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State-level estimates of childhood obesity prevalence in the United States corrected for report bias

International Journal of Obesity volume 40, pages 1523–1528 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

State-specific obesity prevalence data are critical to public health efforts to address the childhood obesity epidemic. However, few states administer objectively measured body mass index (BMI) surveillance programs. This study reports state-specific childhood obesity prevalence by age and sex correcting for parent-reported child height and weight bias.

Subjects/Methods:

As part of the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES), we developed childhood obesity prevalence estimates for states for the period 2005–2010 using data from the 2010 US Census and American Community Survey (ACS), 2003–2004 and 2007–2008 National Survey of Children’s Health (NSCH) (n=133 213), and 2005–2010 National Health and Nutrition Examination Surveys (NHANES) (n=9377; ages 2–17). Measured height and weight data from NHANES were used to correct parent-report bias in NSCH using a non-parametric statistical matching algorithm. Model estimates were validated against surveillance data from five states (AR, FL, MA, PA and TN) that conduct censuses of children across a range of grades.

Results:

Parent-reported height and weight resulted in the largest overestimation of childhood obesity in males ages 2–5 years (NSCH: 42.36% vs NHANES: 11.44%). The CHOICES model estimates for this group (12.81%) and for all age and sex categories were not statistically different from NHANES. Our modeled obesity prevalence aligned closely with measured data from five validation states, with a 0.64 percentage point mean difference (range: 0.23–1.39) and a high correlation coefficient (r=0.96, P=0.009). Estimated state-specific childhood obesity prevalence ranged from 11.0 to 20.4%.

Conclusion:

Uncorrected estimates of childhood obesity prevalence from NSCH vary widely from measured national data, from a 278% overestimate among males aged 2–5 years to a 44% underestimate among females aged 14–17 years. This study demonstrates the validity of the CHOICES matching methods to correct the bias of parent-reported BMI data and highlights the need for public release of more recent data from the 2011 to 2012 NSCH.

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Acknowledgements

This work was supported in part by grants from The JPB Foundation, the Robert Wood Johnson Foundation (Grant No. 66284), the Donald and Sue Pritzker Nutrition and Fitness Initiative, and the Centers for Disease Control and Prevention (Grant No. U48DP001946), including the Nutrition and Obesity Policy Research and Evaluation Network. YC Wang is partly supported by a grant from the National Cancer Institute (1R01CA172814-01A1).

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Authors and Affiliations

  1. Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

    M W Long

  2. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Z J Ward & S C Resch

  3. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    A L Cradock, C M Giles & S L Gortmaker

  4. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA

    Y C Wang

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  1. M W Long
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  2. Z J Ward
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  6. C M Giles
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  7. S L Gortmaker
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Correspondence to M W Long.

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This work is solely the responsibility of the authors and does not represent the official views of the Centers for Disease Control and Prevention or any of the other funders.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Long, M., Ward, Z., Resch, S. et al. State-level estimates of childhood obesity prevalence in the United States corrected for report bias. Int J Obes 40, 1523–1528 (2016). https://doi.org/10.1038/ijo.2016.130

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