Children’s BMI, overweight and obesity

11

Dhriti Mandalia

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

Summary ●

There is a considerable body of evidence that links childhood overweight and obesity with a number of long-term and immediate physiological and psychological health risks. This chapter examines the patterns of overweight and obesity among children aged 2-15, and the relationship between these measures and a number of demographic variables.

●

Mean body mass index (BMI) was slightly higher for girls than boys (18.6kg/m2 and 18.3kg/m2 respectively). BMI generally increased with age in both sexes, ranging from 16.5kg/m2 for boys and girls aged 2-4 to 21.4kg/m2 for boys and 21.9kg/m2 for girls aged 13-15.

●

The prevalence of obesity and overweight was similar among girls and boys aged 215: 17% of boys and 16% of girls were classed as obese, and 31% of boys and 28% of girls were classed as either overweight or obese. Older children were more likely than younger children to be obese (24% of boys and 17% of girls aged 11-15, compared with 10% and 12% respectively among children aged 2-7).

●

The prevalence of obesity varied significantly across strategic health authorities (SHAs), with highest levels in London, the North East, North West and West Midlands.

●

There was evidence of inequalities according to socio-economic status. Obesity levels were highest among boys in the lowest quintile of equivalised income (25%), and among girls in the third and lowest income quintiles (22% and 19% respectively). Similarly, the proportion of children who were obese was higher among those living in the most deprived quintile of the Index of Multiple Deprivation (29% of boys and 22% of girls) than those living in the least deprived quintile (11% of boys and 10% of girls).

●

Among boys aged 2-15 mean BMI increased between 1995 and 2011 by 0.6kg/m2 (from 17.7kg/m2 to 18.3kg/m2); the increase was 0.5kg/m2 among girls (from 18.1kg/m2 to 18.6kg/m2).

●

Between 1995 and 2011, the prevalence of obesity among boys aged 2-15 increased by 6 percentage points (from 11% to 17%), and the equivalent increase for girls was 4 percentage points (from 12% to 16%). However, the pattern has not been one of uniform increase during that period. The prevalence of obesity increased steadily in most years up to around 2004 and 2005, and since then the pattern has been slightly different for boys and girls. Among boys the proportion that was obese has remained at a similarly high level, between 16% and 19%, since 2001. Among girls, there was a significant decrease in obesity between 2005 and 2006, and levels have been maintained at this slightly lower level between 2006 and 2011.

●

The lack of significant change in levels of obesity in the most recent five to six years suggests that the trend is flattening out. It will be important to continue to monitor the trends in future, using HSE data to confirm that this plateau is maintained, or ideally if government ambitions are realised that there may be the beginning of a downward trend.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

1

Overall, 60% of boys and 53% of girls aged 8-15 felt that they were about the right weight, while 11% of boys and 14% of girls felt that they were too heavy, and 10% of boys and 5% of girls thought they were too light (19% of boys and 28% of girls were not sure). The majority of children who thought themselves too heavy were obese (68%). Of those children who thought of themselves as about the right weight, 30% were overweight or obese.

●

The majority of children aged 8-15 said that they were not trying to change their weight (64% of boys and 60% of girls), while 25% of boys and 35% of girls said they were trying to lose weight. Among those who said they were trying to lose weight, 20% were overweight and 50% were obese.

●

Parents of children aged 4-15 were asked whether they felt their child was about the right weight or too heavy or too light. The majority of parents thought that their child was about the right weight (78% for both boys and girls), while around one in ten parents thought their child was too heavy (8% for boys, 10% for girls). Parents were more likely to consider children aged 11-15 to be too heavy than those aged 4-10. 91% of parents who thought their child was too heavy were correct. However, almost half of parents whose child was obese misjudged them to be about the right weight (47%), and similarly the majority of parents whose child was overweight thought they were about the right weight (84%).

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

2

●

11.1 Introduction The increasing prevalence of obesity among adults and children is a major public health concern both nationally and internationally. In 2007, the Foresight report projected that in the UK 25% of children aged 2-15 will be obese and 30% overweight by 2050.1 In November 2010, the coalition government set out its long-term commitment to the future of public health in its white paper, Healthy Lives, Healthy People: Our Strategy for Public Health in England.2 The paper outlined the commitment to tackle childhood obesity nationally through continuing to run the National Child Measurement Programme.3 This set out to provide local areas with feedback on levels of overweight and obesity in children to help inform the planning and commissioning of local services. The paper also outlined a national initiative to tackle obesity by promoting and empowering families to make healthier food choices and be physically active through the Change4Life campaign.4 The aim was to work with businesses and other partners through the Public Health Responsibility Deal.5 This challenged businesses and other organisations to support people to make informed, balanced choices to live healthier lifestyles. Building on these commitments, in October 2011 the government published A call for action on obesity in England.6 This outlined in detail national ambitions to challenge overweight and obesity through a ‘life course’ approach. The paper described the action needed by a wide range of partners to address the issue and set national ambitions for reductions in obesity prevalence. For children the national priority is to achieve ‘a sustained downward trend in the level of excess weight by 2020’. Overweight and obesity are terms that refer to an excess of body fat and they usually relate to increased weight-for-height. The two terms denote different degrees of excess adiposity (body fat), and overweight can be thought of as a stage where an individual is at risk of developing obesity.7 The adverse health consequences associated with obesity are mostly related to an increased adiposity rather than increased weight per se8 and it is therefore important that any indicator of obesity reflects this increased adiposity.

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

The importance of studying early overweight and obesity is highlighted by the increasing body of evidence that links obesity with numerous long-term and immediate physiological health risks. Childhood and adolescent obesity can persist into adulthood, where the direct health risks of obesity are severe and well-established. It has been estimated that up to 50% of obese adolescents remain obese in adulthood.9,10 Other studies have linked childhood and adolescent overweight and obesity directly to middle-age mortality and a range of chronic diseases in adult life.11,12,13,14,15 In addition to the increased risk of health problems in later life, children face immediate health consequences of obesity including increased risks for an abnormal lipids profile and elevated blood pressure.16 Associations between childhood obesity and increased asthma prevalence17 and the incidence of Type 2 diabetes mellitus18 have also been reported. The adverse consequences of obesity are not only limited to the direct impact on physiological health. There has also been increasing attention on the effects of overweight and obesity on psychosocial wellbeing. Evidence suggests that a large proportion of adolescents are dissatisfied with their body size and shape and want to be thinner. This concern increases with body mass, especially among girls.19,20,21 Increases in BMI and decreases in physical activity over time have also been found to be significantly associated with depressive symptoms in adolescents,22 especially young women.23 The adverse effects of being overweight and obese have also been linked to low self esteem and self image,24 with physical appearance and physical competence being most affected.22 Families have an important role to play in the management and treatment of childhood obesity.25 Acknowledging excess weight and an understanding of its health consequences are a first step in tacking obesity. However, evidence suggests that parents who underestimate the weight status of their overweight or obese children may be less likely to provide them with the support they need to achieve a healthy weight.26 Studies have shown

