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Adolescent Obesity in the United States
Facts for Policymakers

Authors: Susan Wile Schwarz and Jason Peterson
Publication Date: November 2010

Adolescent obesity in the United States has many important implications for both the health and well-being of the individual and society. Specific negative impacts of obesity on health include increased susceptibility to a host of diseases, chronic health disorders, psychological disorders, and premature death, 1 2 which in turn add billions of dollars in health care costs each year. 3 Excess medical costs due to overweight adolescents are estimated at more than $14 billion per year. 3 Furthermore, adolescent obesity affects our nation’s ability to protect itself; more than a quarter of 17- to 24-year-olds are not fit to enroll in the military due to their weight. 4

Adolescence is a crucial period for establishing healthy behaviors. Many of the habits formed during this developmental stage will last well into adulthood. 5 Although obesity is a complex problem not yet fully understood by researchers, by addressing the known factors that contribute to obesity in adolescence, policymakers can help ensure a healthy and productive adulthood for our nation’s youth.

Obesity and poor nutrition – combined with mental health disorders and emotional problems, violence and unintentional injury, substance use, and reproductive health problems – form part of a complex web of potential challenges to adolescents’ healthy emotional and physical development. 6

Overweight and Obesity

Obesity and overweight are measured using Body Mass Index (BMI), a number calculated from a person’s weight and height that is a reliable indicator of body fatness for most children and adolescents. BMI for children and adolescents is gender- and age- specific because body fatness changes over the years as they grow and differs between males and females. Adolescents in the 85th to 94th percentile BMI are classified as overweight. Those in the 95th percentile or above are classified as obese.

Facts about Obesity and Nutrition

Prevalence

Overweight and Obesity Among U.S. Children Ages 10-17, by Insurance Status

Figure 1: Overweight and Obesity Among U.S. Children Ages 10-17, by Insurance Status

Obesity in Adolescents Ages 12-19, by Gender and Race/Ethnicity

Figure 2: Obesity in Adolescents Ages 12-19, by Gender and Race/Ethnicity

  • One out of every six adolescents is overweight, and one out of every three is at risk.7
  • – Since the 1980s, the proportion of overweight children has steadily increased.7

  • Obesity rates vary by race/ ethnicity.8
  • – For adolescents ages 12 to 19, non-Hispanic black girls and Mexican-American boys have the highest rates of obesity, 29.2 percent and 26.7 percent respectively. Non-Hispanic white boys and girls have the lowest rates of obesity at 16.7 percent and 14.5 percent respectively.8

  • Childhood obesity was found to be highest in the Southeast, with eight of the 10 states with the highest rates of childhood obesity being in this region.9
  • In 2007, the prevalence of overweight and obesity was greater among publicly insured children ages 10 to 17 than their privately insured peers.10

Lifestyle Factors

  • Adolescents and their families eat more food prepared away from home than in the past.
  • – When people eat outside the home, they consume more total calories per eating occasion than they do at home, and a higher proportion of those calories comes from saturated fats.11

  • According to USDA estimates, 116.3 million Americans, including adolescents, live in areas with low access to supermarkets.12
  • In 2009, less than 20 percent of high school students engaged in the recommended amount of physical activity of 60 minutes every day, and over 20 percent did not get 60 minutes of exercise on any day, though rates vary by gender and race.13

Health Consequences

  • Being overweight increases the risk of developing diabetes, heart disease, high blood pressure, and cancer, among other adverse outcomes.14
  • The current generation of children could potentially live shorter lives than their parents.15
  • Overweight adolescents are more likely to become overweight adults than their normal weight peers, with one study showing 80 percent of children who were overweight at 10 to 15 years were obese adults at age 25.1617
  • Overweight and obese teenage mothers are at increased risk for gestational diabetes and caesarean delivery.18

Economic Consequences

  • The direct and indirect costs of the obesity epidemic exceed $140 billion annually.19
  • – The US spends six to 10 percent of healthcare spending on costs attributable to obesity, compared to two percent to 3.5 percent in other Western countries.19

    – Data show obesity represents 27 percent of the rise in US healthcare costs over the past 20 years.19

System-level Challenges to Preventing and Combating Adolescent Obesity

Below are some of the factors that contribute to increases in adolescent obesity, many of which are experienced to a greater degree by and have a greater impact on adolescents of color than their white peers.20

  • Limited access to healthy and affordable foods.
  • – Millions of Americans, many of whom are low-income or poor, live in areas lacking convenient access to fresh, healthy, and affordable foods.4

