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Emergence of the adolescent obesity epidemic in the United States: five-decade visualization with humanoid avatars



Body size and shape have increased over the past several decades with one in five adolescents now having obesity according to objective anthropometric measures such as weight, height, and body mass index (BMI). The gradual physical changes and their consequences may not be fully appreciated upon visual inspection by those managing the long-term health of adolescents. This study aimed to develop humanoid avatars representing the gradual changes in adolescent body size and shape over the past five decades and to align avatars with key BMI percentile cut points for underweight, normal weight, overweight, and obesity.


Participants included 223 children and adolescents between the ages of 5 and 18 years approximately representative of the race/ethnicity and BMI of the noninstitutionalized US population. Each participant completed a three-dimensional whole-body scan, and the collected data was used to develop manifold regression models for generating humanoid male and female avatars from specified ages, weights, and heights. Secular changes in the mean weights and heights of adolescents were acquired from six U.S. National Health and Nutrition Surveys beginning in 1971–1974 and ending in 2015–2018. Male and female avatars at two representative ages, 10 and 15 years, were developed for each survey and at the key BMI percentile cut points based on data from the 2015–2018 survey.


The subtle changes in adolescent Americans’ body size and shape over the past five decades are represented by 24 male and female 10- and 15-year-old avatars and 8 corresponding BMI percentile cut points.


The current study, the first of its kind, aligns objective physical examination weights and heights with the visual appearance of adolescents. Aligning the biometric and visual information may help improve awareness and appropriate clinical management of adolescents with excess adiposity passing through health care systems.

Trial registration

ClinicalTrials.Gov NCT03706612.

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Fig. 1: Avatars of 10-year olds at two time points.
Fig. 2: Avatars of 10-year old males at key BMI cutpoints.
Fig. 3: Avatars of 10 year old females at key BMI cutpoints.
Fig. 4: Avatars of 10-year olds at two time points.
Fig. 5: Avatars of 15-year old males at key BMI cutpoints.
Fig. 6: Avatars of 15-year old females at key BMI cutpoints.

Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval by the investigators.


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This work was partially supported by National Institutes of Health NORC Center Grants P30DK072476, Pennington/Louisiana, P30DK040561, Harvard, and R01DK111698, Shape UP! Kids.

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Authors’ contributions to manuscript: JB, MCW, CM, NF, and SBH designed research; JB, MCW, CM, JS, and SBH conducted research; JS and SBH provided essential materials; JB, MCW, CM, NF, JS, and SBH analyzed data; JB, MCW, CM, NF, KQ, JS, and SBH wrote the paper; JB, MCW, CM, NF, KQ, JS, and SBH had primary responsibility for final content.

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Correspondence to Steven B. Heymsfield.

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Competing interests

SBH is on the Medical Advisory Board of Tanita Corporation and he is an Amazon Scholar. The other authors and their close relatives and their professional associates have no financial interests in the study outcome, nor do they serve as an officer, director, member, owner, trustee, or employee of an organization with a financial interest in the outcome or as an expert witness, advisor, consultant, or public advocate on behalf of an organization with a financial interest in the study outcome.

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Bennett, J., Wong, M.C., McCarthy, C. et al. Emergence of the adolescent obesity epidemic in the United States: five-decade visualization with humanoid avatars. Int J Obes (2022).

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