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

3

that, among parents of pre school children, as many as 90% do not correctly identify their child as overweight when this is the case.27 This chapter examines patterns of overweight and obesity among children aged 2-15, and their relationship with demographic and attitude variables. Trend data on key HSE measures, including child obesity, are available in Health Survey for England 2011 trend tables on the Health and Social Care Information Centre website.28

11.2 Methods and definitions 11.2.1

Methods Children aged 2-15 had their height and weight measured and BMI was calculated from the valid readings. The calculation uses sex and exact age in 6 month bands (extracted from the date of interview minus the date of birth). Presentation of the results is based, however, on the age at last birthday, which is the HSE standard. Also in line with the HSE standard for children, none of the results have been age-standardised. Trends from HSE years 1995 through to 2011 show BMI, overweight and obesity prevalence calculated for children aged 2-15. Children were first included in the HSE in 1995 and since then weighting has been necessary to compensate for the fact that the number of children interviewed in a household is limited to two. This weighting is used to adjust the data to ensure that the age/sex distribution matches that of all children in co-operating households. Non-response weighting was also introduced in 2003. The child-selection weighted estimates are shown for 1995-2002 and the non-response weighted estimates (including adjustment for child selection) for 2003-2011. National trend data are presented separately for three age groups: 2-10, 11-15 and 2-15. Questions about children’s perceptions of their own weight and their desire to change their weight have been asked since 2006. Children aged 8-15 were asked as part of a selfcompletion questionnaire whether or not they thought they were about the right weight and also whether they were trying to change their weight. In 2011 for the first time, parents of children aged 4-15 were asked about their perceptions of their child’s weight. This question was included at the end of the Strengths and Difficulties Questionnaire (SDQ), a selfcompletion booklet completed by one of the parents of each child aged 4-15. Analyses of parents’ perceptions are presented in Tables 11.8 to 11.10, and it should be noted that there are relatively small numbers of children for whom parent information is also available. Therefore in some cases data for boys and girls have been combined, and margins of error for some of the estimates will be wide. Definitions Body mass index (BMI), calculated as weight (kg) divided by height squared (m2), has been shown to correlate strongly with adiposity in adults29,30 and children.31,32,33 It is the key measure of overweight and obesity used in this chapter. The decision to use BMI is supported by recommendations made by the International Obesity Task Force, which concluded that BMI is a reasonable measure of body adiposity in children.34 As in previous HSE reports, children’s overweight and obesity prevalence and trends have been produced using the UK National BMI percentiles classification.35,36 This classification was used to produce obesity trend estimates in the Chief Medical Officer’s 2002 Annual Report.37 Different growth patterns among boys and girls at each age mean that a universal categorisation cannot be used to define childhood overweight and obesity. Overweight and obesity prevalence for children aged 2-15 is therefore estimated using the exact age (categorised in 6 month bands) and the sex-specific UK National BMI percentiles classification.38,39 This classification gives the BMI threshold for each age above which a child is considered overweight or obese. The classification estimates were produced by calculating the percentage of boys and girls who were at or above the 85th (overweight) or 95th (obese) BMI percentiles of the 1990 reference population.

4

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

11.2.2

11.3 BMI and prevalence of overweight and obesity 11.3.1

BMI, overweight and obesity, by age and sex Mean BMI was higher overall among girls than boys aged 2-15 (18.6kg/m2 and 18.3kg/m2 respectively, a difference of 0.3kg/m2). As Figure 11A shows, BMI generally increased with age in both sexes. Mean BMI ranged from 16.5kg/m2 for boys and girls aged 2-4 to 21.4kg/m2 for boys and 21.9kg/m2 for girls aged 13-15. Table 11.1, Figure 11A Figure 11A Mean BMI, by age and sex

Boys Girls

Base: Aged 2-15 with valid height and weight measurements

25

Mean BMI (kg/m2)

20

15

10

5

0 2-4

5-7

8-10

11-12

13-15

Age group

17% of boys and 16% of girls aged 2-15 were classed as obese, and 31% of boys and 28% of girls were classed as either overweight or obese; the differences between the sexes were not statistically significant. Table 11A summarises the proportions within three broad age groups. Older children were more likely than younger children to be obese, or overweight including obese. 24% of boys aged 11-15, 17% aged 8-10 and 10% aged 2-7 were obese; among girls the respective proportions were 17%, 24% and 12%. Similarly, 38% of boys and 36% of girls aged 11-15 were overweight including obese, compared with 33% and 29% respectively aged 8-10, and 25% and 22% respectively in the younger age group. Tables 11.2, 11A Table 11A

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

Overweight and obesity prevalence, by age and sex

Boys Overweight Obese Overweight including obese Girls Overweight Obese Overweight including obese

Age group

Total

2-7

2-15

8-10 11-15

%

%

%

%

15 10

15 17

15 24

15 17

25

33

38

31

10 12

5 24

19 17

13 16

22

29

36

28

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

5

11.3.2

BMI, overweight and obesity, by strategic health authority There was significant variation in the proportion of children aged 2-15 who were classed as obese by strategic health authority (SHA), with highest levels of obesity in London, the North East,40 North West and West Midlands. There was no similar variation by SHA for mean BMI, however. Table 11.3 BMI, overweight and obesity, by equivalised household income There was significant variation in the proportion of children aged 2-15 who were obese according to equivalised household income, although there was no similar variation for mean BMI. Figure 11B shows the proportion of children who were overweight or obese in each income quintile. Boys in the lowest quintile were most likely to be obese (25%), whereas obesity was lowest among boys in the highest three income quintiles (9% to14%). The pattern was slightly different among girls, among whom those in the third and lowest income quintiles were more likely to be obese (22% and 19% respectively) than those in highest quintile (5%). Figure 11B Prevalence of overweight and obesity, by equivalised household income and sex

Overweight Obese

Base: Aged 2-15 with valid height and weight measurements

Boys 45 40 35

Percent

30 25 20 15 10 5 0 Highest

2nd

3rd

4th

Lowest

4th

Lowest

Equivalised household income

Girls 45 40 35 30 25 20 15 10 5 0 Highest

2nd

3rd

Equivalised household income

The pattern was slightly different for the proportion of children who were overweight. Boys in the highest and lowest income quintiles were more likely to be overweight (20% and 16% respectively), with little variation in the middle three quintiles (11-13%). The proportion of girls who were overweight was similar across the income quintiles (9-14%). Table 11.4, Figure 11B

6

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

Percent

11.3.3

11.3.4

BMI, overweight and obesity, by Index of Multiple Deprivation (IMD) The impact of area deprivation was examined by looking at mean BMI and obesity prevalence by quintiles of IMD. The general pattern was that the proportion of children aged 2-15 who were obese was higher among those living in the most deprived quintile (29% of boys and 22% of girls) than those living in the least deprived quintile (11% of boys and 10% of girls). A similar pattern emerged with the proportion of children who were overweight including obese, with prevalence ranging from 39% of boys and 36% of girls in the most deprived quintile to 27% of boys and 19% of girls in the least deprived quintile. There were no equivalent significant variations by IMD quintiles in mean BMI.