    – Limited access to healthy foods encourages poor food choices that have serious health consequences.2122

  • Environment.
  • – Close proximity of a fast food restaurant to schools is associated with increased obesity rates in adolescents.23

    – Outside of government-regulated child nutrition programs, the foods sold to adolescents at schools are disproportionately high-fat snacks and sweetened beverages.24

  • Food insecurity.
  • – In 2008, children, including adolescents, in more than 500,000 households ate less than they needed as a result of a lack of money.25

    – Researchers believe that when a person is food insecure they choose inexpensive, unhealthy, calorie-dense foods and beverages.26

  • Poor eating habits.
  • – Adolescents consume more calories from sugar-sweetened beverages and fruit juices than in the past, and more than half of these beverages are consumed in the home.27

  • Food marketing targeting children and adolescents.
  • – Food marketers spent $1 billion in 2006 marketing food, much of it unhealthy, to adolescents using TV, Internet, and other media sources.28

  • Increases in “screen time.”
  • – Even with bouts of physical activity, more time spent in front of a screen during adolescence is associated with increased obesity in both adolescence and young adulthood, and the association is greater among females than males.29

  • Decreased physical activity both inside and outside of school.
  • – Between 1969 and 2001, the percentage of middle and high school students walking or biking to school decreased from 41.6 percent and 26.4 percent, respectively, to 15.2 percent and 8.1 percent.30

Recommendations

Obesity is a complex, multifactor problem, and effective solutions require comparable sophistication. Although the causes of obesity have not been exhaustively and precisely characterized, there are choices policymakers can make to combat the problem and reduce its impact. As with most interventions, prevention typically trumps treatment, and policymakers should keep that in mind while developing policies. Closely guided by the comprehensive White House Task Force on Childhood Obesity Report to the President, we developed the following recommendations for local, state, and federal policymakers:

  • Implement and enforce rules on nutritional information that make it easier for parents and adolescents to make healthy choices. Clear food and menu labeling can enable families to make better choices for themselves and their families.4
  • Increase access to healthy and affordable foods. A growing body of evidence suggests that increases in food store availability improve adolescent BMI.31 In addition, when the price of healthy foods is reduced, people consume more of them.32 Government can promote access through a variety of initiatives, such as providing tax credits for supermarkets and grocery stores in underserved communities and creating incentives to promote production of fruits and vegetables.4
  • Ensure that families who need food assistance have access to it. Policymakers can promote access to food assistance by simplifying the application process for food assistance programs, ensuring that people who qualify for these programs are aware of them, enabling the use of WIC and food stamps at greenmarkets, and providing subsidies for healthier foods.4
  • Limit childhood exposure to food marketing. Food advertising has been shown to strongly affect children’s food habits. By limiting advertisements for unhealthy foods targeting young people, policymakers can make it more likely that adolescents will make healthier decisions about food.33
  • Improve quality of and safeguard funding for school food programs. School represents a crucial opportunity for government to teach children and youth about and enable them to develop healthy eating habits. Improving the quality and reach of school food programs can tangibly improve the health of children.4
  • Improve quality of other foods sold at or near schools. Many foods are sold at school that are not subject to federal nutrition standards and typically contribute to poor nutritional choices.24 School food policies that decrease access to foods high in fats and sugars, such as restricting vending machine hours or limiting the types of food that are sold, are associated with less frequent purchase of high fat and sugar items among high school students.34
  • Increase opportunities for and access to physical activity, including support for evidence-based physical education curricula such as SPARK. Physical activity can reduce the risk of obesity and has numerous benefits that extend beyond just physical health, such as reducing depression symptoms and improving self-esteem.35
  • Partner with the private sector to encourage safe pedestrianand physical-activity-friendly development projects, especially in low-income communities. Making neighborhoods safer and more pedestrian-friendly can encourage physical activity and reduce the negative effects of our modern environment.36
  • Fund promising demonstration projects addressing disparities in obesity rates and further research into culturally responsive alternatives. Higher rates of obesity in ethnic minority groups compared to whites of the same socioeconomic status suggest that different strategies need to be developed to address obesity in different race and ethnic groups.37

Endnotes

1. Flegal, Katherine M.; Graubard, Barry I.; Williamson, David F.; Gail, Mitchell H. 2005. Excess Deaths Associated with Underweight, Overweight, and Obesity. Journal of the American Medical Association 293(15): 1861-1867.

