Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Highlight
  • Published:

Getting heavier, younger: trajectories of obesity over the life course

International Journal of Obesity volume 34, pages 614–623 (2010)Cite this article

Abstract

Context:

Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes.

Objective:

Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race.

Design, Setting and Participants:

We conducted an age, period and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (NHANES) (1971–2006).

Main Outcome Measures:

Obesity was defined as a body mass index ⩾95th percentile for individuals aged 2–16 years or ⩾30 kg m–2 among individuals older than 16 years. Age was represented by the age of the individual at each NHANES, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period.

Results:

Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, although the 1966–1975 and 1976–1985 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20–29 years of age, this level was only reached by 30–39 years for the 1946–1955 and 1956–1965 birth cohorts, by 40–49 years for the 1936–1945 birth cohort and by 50–59 years of age for the 1926–1935 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts.

Conclusions:

The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

References

  1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM . Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 1549–1555.

    Article  CAS  Google Scholar 

  2. Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.

    Article  Google Scholar 

  3. Baker JL, Olsen LW, Sorensen TI . Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007; 357: 2329–2337.

    Article  CAS  Google Scholar 

  4. Knowler WC, Pettitt DJ, Saad MF, Charles MA, Nelson RG, Howard BV et al. Obesity in the Pima Indians: its magnitude and relationship with diabetes. Am J Clin Nutr 1991; 53 (6 Suppl): 1543S–1551S.

    Article  CAS  Google Scholar 

  5. Flegal KM, Graubard BI, Williamson DF, Gail MH . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–1867.

    Article  CAS  Google Scholar 

  6. Alley DE, Chang VW . The changing relationship of obesity and disability, 1988–2004. JAMA 2007; 298: 2020–2027.

    Article  CAS  Google Scholar 

  7. Lakdawalla DN, Bhattacharya J, Goldman DP . Are the young becoming more disabled? Health Aff (Millwood) 2004; 23: 168–176.

    Article  Google Scholar 

  8. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138–1145.

    Article  CAS  Google Scholar 

  9. Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A . Body Mass Index variations: centiles from birth to 87 years. Eur J Clin Nutr 1991; 45: 13–21.

    CAS  Google Scholar 

  10. 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: 653–658.

    Article  CAS  Google Scholar 

  11. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF . Lifetime risk for diabetes mellitus in the United States. JAMA 2003; 290: 1884–1890.

    Article  CAS  Google Scholar 

  12. National Center for Health Statistics, National Health and Nutrition Examination Survey. (Accessed 7 February 2007, available at: http://www.cdc.gov/nchs/nhanes.htm).

  13. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002; 11: 1–190.

    Google Scholar 

  14. Rust KF, Rao JN . Variance estimation for complex surveys using replication techniques. Stat Methods Med Res 1996; 5: 283–310.

    Article  CAS  Google Scholar 

  15. Everhart JE . Duration of obesity increases the incidence of NIDDM. Diabetes 1992; 41: 235–240.

    Article  CAS  Google Scholar 

  16. Brancati FL, Wang NY, Mead LA, Liang KY, Klag MJ . Body weight patterns from 20 to 49 years of age and subsequent risk for diabetes mellitus: the Johns Hopkins Precursors Study. Arch Intern Med 1999; 159: 957–963.

    Article  CAS  Google Scholar 

  17. Orchard TJ, Dorman JS, Maser RE, Becker DJ, Drash AL, Ellis D et al. Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes 1990; 39: 1116–1124.

    Article  CAS  Google Scholar 

  18. Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG . Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA 2006; 296: 421–426.

    Article  CAS  Google Scholar 

  19. Ogden CL, Carroll MD, Flegal KM . High body mass index for age among US children and adolescents, 2003–2006. JAMA 2008; 299: 2401–2405.

    Article  CAS  Google Scholar 

  20. Ogden CL, Carroll MD, McDowell MA, Flegal KM . Obesity among adults in the United States—no change since 2003–2004. In: Statistics NCfH (ed). NCHS Data Brief No 1. Hyattsville: MD, 2007.