Table 11.5

11.4 Child and parent perceptions of weight 11.4.1

Child perceptions of their own weight Children aged 8-15 were asked about their perception of their own weight in the selfcompletion booklet. Parents of children aged 4-15 were also asked about their perceptions of their child’s weight in a self-completion booklet. Table 11.6 shows 60% of boys and 53% of girls aged 8-15 thought that they were about the right weight. 11% of boys and 14% of girls thought they were too heavy, while 10% of boys and 5% of girls thought they were too light. A substantial proportion of children were not sure whether they were about the right weight (19% of boys and 28% of girls). The mean BMI of children aged 8-15 who thought that they were about the right weight was 19.3kg/m 2, compared with 26.0kg/m 2 for those who thought they were too heavy. The majority of children who thought they were too heavy were obese (68%). However, almost a third of children who considered themselves to be about the right weight were overweight or obese (30% in total, 14% obese and 15% overweight). Looking at the data from a different perspective, the majority of children aged 8-15 who were not overweight or obese thought they were about the right weight (61%), while most of the remainder were not sure. However, a similar proportion of children who were overweight also judged that they were about the right weight (62%), as did 40% of those who were obese. This pattern is comparable with the findings from the HSE in 2010,41 and continues to suggest a lack of awareness of a weight problem among many children of this age. Tables 11.6, 11.7

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

11.4.2

Parent perceptions of their child’s weight Table 11.8 shows parent perceptions of their child’s weight. The majority of parents of children aged 4-15 thought that their child was about the right weight (78% for both boys and girls), while around one in ten parents thought their child was too heavy (8% for boys, 10% for girls). Parent perception varied significantly according to the age of their child. A higher proportion of parents of children aged 4-10 thought that their child was about the right weight (82% for boys and 79% of girls) than parents of children aged 11-15 (72% for boys and 75% for girls). Correspondingly, parents of children aged 11-15 were more likely to think their child was too heavy (13% for boys and 16% for girls) than parents of children aged 4-10 (4% for boys and 6% for girls). Table 11.9 shows mean BMI and prevalence of obesity by parent perception of their child’s weight for all children aged 4-15, while Table 11.10 shows the 8-15 age group, directly comparable with Table 11.7 (based on perceptions of their own weight among children aged 8-15). In cases where parents of children aged 4-15 thought they were about the right weight, the mean BMI was 18.0kg/m 2, compared with 26.0kg/m for children whose parents thought they were too heavy. In the majority of cases where parents thought their child was too heavy, the child was in fact overweight or obese (91%), while in around a quarter of cases where parents thought their child was about the right weight, the child was in fact overweight or obese (24%). The pattern was very similar among the slightly older group of children aged 8-15. HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

7

11.4.3

Children trying to change weight Looking at the data from a different perspective, almost half of parents whose children aged 4-15 were obese misjudged their child to be about the right weight (47%). Similarly, a large proportion of parents whose children were overweight thought their child was about the right weight (84%). Tables 11.8-11.10 Table 11.11 shows the proportion of children aged 8-15 who reported that they were trying to change their weight. The majority of children were not trying to change their weight (64% of boys and 60% of girls). More girls than boys said they were trying to lose weight (35% of girls and 25% of boys), and this was more likely to be the case among older children for both sexes. The mean BMI of children trying to lose weight was 23.5kg/m 2, compared with 16.8 kg/m 2 for those trying to gain weight and 18.7kg/m 2 for those who felt they were the correct weight. Among those who were trying to lose weight 20% were overweight and 50% were obese, while 30% were neither overweight nor obese. Looking at the data from another perspective, 28% of children aged 8-15 who were obese were not trying to change their weight, and neither were 55% who were overweight. Tables 11.11, 11.12

11.5 Trends in BMI, overweight and obesity Tables 11.13 to 11.15 show trends in mean BMI and the prevalence of overweight and obesity between 1995 and 2011. The tables present trend data for children aged 2-15 and then for the age groups 2-10 and 11-15 separately. Among boys aged 2-15 mean BMI increased between 1995 and 2011 by 0.6kg/m 2 (from 17.7kg/m 2 to 18.3kg/m 2); the increase was 0.5kg/m 2 among girls (from 18.1kg/m 2 to 18.6kg/m 2). With fluctuations from year to year, overall increases in mean BMI were evident for both sexes during this period. Figure 11C shows three-year moving averages from 1995 to 2011 for children aged 2-15 who were obese, and overweight including obese. It has been well documented that childhood obesity in the UK has increased significantly since 1995. While the trends in Table 11.13 show yearly fluctuations between 1995 and 2011, the prevalence of obesity among boys aged 2-15 increased by 6 percentage points (from 11% to 17%), and the equivalent increase for girls was 4 percentage points (from 12% to 16%). However, the pattern has not Figure 11C Overweight and obesity prevalence for children aged 2-15, 1995-2011, by age and sex (three year moving averages)

Boys obese Boys overwt incl obese Girls obese Girls overwt incl obese

Base: Aged 2-15 with valid height and weight measurements

30

Percent

25 20 15 10 5 0

1 1 19 19 19 2 2 2 2 2 2 2 2 2 2 2 2 95 96 97 998 999 000 001 002 003 004 005 006 007 008 009 010 011 Year (mid year of moving average)

8

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

35

Figure 11D Prevalence of obesity, 1995-2011, by sex Base: Aged 2-15 with valid height and weight measurements

Age 2-10 Age 11-15

Boys 30 25

Percent

20

15 10 5 0

19 19 19 19 19 20 20 2 2 2 2 2 2 2 2 2 2 95 96 97 98 99 00 01 002 003 004 005 006 007 008 009 010 011 Year

Girls 30 25

Percent

20

15 10 5 0

19 19 19 19 19 20 20 2 2 2 2 2 2 2 2 2 2 95 96 97 98 99 00 01 002 003 004 005 006 007 008 009 010 011 Year