2. Rofey, Dana L.; Kolko, Rachel P.; Ana-Maria, Iosif; Silk, Jennifer S.; Bost, James E.; Fang, Wentao; Szigethy, Eva M.; Noll, Robert B.; Ryan, Neal D.; Dahl, Ronald E. 2009. A Longitudinal Study of Childhood Depression and Anxiety in Relation to Weight Gain. Child Psychiatry and Human Development 40(4): 517-526.

3. Trasande, Leonardo; Chatterjee, Samprit. 2009. The Impact of Obesity on Health Service Utilization and Costs in Childhood. Obesity (Silver Spring) 17(9): 1749-1754.

4. White House Task Force on Childhood Obesity Report to the President: Solving the Problem of Childhood Obesity Within a Generation. 2010. Washington DC.

5. Challenges in Adolescent Health Care: Workshop Report. 2007. Washington, D.C.: Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education.

6. Steinberg, Laurence; Dahl, Ronald; Keating, Daniel; Kupfer, David J.; Masten, Ann S.; Pine, Daniel S. 2004. The Study of Developmental Psychopathology in Adolescence: Integrating Affective Neuroscience with the Study of Context (draft manuscript, Aug. 2003). Handbook of Developmental Psychopathology. New York: John Wiley & Sons.

7. Wang, Youfa; Beydoun, May A. 2007. The Obesity Epidemic in the United States Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiologic Reviews 29(1): 6-28.

8. Ogden, Gynthia L.; Carroll, Margaret D.; Curtin, Lester R.; Lamb, Molly M.; Flegal, Katherine M. 2010. Prevalence of High Body Mass Index in U.S. Children and Adolescents, 2007-2008. Journal of the American Medical Association 303(3): 242-249.

9. Levi, Jeffrey; Vinter, Serena; Richardson, Liz; St. Laurent, Rebecca; Segal, Laura. 2009. F as in Fat: How Obesity Policies Are Failing in America. Washington, DC: Robert Wood Johnson Foundation.

10. Bethell, Christina; Simpson, Lisa; Stumbo, Scott; Carle, Adam C.; Gombojav, Narangerel. 2010. National, State, and Local Disparities in Childhood Obesity. Health Affairs 29(3): 347-356.

11. Guthrie, Joanne F.; Lin, Biin-Hwan; Frazao, Elizabeth. 2002. Role of Food Prepared Away from Home in the American Diet, 1977-78 Versus 1994- 96: Changes and Consequences. Journal of Nutrition Education and Behavior 34(3): 140-150.

12. Ver Ploeg, Michele; Breneman, Vince; Farrigan, Tracey; Hamrick, Karen; Hopkins, David; Kaufman, Phil; Lin, Biing-Hwan; Nord, Mark; Smith, Travis; Williams, Ryan; Kinnison, Kelly; Olander, Carol; Singh, Anita; Tuckermanty, Elizabeth. 2009. Access to Affordable and Nutritious Food—Measuring and Understanding Food Deserts and Their Consequences: Report to Congress Ap-036. Washington, DC: Economic Research Service, U.S. Department of Agriculture.

13. National Youth Risk Behavior Surveillance— United States, 2007. 2007. Centers for Disease Control and Prevention.

14. Overweight and Obesity: Health Consequences. 2010. Retrieved Aug. 24, from www.cdc.gov/obesity/ causes/health.html.

15. Olshansky, S. Jay; Passaro, Douglas J.; Hershow, Ronald C.; Layden, Jennifer; Carnes, Bruce A.; Brody, Jacob; Hayflick, Leonard; Butler, Robert N.; Allison, David B.; Ludwig, David S. 2005. A Potential Decline in Life Expectancy in the United States in the 21st Century. New England Journal of Medicine 352(11): 1138-1145.

16. Whitlock, Evelyn P.; Williams, Selvi B.; Gold, Rachel; Smith, Paula R.; Shipman, Scott A. 2005. Screening and Interventions for Childhood Overweight: A Summary of Evidence for the U.S. Preventive Services Task Force. Pediatrics 116(1): e125-144.

17. Whitaker, Robert C.; Wright, Jeffrey A.; Pepe, Margaret S.; Seidel, Kristy D.; Dietz, William H. 1997. Predicting Obesity in Young Adulthood from Childhood and Parental Obesity. New England Journal of Medicine 37(13): 869-873.

18. Haeri, Sina; Guichard, Isabelle; Baker, Arthur M.; Saddlemire, Stephanie; Boggess, Kim A. 2009. The Effect of Teenage Maternal Obesity on Perinatal Outcomes. Obstetrics and Gynecology 113(2): 300-304.

