Children and Teens Told by Doctors That They Were Overweight --- United States, 1999--2002

The percentage of children and teens aged 6--19 years in the United States who are overweight nearly tripled to 16% during 1980--2002 (1). Overweight and obese children and teens are at greater risk for many comorbid conditions, both immediate and long-term (2). Their risk is approximately 10 times greater than that of normal weight children for hypertension in young adulthood, three to eight times greater for dyslipidemias, and more than twice as great for diabetes mellitus (2). To determine what percentage of overweight children (or their parents) and teens were ever told their weight status by doctors or other health-care professionals, CDC analyzed data from the 1999--2002 National Health and Nutrition Examination Survey (NHANES). This report summarizes the results of that analysis, which determined that 36.7% of overweight children and teens aged 2--19 years had been told by a doctor or other health-care professional that they were overweight, and teens aged 16--19 years were more likely to be told than parents of children aged 2--11 years. By discussing weight status with overweight patients and their parents, pediatric health-care providers might help these patients implement lifelong improvements in diet and physical activity.

NHANES is an ongoing series of cross-sectional surveys on health and nutrition designed to be nationally representative of the noninstitutionalized, U.S. civilian population by using a complex, multistage probability design.* During 1999--2002, populations of persons aged 12--19 years, non-Hispanic blacks, and Mexican Americans were among those oversampled. The analyses described in this report include data from 1,473 children and teens aged 2--19 years who were determined to be overweight. This sample represented the approximately 10.3% of U.S. children aged 2--5 years and 16.0% of children and teens aged 6--19 years who were overweight. Overweight was defined as having a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) >95th percentile on the BMI-for-age, sex-specific 2000 CDC growth charts for the United States.^†

Parents of overweight children aged 2--11 years were asked, "Has a doctor or health professional ever told you that [child] was overweight?" Parents of those aged 12--15 years were asked, "Has a doctor or health professional ever told [child] that he/she was overweight?" Teens aged 16--19 years were asked, "Has a doctor or health professional ever told you that you were overweight?"

Results were stratified by sex and age and by sex and race/ethnicity. Pregnant females were excluded from analysis. Weighted prevalence estimates were calculated. A chi-square test for trend was performed to evaluate the effect of age. Individual t-tests were performed to test differences between racial/ethnic populations. The cutoff for statistical significance was p = 0.05. Bonferroni adjustments were used to account for multiple comparisons between racial/ethnic populations.

Among all overweight children and teens aged 2--19 years (or their parents), 36.7% reported having ever been told by a doctor or health-care professional that they were overweight (Table). A significant increasing trend (p<0.05) by age group was observed in the percentage of the overall sample told that they were overweight (17.4% for ages 2--5 years, 32.6% for ages 6--11 years, 39.6% for ages 12--15 years, and 51.6% for ages 16--19 years). Similar trends by age group were observed among males and females. Among racial/ethnic populations, overweight non-Hispanic black females were significantly more likely to be told that they were overweight than non-Hispanic white females (47.4% versus 31.0%). Among those informed of overweight status, 39% of non-Hispanic black females were severely overweight (BMI >99th percentile for age and sex), compared with 17% of non-Hispanic white females.

Reported by: CL Ogden, PhD, National Center for Health Statistics; CJ Tabak, MD, EIS Officer, CDC.

Editorial Note:

Annual well-child visits to health-care professionals should include measurement of BMI to determine weight status, as recommended by the American Academy of Pediatrics (3). Without intervention, many overweight children will grow up to be overweight or obese adults (4,5). The following four behavioral strategies are recommended for families with overweight children: controlling the environment, monitoring behavior, setting goals, and rewarding successful changes in behavior (6). Families with overweight children might be more motivated to make these changes if they are recommended by a doctor or health-care professional.

In a study of adults who had visited their physicians for routine checkups during the preceding 12 months, fewer than half of those classified as obese (i.e., BMI >30 kg/m²) reported being advised by their health-care professionals to lose weight (7). A study of 473 children in Kentucky determined that overweight condition had been diagnosed in only 29% of 93 overweight children (i.e., BMI >95th percentile); however, that study did not report whether the diagnoses were shared with children and parents (8).

In the study described in this report, significant differences in being informed of overweight status were observed by age group and race/ethnicity. For example, 51.6% of teens aged 16--19 years were informed of their overweight status, but only 17.4% of parents of children aged 2--5 years were informed, possibly suggesting reluctance by health-care providers to inform parents of the weight status of very young overweight children. In addition, non-Hispanic black females were more likely to be told that they were overweight than were non-Hispanic white females. However, 39% of non-Hispanic black females informed of overweight status were severely overweight, compared with 17% of non-Hispanic white females. Health-care providers might have been more likely to discuss weight status with patients who were severely overweight.

The findings in this report are subject to at least three limitations. First, NHANES data are cross-sectional and therefore cannot capture information about duration of overweight in these children and teens; a longer duration of overweight might have made a provider more likely to inform a child or parent of the child's overweight status. Second, teens might have had more visits to a health-care professional than young children and therefore more opportunities to be told of their overweight status; however, multiple logistic regression controlling for number of health-care visits during the preceding year produced similar results. Third, the question regarding being told of overweight status was asked of parents for children and teens ages 2--15 years and of teens themselves for those aged 16--19 years. Overweight teens might answer this question differently than parents of overweight children, resulting in either a lesser or greater difference among age groups in reports of being told of overweight status.

Among overweight children who become obese adults, earlier onset of childhood overweight is associated with higher BMI in adulthood (9). Previous findings suggest that children begin to respond to environmental cues regarding dietary patterns by age 5 years (10). Thus, early recognition and discussion of overweight status is a necessary first step to developing healthier lifelong behaviors. Addressing overweight among children and teens requires recognition by health-care providers, discussion of potential consequences with families, acknowledgment of those consequences by families of affected children, and a commitment to work together toward attaining a healthier lifestyle (6).

References

1. CDC. Prevalence of overweight among children and adolescents: United States, 1999--2002. National Health and Nutrition Examination Survey. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm.
2. Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999;23(Suppl 2):S2--S11.
3. Krebs NF, Jacobson MS; American Academy of Pediatrics Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics 2003;112:424--30.
4. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167--77.
5. Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr 2002;76:653--8.
6. Dietz WH, Robinson TN. Overweight children and adolescents. N Engl J Med 2005;352:2100--9.
7. Galuska DA, Will JC, Serdula MK, Ford ES. Are health care professionals advising obese patients to lose weight? JAMA 1999;282:1576--8.
8. Louthan MV, Lafferty-Oza MJ, Smith ER, Hornung CA, Franco S, Theriot JA. Diagnosis and treatment frequency for overweight children and adolescents at well child visits. Clinical Pediatr(Phila) 2005;44:57--61.
9. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 2001;108:712--8.
10. Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children's food intakes. J Am Diet Assoc 2000;100:232--4.

* Available at http://www.cdc.gov/nchs/nhanes.htm.

^† Available at http://www.cdc.gov/growthcharts

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Date last reviewed: 8/31/2005