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

been one of uniform increase during that period. The prevalence of obesity increased steadily in most years up to around 2004 and 2005, and since then the pattern has been slightly different for boys and girls. Among boys the proportion who were obese has remained at a similarly high level, between 16% and 19%, since 2001. Among girls, there was a significant decrease in obesity between 2005 and 2006, and levels have been maintained at this slightly lower level between 2006 and 2011. The proportion of children who were overweight varied less over the period than the proportion who were obese. While there has been a gradual slight increase overall, there have been fluctuations from year to year. Thus changes in the proportion who were either overweight or obese have closely followed the pattern of changes in the proportion who were obese. The moving averages shown in Figure 11C, and the lack of significant change in the proportion of children who were obese in the most recent five to six years, suggest that the trend in obesity is flattening out. It will be important to continue to monitor the trends in future, using HSE data to confirm that this plateau is maintained, or ideally if government ambitions are realised that there may be the beginning of a downward trend. As well as the differences between boys and girls highlighted above, there were differences in trends according to age. Figure 11D shows, for the period from 1995 to 2011, the proportion of children aged 2-10 and 11-15 who were obese. Among boys, there was a broadly similar pattern of increase for both age groups up to 2005; since 2006 among those aged 2-10 the proportion who were obese has decreased from 17% to 12%. However, among boys aged 11-15 there has not been any decrease, and the proportion obese in

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

9

2011 was 24%, one of the highest levels recorded. While this was not a significant increase from 2010, it remains to be seen whether the upward trend is starting again or whether this is a temporary fluctuation in the data.42 Among girls aged 2-10 and 11-15, the overall pattern was similar to that among older boys. Among the older girls, the prevalence of obesity increased between 1995 and 2003 (16% to 22%); since then, apart from an apparently anomalous result in 2004,43 there has been no significant year on year change. The proportion of girls in this age group who were obese in 2010 and 2011 (17% each year) was at a similar level to that in 1995 (16%), and it would seem that the trend has been flattening out over the most recent few years. Among younger girls aged 2-10, again the proportion obese has remained similar over the last six years. Figures 11C, 11D, Tables 11.13-11.15

11.6 Discussion Findings presented in this chapter showed significant variation in mean BMI among boys and girls aged 2-15. Mean BMI was higher among girls than boys, and also varied across age groups, being generally lower among younger children and increasing in older children. Similarly, as in previous years, children aged 11-15 were more likely to be overweight and obese than those aged 2-10. Consistent with previous HSE findings, there were inequalities in the prevalence of obesity by equivalised household income. For boys, higher prevalence of obesity was found in the lowest income quintile and for girls in the third and lowest income quintiles. This reflects a similar pattern among adults, with higher prevalence of obesity in the lower income quintiles. Obesity prevalence was also generally higher among children living in the most deprived areas of England compared with those living in the least deprived, an association which has also been found in the National Child Measurement Programme.3 The government’s Call for Action on Obesity recognises these inequalities and suggests targeting public health messages through local level initiatives to address the socioeconomic differences in obesity and overweight prevalence.6

In 2011, for the first time parents of children aged 4-15 were asked about their perceptions of their child’s weight. Consistent with previous studies,26,45 findings from this chapter indicate that many parents of obese or overweight children do not accurately perceive their child’s weight status. Although base sizes in the HSE 2011 are not big enough to detect different patterns between boys and girls, findings from other studies indicate that parents of obese or overweight boys were more likely to misperceive their child’s weight status than parents of obese or overweight girls.46,47 It has also been shown that parents have an important role to play in providing support and influencing children’s behaviours in regards to healthy weight management and the treatment of obesity.25,26

References and notes 1 Foresight. Tackling Obesities: Future Choices – Project report; Government Office for Science, 2007. www.bis.gov.uk/foresight/our-work/projects/published-projects/tackling-obesities/reports-andpublications 2 Department of Health. Healthy Lives, Healthy People: Our Strategy for Public Health in England. HMSO, London, 2010. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941 3 National Child Measurement Programme. Health and Social Care Information Centre, Leeds, 2010. www.ic.nhs.uk/ncmp

10

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

Continuing the trend in previous reports, there is a substantial proportion of children aged 8-15 who were overweight or obese but thought that they were about the right weight (62% who were overweight, and 40% who were obese). These findings indicate that many children lack awareness and understanding that they have a problem with their weight, and without this recognition it is unlikely that they will be able to address the issue. Therefore, initiatives such as Healthy Schools Programme,44 which includes a toolkit to help schools deliver information about health and healthy lifestyles, may play an important role in providing information on healthy choices to children.

4 Change4Life. Department of Health, London, 2009. www.nhs.uk/Change4Life 5 Public Health Responsibility Deal. Department of Health, London, 2011. www.dh.gov.uk/en/Publichealth/Publichealthresponsibilitydeal/index.htm 6 Department of Health. Healthy Lives, Healthy People: A call for action on obesity in England. HMSO, London, October 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130401 7 Barlow S, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. Paediatrics 1998;102:E29. 8 Taylor RW, Jones IE, Williams SM, Goulding A. Body fat percentages measured by dual-energy X-ray absorptiometry corresponding to recently recommended body mass index cutoffs for overweight and obesity in children and adolescents aged 3-18y. American Journal of Clinical Nutrition 2002;76:14161421. 9 Steinbeck K. The importance of physical activity in the prevention of overweight and obesity in childhood:a review and an opinion. Obesity Reviews 2001;2:117-130. 10 Greater London Authority. Childhood obesity in London, 2011. www.london.gov.uk/sites/default/files/glae-childhood-obesity.pdf 11 Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. Journal of Chronic Disease 1978;32:563-565. 12 Rhoads GG, Kagan A. The relation of coronary-disease, stroke, and mortality to weight in youth and in middle-age. Lancet 1983;1:492-495. 13 Gunnell D, Frankel S, Nanchahal K, Peters TJ, Smith GD. Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. American Journal of Clinical Nutrition1998;67:1111-18. 14 Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents – a follow-up of the Harvard growth study of 1922 to 1935. New England Journal of Medicine 1992;327:1350-55. 15 Engeland A, Bjorge T, Sogaard AJ, Tverdal A. Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227,000 Norwegian boys and girls. American Journal of Epidemiology 2003;157:517-523. 16 Freedman D, Dietz WH, Srinivasan S, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics, 1999;103:1175-1182. 17 von Mutius E, Schwartz J, Neas LM, Dockery D, Weiss ST. Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III. Thorax, 2001;56:835-838. 18 Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR et al. Type 2 diabetes among North American children and adolescents: an epidemiological review and a public health perspective. Journal of Pediatrics, 2000;136:664-672. 19 Braet C, Wydhooge K. Dietary restraint in normal weight and overweight children. A cross-sectional study. International Journal of Obesity 2000:24:314-318. 20 Hill AJ, Draper E, Stack J. A weight on children’s minds: body shape dissatisfactions at 9-years old. International Journal of Obesity 1994;18:383-389. 21 Gustafson-Larson AM, Terry RD. Weight-related behaviours and concerns of fourth-grade children. Journal of American Dietectic Association 1992;92:818-822.

