or obese, compared to more than 40 percent of non-Hispanic Black children and at least 38 percent of Hispanic children in both areas. In small rural areas, racial and ethnic differences in the proportion of children who were overweight or obese were not statistically significant.

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