DESIGN, SETTING, AND PARTICIPANTS Analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population that includes measured weight and height. EXPOSURES Survey period. MAIN OUTCOMES AND MEASURES Prevalence of obesity (body mass index Ն30) and class 3 obesity (body mass index Ն40). RESULTS This report is based on data from 2638 adult men (mean age, 46.8 years) and 2817 women (mean age, 48.4 years) from the most recent 2 years (2013-2014) of NHANES and data from 21 013 participants in previous NHANES surveys from 2005 through 2012. For the years 2013-2014, the overall age-adjusted prevalence of obesity was 37.7% (95% CI, 35.8%-39.7%); among men, it was 35.0% (95% CI, 32.8%-37.3%); and among women, it was 40.4% (95% CI, 37.6%-43.3%). The corresponding prevalence of class 3 obesity overall was 7.7% (95% CI, 6.2%-9.3%); among men, it was 5.5% (95% CI, 4.0%-7.2%); and among women, it was 9.9% (95% CI, 7.5%-12.3%). Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity (P = .004) and for class 3 obesity (P = .01) but not among men (P = .30 for overall obesity; P = .14 for class 3 obesity). CONCLUSIONS AND RELEVANCE In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends.

IMPORTANCE Previous analyses of obesity trends among children and adolescents showed an increase between 1988–1994 and 1999–2000, but no change between 2003–2004 and 2011–2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011–2014 and investigate trends by age between 1988–1994 and 2013–2014. DESIGN, SETTING, AND PARTICIPANTS Children and adolescents aged 2 to 19 years with measured weight and height in the 1988–1994 through 2013–2014 National Health and Nutrition Examination Surveys. EXPOSURES Survey period. MAIN OUTCOMES AND MEASURES Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011–2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005–2006 and 2013–2014 also were conducted. RESULTS Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988–1994 and 2013–2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% (95% CI, 15.5%−18.6%) and extreme obesity was 5.8% (95% CI, 4.9%−6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%−8.8%) in 1988–1994 to 13.9% (95% CI,10.7%−17.7%) (P < .001) in 2003–2004 and then decreased to 9.4% (95% CI, 6.8%−12.6%)(P = .03) in 2013–2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%−13.4%) in 1988–1994 to 19.6% (95% CI, 17.1%−22.4%) (P < .001) in 2007–2008, and then did not change (2013–2014: 17.4% [95% CI, 13.8%−21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988–1994 (10.5% [95% CI, 8.8%−12.5%]) and 2013–2014 (20.6% [95% CI, 16.2%−25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%−5.0%] in 1988–1994 to 4.3% [95% CI,3.0%−6.1%] in 2013–2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI,1.7%−3.9%] in 1988–1994 to 9.1% [95% CI, 7.0%−11.5%] in 2013–2014; P < .001). No significant trends were observed between 2005–2006 and 2013–2014 (P value range, .09-.87). CONCLUSIONS AND RELEVANCE In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% and extreme obesity was 5.8%. Between 1988–1994 and 2013–2014, the prevalence of obesity increased until 2003–2004 and then decreased in children aged 2 to 5 years, increased until 2007–2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.

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IMPORTANCE Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied. OBJECTIVES To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population. EXPOSURES Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: Ն1 million population). MAIN OUTCOMES AND MEASURES Prevalence of obesity (body mass index [BMI] Ն30) and severe obesity (BMI Ն40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016. RESULTS Complete data on weight, height, and urbanization level were available for 10 792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6% (95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, −2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels. CONCLUSIONS AND RELEVANCE In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared wit...

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Public health surveillance of obesity describes changes over time and identifies subgroups at risk of obesity-related consequences. We analyzed trends, stratified by race and Hispanic origin, in high weight for length, obesity, and severe obesity in the US from 1999 to 2018.

In 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.