19. FAQ, Yale Rudd Center for Food Policy and Obesity. Yale Rudd Center for Food Policy and Obesity website. Retrieved Aug. 25, 2010, from www. yaleruddcenter.org/what_we_do.aspx?id=79.

20. Overweight and Obesity Among African-American Youths. 2010. Robert Wood Johnson Foundation.

21. Mikkelsen, Leslie; Chehimi, Sana. 2007. The Links Between the Neighborhood Food Environment and Childhood Nutrition. Princeton, NJ: Robert Wood Johnson Foundation.

22. Van Duyn, Mary Ann; Pivonka, Elizabeth. 2000. Overview of the Health Benefits of Fruit and Vegetable Consumption for the Dietetics Professional: Selected Literature. Journal of the American Dietetic Association 100(12): 1511-1521.

23. Currie, Janet; DellaVigna, Stefano; Moretti, Enrico; Pathania, Vikram. 2009. The Effect of Fast Food Restaurants on Obesity and Weight Gain, NBER Working Paper Series. National Bureau of Economic Research.

24. Kubik, Martha Y.; Lytle, Leslie A.; Hannan, Peter J.; Perry, Cheryl L.; Story, Mary. 2003. The Association of the School Food Environment with Dietary Behaviors of Young Adolescents. American Journal of Public Health 93(7): 1168-1173.

25. Nord, Mark; Andrews, Margaret; Carlson, Steven. 2009. Household Food Security in the United States, 2008. Washington, DC: U.S. Department of Agriculture, Economic Research Service.

26. Dinour, Lauren M.; Bergen, Dara; Yeh, Ming- Chin. 2007. The Food Insecurity-Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play. Journal of the American Dietetic Association 107(11): 1952-1961.

27. Wang, Y. Claire; Bleich, Sara N.; Gortmaker, Steven L. 2008. Increasing Caloric Contribution from Sugar-sweetened Beverages and 100% Fruit Juices Among U.S. Children and Adolescents, 1988-2004. Pediatrics 121(6): e1604-1614.

28. Marketing Food to Children and Adolescents: A Review of Industry Expenditure, Activities, and Self- Regulation. 2008. Washington, DC: Federal Trade Commission.

29. Boone, Janne E.; Gordon-Larsen, Penny; Adair, Linda S.; Popkin, Barry M. 2007. Screen Time and Physical Activity During Adolescence: Longitudinal Effects on Obesity in Young Adulthood. International Journal of Behavioral Nutrition and Physical Activity 4(26): 1-10.

30. McDonald, Noreen C. 2007. Active Transportation to School: Trends Among U.S. Schoolchildren, 1969-2001. American Journal of Preventive Medicine 32(6): 509-516.

31. Powell, Lisa M.; Auld, M. Christopher; Chaloupka, Frank J.; O’Malley, Patrick M.; Johnston, Lloyd D. 2007. Associations Between Access to Food Stores and Adolescent Body Mass Index. American Journal of Preventive Medicine 33(4, Supplement 1): S301-S307.

32. Drewnowski, Adam; Specter, S. E. 2004. Poverty and Obesity: The Role of Energy Density and Energy Costs. American Journal of Clinical Nutrition 79(1): 6-16.

33. Food Marketing to Children and Youth, Threat or Opportunity? 2006. Washington, DC: Institute Of Medicine.

34. Neumark-Sztainer, Dianne; French, Simone A.; Hannan, Peter J.; Story, Mary; Fulkerson, Jayne A. 2005. School Lunch and Snacking Patterns Among High School Students: Associations with School Food Environment and Policies. International Journal of Behavioral Nutrition and Physical Activity 2(14).

35. Tremblay, Mark; Inman, J. Wyatt; Willms, J. Douglas. 2000. The Relationship between Physical Activity, Self-esteem, and Aademic Achievement in 12-year-old Children. Pediatric Exercise Science (12): 312-323.

36. Booth, Katie M.; Pinkston, Megan M.; Poston, Walker S. Carlos. 2005. Obesity and the Built Environment. Journal of the American Dietetic Association 105(5, Supplement 1): S110-117.

37. Wang, Youfa; Zhang, Qi. 2006. Are American Children and Adolescents of Low Socioeconomic Status at Increased Risk of Obesity? Changes in the Association Between Overweight and Family Income Between 1971 and 2002. American Journal of Clinical Nutrition 84(4): 707-716.