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

22 Sjoberg RL. Obesity, Shame, and Depression in School-Aged Children: A Population-Based Study. Paediatrics 2005;116(3):389-92. 23 Ball K, Burton NW, Brown WJ. A prospective study of overweight, physical activity, and depressive symptoms in young women. Obesity 2009;1791:66-71. 24 Cornette R. The emotional impact of obesity on children. Worldviews on Evidence-Based Nursing 2008;5(3):136-41. 25 Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annual Review of Public Health, 2001;22:337-353. 26 Carnell S, Edwards C, Croker H et al. Parental perceptions of overweight in 3-5y olds. International Journal of Obesity, 2005;29:353-355. 27 Baughcum AE, Chamberlin LA, Deeks CM, Powers SW, Whittaker RC. Maternal perceptions of overweight preschool children. Paediatrics, 2000;106;1380-1386. 28 www.ic.nhs.uk/pubs/hse11trends 29 Russell-Aulet M, Wang J, Thornton J, Pierson RN. Comparison of Dual-Photon Absorptiometry systems for total-body bone and soft-tissue measurements: dual-energy X-rays versus Gd-153. Journal of Bone and Mineral Research 1991;6:411-415. 30 Fernandez JR, Heo M, Heymsfield SB, Pierson RN, Pi-Sunyer FX et al. Is percentage body fat differentially related to body mass index in Hispanic Americans, African Americans, and European Americans? American Journal of Clinical Nutrition 2003;77:71-75.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

11

31 Department of Health. Choosing Health: Making healthier choices easier. HMSO, London, 2004. 32 Lindsay RS, Hanson RL, Roumain J, Ravussin E, Knowler WC, Tataranni PA. Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy X-ray absorptiometry and to cardiovascular risk factors. The Journal of Clinical Endocrinology and Metabolism 2001;86:4061-67. 33 Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB. Body mass index as a measure of adiposity among children and adolescents: a validation study. Journal of Pediatrics 1998;132:204-210. 34 Bellizzi MC, Dietz WH. Workshop on childhood obesity: summary of the discussion. American Journal of Clinical Nutrition 1999;70:173S-175. 35 Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Archives of Disease in Childhood 1995;73:25-29. 36 Scholes S, Heeks F. BMI, overweight and obesity. Chapter 2 in Craig R, Mindell J (eds). Health Survey for England 2006. Volume 2: Obesity and other risk factors in children. Health and Social Care Information Centre, Leeds, 2008. www.ic.nhs.uk/pubs/hse08physicalactivity 37 Chief Medical Officer of England. Annual Report 2002. Department of Health, London, 2003. 38 There is no generally agreed definition of childhood obesity, but there are two widely used indicators: the International Classification, based on reference points derived from an international survey; and the National Body Mass Index percentile classification, based on the UK 1990 reference curves (as used in this report). Although the figures produced by the two different definitions differ considerably (obesity estimates derived using the National Body Mass Index percentile classification are much higher than those derived by the international classification), the overall trends are not affected by the definition used. 39 Stamatakis E. Anthropometric measures, overweight, and obesity. Chapter 9 in Sproston K, Primatesta P (eds). Health Survey for England 2002. The Stationery Office, London, 2003. 40 Note that the base sizes for the North East, particularly for girls, are very small and results should be interpreted with caution. 41 Bridges S, Thompson J. Children’s BMI, overweight and obesity. Chapter 11 in Craig R, Mindell J (eds). Health Survey for England 2010. Health and Social Care Information Centre, Leeds, 2011. www.ic.nhs.uk/pubs/hse10report 42 The base sizes for children aged 2-15 with valid height and weight measurements in 2011 are smaller than in previous years, because there is no child boost, so margins of error are wider for 2011 estimates. 43 The estimate for obesity for girls aged 11-15 in 2004, based on a small sample, was higher than other years. The longer term trends suggest that 2004’s estimates may have been an outlier in the series (due to random variation), and otherwise the trend appears to be flattening out for this and other age groups over the most recent years. 44 www.education.gov.uk/a0075278/healthy-schools 45 Huang JS, Donohue M, Becerra K, Xu R. Relationship between parents’ and children’s weight perceptions. Results of a survey. ICAN: Infant, Child & Adolescent Nutrition, 2012:1(1);15-20. 46 O La De A, Jordan CK, Ortiz K et al. Do parents accurately perceive their child’s weight status? Journal of Paediatric Health Care, 2009:23(4);216-221.

12

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

47 Jeffery AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ. Parents’ awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21). BMJ Jan 2005:330;23-24.

Tables

11.1 BMI, by age and sex

Notes on the tables

11.2 Overweight and obesity prevalence, by age and sex

1. The group on which the figures in the table are based is stated at the upper left corner of the table.

11.3 BMI, overweight and obesity prevalence, by strategic health authority and sex 11.4 BMI, overweight and obesity prevalence, by equivalised household income and sex 11.5 BMI, overweight and obesity prevalence, by Index of Multiple Deprivation and sex 11.6 Child’s perception of own weight, by age and sex 11.7 BMI, overweight and obesity prevalence, by child’s perception of own weight 11.8 Parent perception of child’s weight, by child’s age and sex 11.9 BMI, overweight and obesity prevalence, by parent perception of child’s weight, children aged 4-15

2. The data in most tables have been weighted. See Chapter 7, Volume 2 of this report for more detail. Both unweighted and weighted sample sizes are shown at the foot of each table. 3. Apart from tables showing age breakdowns, data have been age-standardised to allow comparisons between groups after adjusting for the effects of any differences in their age distributions. See Chapter 8.3.3, Volume 2 of this report for more detail. 4. The following conventions have been used in tables: - no observations (zero value) 0 non-zero values of less than 0.5% and thus rounded to zero [ ] used to warn of small sample bases, if the unweighted base is less than 50. If a group’s unweighted base is less than 30, data are normally not shown for that group. 5. Because of rounding, row or column percentages may not add exactly to 100%. 6. ‘Missing values’ occur for several reasons, including refusal or inability to answer a particular question; refusal to co-operate in an entire section of the survey (such as the nurse visit or a self-completion questionnaire); and cases where the question is not applicable to the participant. In general, missing values have been omitted from all tables and analyses.