    Google Scholar 

  21. Dietz W . Critical periods in childhood for the development of obesity. Am J Clin Nutr 1994; 59: 955–959.

    Article  CAS  Google Scholar 

  22. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM et al. Prevalence of diabetes and impaired fasting glucose in adults in the US population. Diabetes Care 2006; 29: 1263–1268.

    Article  Google Scholar 

  23. Wang Y, Beydoun MA . The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 2007; 29: 6–28.

    Article  CAS  Google Scholar 

  24. Leveille SG, Wee CC, Iezzoni LI . Trends in obesity and arthritis among baby boomers and their predecessors, 1971–2002. Am J Public Health 2005; 95: 1607–1613.

    Article  Google Scholar 

  25. Wang YC, Colditz GA, Kuntz KM . Forecasting the obesity epidemic in the aging U.S. population. Obesity (Silver Spring) 2007; 15: 2855–2865.

    Article  Google Scholar 

  26. Liese AD, D’Agostino Jr RB, Hamman RF, Kilgo PD, Lawrence JM, Liu LL et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006; 118: 1510–1518.

    Article  Google Scholar 

  27. Lee JM . Why young adults hold the key to assessing the obesity epidemic in children. Arch Pediatr Adolesc Med 2008; 162: 682–687.

    Article  Google Scholar 

  28. Gallagher D, Visser M, Sepulveda D, Pierson RN, Harris T, Heymsfield SB . How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups? Am J Epidemiol 1996; 143: 228–239.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was considered exempt from the IRB. Dr Lee was supported by NIDDK K08DK082386 and the Clinical Sciences Scholars Program at the University of Michigan. The funding sources had no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA

    J M Lee

  2. Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI, USA

    J M Lee, S Pilli, A Gebremariam, M M Davis, G L Freed & J G Gurney

  3. Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA

    C C Keirns

  4. Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA

    M M Davis

  5. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA

    M M Davis

  6. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    M M Davis, S Vijan & W H Herman

  7. Veterans Affairs Health Services Research and Development, University of Michigan, Ann Arbor, MI, USA

    S Vijan

  8. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

    W H Herman

Authors
  1. J M Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Pilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Gebremariam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C C Keirns
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M M Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Vijan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G L Freed
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W H Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J G Gurney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J M Lee.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Authors’ Contributions

Joyce Lee (JL) accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish. JL was involved with conception and design, acquisition of data, analysis and interpretation of data, drafting of the paper, critical revision of the paper for important intellectual content, statistical analysis, obtaining funding and supervision. JG was involved with conception and design, acquisition of data, analysis and interpretation of data, drafting of the paper and critical revision of the paper for important intellectual content. SP and AG were involved with acquisition of data, analysis and interpretation of data, drafting of the paper, critical revision of the paper for important intellectual content and statistical analysis. MD, CK, GF, WH and SV were involved with analysis and interpretation of data, drafting of the paper and critical revision of the paper for important intellectual content. All authors read and approved the final paper.

Appendix

Appendix

Table A1, Table A2, Table A3, Table A4, Table A5, Table A6, Table A7

Table a1 Period trends in obesity prevalence by age group (1971–2006) (% (standard error))
Full size table
Table a2 Period trends in obesity prevalence by birth cohort (1971–2006) (% (standard error))
Full size table
Table a3 Age trends in obesity prevalence by birth cohort (1971–2006) (% (standard error))
Full size table
Table a4 Age trends in obesity prevalence by birth cohort for males (1971–2006) (% (standard error))
Full size table
Table a5 Age trends in obesity prevalence by birth cohort for females (1971–2006) (% (standard error))
Full size table
Table a6 Age trends in obesity prevalence by birth cohort for whites (1971–2006) (% (standard error))
Full size table
Table a7 Age trends in obesity prevalence by birth cohort for blacks (1971–2006) (% (standard error))
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, J., Pilli, S., Gebremariam, A. et al. Getting heavier, younger: trajectories of obesity over the life course. Int J Obes 34, 614–623 (2010). https://doi.org/10.1038/ijo.2009.235

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2009.235

Keywords

This article is cited by

Search

Advanced search

Quick links