Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in US Adults: 1988 to 2010

doi:10.1016/j.amjmed.2014.02.026

The American Journal of Medicine

Volume 127, Issue 8, August 2014, Pages 717-727.e12

https://doi.org/10.1016/j.amjmed.2014.02.026 Get rights and content

Abstract

Background

Obesity and abdominal obesity are associated independently with morbidity and mortality. Physical activity attenuates these risks. We examined trends in obesity, abdominal obesity, physical activity, and caloric intake in US adults from 1988 to 2010.

Methods

Univariate and multivariate analyses were performed using National Health and Nutrition Examination Survey data.

Results

Average body mass index (BMI) increased by 0.37% (95% confidence interval [CI], 0.30-0.44) per year in both women and men. Average waist circumference increased by 0.37% (95% CI, 0.30-0.43) and 0.27% (95% CI, 0.22-0.32) per year in women and men, respectively. The prevalence of obesity and abdominal obesity increased substantially, as did the prevalence of abdominal obesity among overweight adults. Younger women experienced the greatest increases. The proportion of adults who reported no leisure-time physical activity increased from 19.1% (95% CI, 17.3-21.0) to 51.7% (95% CI, 48.9-54.5) in women, and from 11.4% (95% CI, 10.0-12.8) to 43.5% (95% CI, 40.7-46.3) in men. Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level but not caloric intake. The associated changes in adjusted BMIs were 8.3% (95% CI, 6.9-9.6) higher among women and 1.7% (95% CI, 0.68-2.8) higher among men with no leisure-time physical activity compared with those with an ideal level of leisure-time physical activity.

Conclusions

Our analyses highlight important dimensions of the public health problem of obesity, including trends in younger women and in abdominal obesity, and lend support to the emphasis placed on physical activity by the Institute of Medicine.

Section snippets

Data Source

We used data from the National Health and Nutrition Examination Survey (NHANES), beginning with NHANES-III (1988-1994) and including the continuous NHANES 2-year survey cycles from 1999-2000 to 2009-2010.¹⁴ The samples in each cycle were selected using a stratified, multistage, clustered probability sampling design, described in detail before.15, 16

Study Population

All examined participants aged ≥18 years, except pregnant women, were included. For the caloric intake analyses, only eligible participants who had

Body Mass Index and Obesity

From 1988-1994 to 2009-2010, the average BMI in the United States increased by 0.37% (95% CI, 0.30-0.44) per year in both women and men. Average BMI increased in all age and racial/ethnic groups (Figure 1, Table 1). The age subgroup with the greatest annual increase was 18- to 39-year-old women (Table 1). Joinpoint analyses identified a change in the trend for average BMI only in women, with annual increases of 0.60% (95% CI, 0.50-0.69) from 1991 to 2002, and smaller annual increases of 0.22%

Discussion

Our analyses highlight important dimensions of the public health problem of obesity in the United States. The average BMI, average waist circumference, prevalence of obesity, and prevalence of abdominal obesity increased substantially over the past 2 decades in both women and men. The annual increases in BMI have been most pronounced in younger women, the greatest increases in the prevalence of abdominal obesity have been in younger women and men, and both obesity and abdominal obesity

Conclusions

Average BMI and waist circumference both increased among US adults from 1988 to 2010. Abdominal obesity, an independent predictor of mortality, has become more prevalent among normal-weight women and overweight women and men. At the population level, we found associations between the reported level of leisure-time physical activity and obesity, but even among adults reporting an ideal level of leisure-time physical activity, obesity prevalence has increased. Although it is encouraging that

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: Funding: National Institutes of Health T32 Training Grant T32DK007056 Awarded to PAM. The sponsor had no design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

: Conflict of Interest: UL has served as a consultant for Endosphere.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

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Clinical research studyObesity, Abdominal Obesity, Physical Activity, and Caloric Intake in US Adults: 1988 to 2010

Abstract

Background

Methods

Results

Conclusions

Section snippets

Data Source

Study Population

Body Mass Index and Obesity

Discussion

Conclusions

Prev Med

Am J Clin Nutr

Am J Clin Nutr

Am J Med

Am J Clin Nutr

Am J Prev Med

Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation

Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

JAMA

Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

N Engl J Med

Body-mass index and mortality among 1.46 million white adults

N Engl J Med

Prevalence and trends in obesity among US adults, 1999-2008

JAMA

Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010

JAMA

A potential decline in life expectancy in the United States in the 21st century

N Engl J Med

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report

General and abdominal adiposity and risk of death in Europe

N Engl J Med

Waist circumference and mortality

Am J Epidemiol

Waist circumference and all-cause mortality in a large US cohort

Arch Intern Med

The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Changes in diet and lifestyle and long-term weight gain in women and men

N Engl J Med

Clinical research study
Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in US Adults: 1988 to 2010