11.10 BMI, overweight and obesity prevalence, by parent perception of child’s weight, children aged 8-15 11.11 Desire to change weight, by age and sex

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

11.12 BMI, overweight and obesity prevalence, by desire to change weight 11.13 Trends in BMI, overweight and obesity prevalence among children aged 2-15, 19952011, by sex 11.14 Trends in BMI, overweight and obesity prevalence among children aged 2-10, 19952011, by sex 11.15 Trends in BMI, overweight and obesity prevalence among children aged 11-15, 19952011, by sex

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

13

Table 11.1 BMI, by age and sex Aged 2-15 with valid height and weight measurements BMI (kg/m2)

2011

Age group

Total

2-4

5-7

8-10

11-12

13-15

Mean

16.5

16.4

Standard error of the mean

0.13

0.18

17.5

20.1

21.4

0.25

20.08

0.32

5th percentilea 10th percentile 15th percentile Median 85th percentile 90th percentile 95th percentile

14.0 14.6 15.0 16.5 18.2 18.4 19.0

0.16

13.9 14.2 14.4 16.2 18.1 18.8 19.9

14.1 14.4 14.9 16.9 20.2 20.9 22.6

15.0 15.5 16.5 19.6 23.4 25.6 27.1

16.7 17.6 18.1 20.5 25.0 26.1 29.7

14.1 14.8 15.2 17.4 21.6 23.0 25.2

Mean Standard error of the mean

16.5

16.3

18.5

20.4

21.9

18.6

0.14

0.16

0.43

0.43

0.35

5th percentile 10th percentile 15th percentile Median 85th percentile 90th percentile 95th percentile

0.18

14.3 15.0 15.2 16.3 18.3 18.6 19.1

13.6 13.9 14.3 15.9 17.9 18.8 20.9

14.1 14.7 15.2 17.3 22.3 23.6 26.6

15.6 16.3 16.6 19.5 23.7 25.7 28.6

17.0 17.7 18.2 21.3 25.0 27.6 29.5

14.1 14.9 15.2 18.6 22.5 23.6 26.3

164 128

153 192

141 133

74 88

146 119

678 660

138 127

154 158

141 135

79 98

174 148

687 666

Boys 18.3

Girls

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Percentiles show a set of points within a scale from 1-100 which is divided into

14

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

groups based on order of magnitude. For example, the group of those with a mean BMI that is equal to or less than the value of 5% of those who have valid height and weight measurements is expressed as the 5th percentile.

Table 11.2 Overweight and obesity prevalence, by age and sex Aged 2-15 with valid height and weight measurements BMI status

2011

Age group

Total

2-4

5-7

8-10

11-12

13-15

%

%

%

%

%

%

19 8

11 12

15 17

25 24

10 24

15 17

27

23

33

50

33

31

10 12

10 11

5 24

18 19

20 15

13 16

23

21

29

37

35

28

164 128

153 192

141 133

74 88

146 119

678 660

138 127

154 158

141 135

79 98

174 148

687 666

Boys Overweighta,b Obesea,b Overweight including obese

Girls Overweighta,b Obesea,b Overweight including obese Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Categories are mutually exclusive, i.e. overweight does not include those who are

obese. b Overweight was defined as at or above the 85th but below the 95th UK National BMI

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

percentile; obese was defined as at or above the 95th UK National BMI percentile.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

15

Table 11.3 BMI, overweight and obesity prevalence, by strategic health authoritya and sex Aged 2-15 with valid height and weight measurements BMI (kg/m2) and BMI status

2011

Strategic health authority North East

North Yorkshire East West West & the Midlands Midlands Humber

East of England

London

South East Coast

South Central

South West

19.2

Boys Mean BMI

19.8

18.5

17.7

17.8

18.7

17.5

18.4

17.7

18.4

Standard error of the mean

0.85

0.49

0.35

0.42

0.48

0.40

0.40

0.53

0.43

0.81

Median BMI % overweightb,c % obeseb,c % overweight including obese

18.5 15 30 45

16.9 15 18 33

17.4 13 7 20

17.2 18 10 28

17.5 14 18 32

16.9 19 9 28

18.1 14 27 40

17.1 15 10 25

17.6 15 11 26

18.1 11 22 33

[18.0]

18.5

18.4

17.5

19.0

18.6

19.2

19.6

17.9

18.5

[0.65]

0.42

0.45

0.48

0.68

0.41

0.55

0.71

0.65

0.58

[16.8] [6] [13] [19]

17.5 14 25 39

18.1 11 12 23

16.7 11 8 19

18.4 11 19 30

17.4 8 17 25

17.6 16 19 35

18.5 23 11 34

17.3 7 13 20

17.4 13 12 25

69 43

85 90

69 68

56 61

72 69

63 77

86 81

55 57

68 56

55 58

42 26

98 93

71 68

52 58

70 70

68 80

113 104

59 63

60 48

54 58

Girls Mean BMI Standard error of the mean

Median BMI % overweightb,c % obeseb,c % overweight including obese Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a This table provides data for regional analysis by the configuration of strategic health authorities (SHAs) in place from July 2006. b Categories are mutually exclusive, i.e. overweight does not include those who are obese. c Overweight was defined as at or above the 85th but below the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI

percentile.

16

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

[ ] Results in brackets should be treated with caution because of the small base size.

Table 11.4 BMI, overweight and obesity prevalence, by equivalised household income and sex Aged 2-15 with valid height and weight measurements

2011

BMI (kg/m2) and

Equivalised household income quintile

BMI status

Highest

2nd

3rd

4th

Lowest

Mean BMI

18.3

17.6

18.0

18.7

18.9

Standard error of the mean

0.41

0.29

0.42

0.39

0.40

Median BMI % overweighta,b % obesea,b

17.4 20 14

17.2 13 9

17.4 13 14

17.6 11 17

18.1 16 25

34

21

27

29

41

Mean BMI

17.7

18.2

19.3

18.4

18.8

Standard error of the mean

0.39

0.37

0.46

0.42

0.54

Median BMI % overweighta,b % obesea,b % overweight including obese

16.9 9 5

17.4 11 16

18.4 14 22

17.1 10 13

17.4 13 19

14

27

36

23

32

111 88

117 124

87 98

139 135

124 110

105 85

109 120

80 93

143 132

139 120

Boys

% overweight including obese

Girls

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Categories are mutually exclusive, i.e. overweight does not include those who are

obese. b Overweight was defined as at or above the 85th but below the 95th UK National

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

17

Table 11.5 BMI, overweight and obesity prevalence, by Index of Multiple Deprivation (IMD)a and sex Aged 2-15 with valid height and weight measurements

2011

BMI (kg/m2) and BMI

IMD quintile

status

Least deprived

2nd

3rd

4th

Most deprived

Mean BMI

17.9

18.6

17.9

18.5

18.7

Standard error of the mean

0.24

0.50

0.33

0.26

0.44

Median BMI 17.3 % overweightb,c 17 % obeseb,c 11 % overweight including obese 27

18.2 15 19 33

18.0 16 12 29

17.0 17 11 28

17.6 10 29 39

19.0

Boys

Girls Mean BMI

18.1

18.8

18.5

18.6

Standard error of the mean

0.34

0.39

0.39

0.50

0.43

Median BMI 17.3 % overweightb,c 8 % obeseb,c 10 % overweight including obese 19

18.2 19 14 33

18.0 15 14 29

17.0 7 19 26

17.6 14 22 36

171 153

123 120

120 126

124 119

140 142

161 148

122 122

115 124

133 120

157 152

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a The Index of Multiple Deprivation 2010 (IMD) combines a number of indicators,

chosen to cover a range of economic, social and housing issues, into a single deprivation score at the small area level in England. b Categories are mutually exclusive, i.e. overweight does not include those who are

obese. c Overweight was defined as at or above the 85th but below the 95th UK National BMI

18

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

percentile; obese was defined as at or above the 95th UK National BMI percentile.

Table 11.6

Table 11.7

Child’s perception of own weight, by age and sex Aged 8-15 with valid height and weight measurements Child’s perception of own weight

BMI, overweight and obesity prevalence, by child’s perception of own weight 2011

Age group

Total

Aged 8-15 with valid height and weight measurements

8-10 11-12

8-15

BMI (kg/m2) and

%

%

%

Child’s perception of own weight

BMI status

About Too the right heavy weight

Boys About the right weight Too heavy Too light Don’t know

56 4 12 28

62 14 9 15

60 11 10 19

53 7 6 33

53 17 4 26

53 14 5 28

141 137

228 223

369 360

Girls About the right weight Too heavy Too light Don’t know Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

2011

Too light

Mean BMI

19.3

26.0

Standard error of the mean

0.17

0.58

[0.31]

Median BMI 19.0 % neither overweight or obese 70 % overweighta,b 15 % obesea,b 14 % overweight including obese 30

25.4 17 15 68 83

[15.8] 94 [6] [-] 6

65 80

49 54

Bases (unweighted) Bases (weighted)

382 413

[16.5]

a Categories are mutually exclusive, i.e. overweight does not

include those who are obese. b Overweight was defined as at or above the 85th but below

142 141

268 262

410 402

the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile. [ ] Results in brackets should be treated with caution because of the small base size.

Table 11.9 Table 11.8 Parent perception of child’s weight, by child’s age and sex

BMI, overweight and obesity prevalence, by parent perception of child’s weight, children aged 4-15

Parents of children aged 4-15 with valid height and weight measurements 2011

Parents of children aged 4-15 with valid height and weight measurements

Parent perception of child’s weight

BMI (kg/m2) and

Child’s age group

Total

4-10 11-15

4-15

BMI status

%

%

%

82 4 9 5

72 13 7 7

78 8 8 6

79 6 6 9

75 16 5 4

78 10 5 7

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

Boys About the right weight Too heavy Too light Don’t know

Girls About the right weight Too heavy Too light Don’t know

2011

Parent perception of child’s weight About Too the right heavy weight

Too light

Mean BMI

18.0

26.0

Standard error of the mean

0.12

0.64

0.27

Median BMI 17.4 % neither overweight nor obese 76 % overweighta,b 14 % obesea,b 10 % overweight including obese 24

25.4 9 17 74 91

15.3 94 6 6

87 96

71 70

Bases (unweighted) Bases (weighted)

842 845

15.9

a Categories are mutually exclusive, i.e. overweight does not

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

include those who are obese.

397 416

238 229

635 645

381 374

280 264

661 638

b Overweight was defined as at or above the 85th but below

the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

19

Table 11.11

Table 11.10 BMI, overweight and obesity prevalence, by parent perception of child’s weight, children aged 8-15

Aged 8-15 with valid height and weight measurements

Parents of children aged 8-15 with valid height and weight measurements BMI (kg/m2) and BMI status

Desire to change weight, by age and sex

2011

Desire to change weight

Parent perception of child’s weight About Too the right heavy weight

Too light

Mean BMI

19.1

26.8

Standard error of the mean

0.15

0.64

[0.33]

Median BMI 18.7 % neither overweight nor obese 73 % overweighta,b 15 % obesea,b 12 % overweight including obese 27

26.3 6 19 75 94

[15.5] [100] -

75 85

39 39

Bases (unweighted) Bases (weighted)

489 528

2011

Age group

Total

8-10 11-15

8-15

%

%

%

73 15 13

59 31 11

64 25 11

66 27 7

57 40 3

60 35 4

141 137

227 224

368 361

142 141

268 263

410 404

Boys Not trying to change weight Trying to lose weight Trying to gain weight

[16.1]

Girls Not trying to change weight Trying to lose weight Trying to gain weight Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Categories are mutually exclusive, i.e. overweight does not

include those who are obese. b Overweight was defined as at or above the 85th but below

the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

Table 11.12 BMI, overweight and obesity prevalence, by desire to change weight Aged 8-15 with valid height and weight measurements BMI status

2011

Desire to change weight Not trying to change

Trying to lose weight

Trying to gain weight

Mean BMI

18.7

23.5

16.8

Standard error of the mean

0.16

0.38

0.34

Median BMI % neither overweight nor obese % overweighta,b % obesea,b % overweight including obese

18.4 79 12 9 21

23.0 30 20 50 70

16.1 94 6 6

Bases (unweighted) Bases (weighted)

421 454

180 213

55 58

a Categories are mutually exclusive, i.e. overweight does not

include those who are obese. b Overweight was defined as at or above the 85th but below the

95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

20

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

BMI (kg/m2) and

Table 11.13 Trends in BMI, overweight and obesity prevalence among children aged 2-15, 1995-2011, by sex Aged 2-15 with valid height and weight measurements

1995-2011

BMI (kg/m2) and

Survey year

BMI status

1995 1996 1997 1998 1999

2000 2001 2002 2003a 2004 2005 2006 2007 2008 2009 2010 2011

Mean

17.7

17.7

17.8

17.9

18.2

18.0

18.2

18.3

18.5

18.6

18.6

18.4

18.4

18.4

18.3

18.2

Standard error of the mean

0.08

0.07

0.06

0.08

0.15

0.14

0.08

0.07

0.12

0.15

0.13

0.07

0.06

0.08

0.09

0.08

0.16

Median % Overweightb,c % Obeseb,c % Overweight including obese

17.0 13 11

17.1 15 12

17.0 13 13

17.1 15 13

17.3 15 17

17.0 13 15

17.4 15 16

17.4 14 17

17.5 15 17

17.5 14 19

17.7 16 18

17.5 13 18

17.5 14 17

17.4 15 17

17.5 15 16

17.4 14 17

17.4 15 17

24

27

26

28

32

27

31

31

32

33

35

31

31

31

31

31

31

Mean

18.1

18.1

18.1

18.4

18.2

18.5

18.6

18.8

18.8

19.3

18.9

18.7

18.7

18.7

18.5

18.3

18.6

Standard error of the mean

0.09

0.10

0.07

0.10

0.15

0.14

0.10

0.07

0.12

0.20

0.14

0.08

0.08

0.08

0.10

0.09

0.18

Median % Overweightb,c % Obeseb,c % Overweight including obese

17.3 13 12

17.2 12 12

17.3 13 13

17.4 14 14

17.3 14 14

17.4 13 14

17.6 16 15

17.8 14 17

17.8 15 16

18.1 17 18

17.8 13 19

17.6 14 15

17.7 14 16

17.7 14 15

17.5 13 15

17.4 14 15

17.5 13 16

26

24

26

28

28

27

31

32

32

35

32

29

31

29

28

29

28

1697 1874 3275 1754 1672 1758 3288 1657

857 789

864 1490 3250 1417 846 1532 3140 1416

635 1166 3029 3255 3030 1733 2303 578 1191 2950 3090 3068 1607 2219

678 660

1918 2130 3061 1980 1901 2012 3068 1872

977 950

875 1652 3744 1452 841 1698 3634 1392

623 1102 2821 2885 2880 1526 2079 581 1091 2668 2792 2740 1464 2033

687 666

Boys 18.3

Girls

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Data for all years have been weighted to correct for the probability of selection. From 2003, non-response weighting has also been applied. b Categories are mutually exclusive, i.e. overweight does not include those who are obese.

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

c Overweight was defined as at or above the 85th but below the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

21

Table 11.14 Trends in BMI, overweight and obesity prevalence among children aged 2-10, 1995-2011, by sex Aged 2-10 with valid height and weight measurements

1995-2011

BMI (kg/m2) and

Survey year

BMI status

1995 1996 1997 1998 1999

2000 2001 2002 2003a 2004 2005 2006 2007 2008 2009 2010 2011

Mean

16.7

16.7

16.7

16.9

17.2

16.9

17.0

17.1

17.2

17.2

17.3

17.1

17.2

17.1

17.0

17.0

Standard error of the mean

0.06

0.06

0.05

0.08

0.15

0.10

0.08

0.06

0.12

0.13

0.12

0.07

0.06

0.07

0.08

0.07

0.11

Median 16.4 % Overweightb,c 13 % Obeseb,c 10 % Overweight including obese 23

16.4 14 11

16.4 13 11

16.5 15 12

16.6 14 17

16.4 14 12

16.6 16 14

16.6 14 16

16.5 15 15

16.6 15 16

16.7 16 17

16.6 12 17

16.7 13 16

16.5 14 14

16.5 16 14

16.6 14 15

16.5 15 12

25

25

27

31

26

30

29

31

31

34

30

30

28

30

30

27

17.0

Boys 16.8

Girls Mean

16.9

16.8

16.9

17

17

17

17.1

17.3

17.2

17.3

17.4

17.1

17.2

17.2

17.1

16.9

Standard error of the mean

0.08

0.08

0.05

0.07

0.13

0.12

0.09

0.07

0.11

0.14

0.13

0.07

0.07

0.07

0.09

0.08

0.17

Median % Overweightb,c % Obeseb,c % Overweight including obese

16.4 13 11

16.4 11 11

16.5 12 11

16.5 13 12

16.6 14 13

16.4 12 12

16.6 15 13

16.7 14 16

16.6 14 13

16.8 15 13

16.7 13 17

16.5 13 14

16.7 14 15

16.6 13 13

16.5 12 15

16.4 13 14

16.3 9 16

23

22

23

25

27

24

27

30

27

28

30

27

29

26

27

27

24

1113 1234 2159 1185 1114 1178 2222 1082

563 535

582 537

913 2036 980 1948

864 869

404 338

707 1875 2006 1863 1086 1466 731 1845 1921 1909 1020 1453

458 453

1261 1418 2005 1336 1266 1365 2081 1215

633 628

570 1035 2364 523 1094 2290

878 857

379 346

664 1737 1766 1762 674 1635 1746 1701

434 420

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

934 1293 916 1298

a Data for all years have been weighted to correct for the probability of selection. From 2003, non-response weighting has also been applied. b Categories are mutually exclusive, i.e. overweight does not include those who are obese. c Overweight was defined as at or above the 85th but below the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

22

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

Table 11.15 Trends in BMI, overweight and obesity prevalence among children aged 11-15, 1995-2011, by sex Aged 11-15 with valid height and weight measurements

1995-2011

BMI (kg/m2) and

Survey year

BMI status

1995 1996 1997 1998 1999

2000 2001 2002 2003a 2004 2005 2006 2007 2008 2009 2010 2011

Mean

19.7

19.7

19.7

19.9

20.1

19.9

20.1

20.3

20.5

20.8

20.5

20.3

20.2

20.5

20.3

20.3

Standard error of the mean

0.15

0.16

0.11

0.15

0.24

0.24

0.16

0.12

0.19

0.27

0.23

0.12

0.11

0.12

0.15

0.14

0.29

Median % Overweightb,c % Obeseb,c % Overweight including obese

19.1 14 14

19.2 15 14

19.1 13 16

19.1 15 17

19.2 15 18

19.2 10 19

19.4 14 19

19.7 15 20

19.7 14 20

20.2 13 24

19.4 15 21

19.7 15 18

19.6 16 18

19.6 16 21

19.5 14 20

19.6 14 20

20.2 15 24

28

29

29

31

33

29

33

35

35

37

36

33

34

36

34

34

38

Mean

20.6

20.8

20.7

21.0

20.5

21.0

21.2

21.2

21.5

22.2

21.4

21.1

21.1

21.2

20.8

20.8

21.3

Standard error of the mean

0.16

0.18

0.13

0.17

0.28

0.24

0.19

0.13

0.2

0.33

0.21

0.13

0.13

0.11

0.19

0.15

0.29

Median % Overweightb,c % Obeseb,c % Overweight including obese

19.9 14 16

20.2 14 16

20.1 16 16

20.4 16 18

20.1 14 16

20.6 15 19

20.6 18 18

20.6 15 20

20.8 17 22

21.3 20 27

20.8 14 21

20.5 17 17

20.4 15 19

20.3 16 18

20.1 15 15

20.2 17 17

20.4 19 17

30

30

32

34

29

33

36

35

39

46

36

34

34

34

31

33

36

584 558

640 1116 580 1066

569 575

294 254

282 309

577 1214 552 1192

553 547

231 240

459 1154 1249 1167 460 1105 1169 1159

647 587

837 766

220 207

658 635

713 1056 648 987

644 657

343 322

305 318

617 1380 604 1343

573 535

244 235

438 1084 1120 1117 417 1033 1046 1039

593 548

786 734

253 245

Boys 21.0

Girls

Bases (unweighted) Boys Girls Bases (weighted) Boys Girls

a Data for all years have been weighted to correct for the probability of selection. From 2003, non-response weighting has also been applied. b Categories are mutually exclusive, i.e. overweight does not include those who are obese.

Copyright © 2012, The Health and Social Care Information Centre. All rights reserved

c Overweight was defined as at or above the 85th but below the 95th UK National BMI percentile; obese was defined as at or above the 95th UK National BMI percentile.

HSE 2011: VOL1 | CHAPTER 11: CHILDREN’S BMI, OVERWEIGHT AND OBESITY

23