Although previous research has suggested that childhood obesity is plateauing, new findings from Duke Health researchers reveal that the rate is still climbing. 

The scientists found that obesity rates for kids aged 2 to 19 continued to rise in 2016, following a three-decade trend in increases. About 35 percent of children in the United States were overweight, up 4.7 percent from 2014. The study appeared Feb. 26 in the journal “Pediatrics.” 

“In previous years, we had thought as a community that the prevalence of childhood obesity was stabilizing if not in some instances going down,” said Sarah Armstrong, associate professor of pediatrics and senior author of the study. “There had been some celebrating that we had turned the corner on the epidemic, but across all age groups, the rates of obesity are going up.”

The researchers used body-mass index data from 3,340 children in the National Health and Nutritional Examination Survey in 2015 and 2016 as well as other data on 33,543 children dating back to 1999. 

They discovered that between 2014 and 2016, obesity among preschool boys rose from 8.5 percent to 14.2 percent and that the rate among girls aged 16 to 19 increased from 35.6 percent to 47.9 percent. 

“Across preschool children for the past five or six years, we thought we were seeing a decline,” said Asheley Skinner, associate professor of population health sciences and lead author. “Any decline we have there seems to be reversing.” 

In addition, teenagers of both genders aged 16 to 19 had the highest rates of obesity out of any age group in 2016—more than 41 percent of them were classified as overweight. 

There were notable racial differences in the findings with African-American and Hispanic children having the highest rates of obesity and Asian-American kids having the lowest. 

Armstrong explained that obesity is worse among among children of color and those who are living in poverty.  

“In this country, more children of color are living in poverty than white children, so there might be some common threads like growing up in food deserts and neighborhoods that are unsafe,” she said.  

Cultural differences in diet and relationships with food could also be a factor, Skinner noted. 

Armstrong acknowledged that there were some limitations to the study, given that the NHANES database only contained two-year data. 

“It’s like taking a picture at a crowded mall to get a sense of who goes to the mall,” she said. “It’s not following the same kids over time.” 

However, the study accessed a wide population and included enough data to create a nationally representative sample of Asian-American children for the first time. 

Reasons for the continuing increase in obesity are wide-ranging, but Armstrong noted that previous attempts to combat the epidemic have focused on public health measures that were not intense enough. She said that communities need to step up their efforts by providing better school lunches and more exercise to students as well as increasing access to healthy foods for those living in poverty. 

“I think what we need to see done in an ideal world is a comprehensive approach that thinks about all of the groups and agencies that a kid touches in their lives,” Skinner said. 

For instance, although improving school lunches is critical, children also often receive unhealthy meals on nights and weekends, she noted. Many parents turn to fast food because they are busy and don’t know how to efficiently cook healthy food. 

Moving forward, Armstrong explained that U.S. children need to decrease their consumption of sugar-sweetened beverages, including most juices, sports drinks and sodas.

“There’s controversy about what makes up healthy and unhealthy foods, but there is no nutritional benefit to sugar sweetened beverages,” she said. 

In addition, tightening media regulations on advertising to children could make a difference. Brightly-colored boxes and cartoon characters are frequently used to attract kids’ attention to sugary snacks and cereal in grocery stores. 

Armstrong noted that talk about diet and nutrition tends to dominate the spotlight but that exercise is also extremely important for kids. Along with helping children maintain a healthy weight, it enhances muscle and bone development, social skills and quality of life. 

In the future, Armstrong and Skinner plan to continue studies to understand the mechanisms of obesity. 

“The next step for us is to look at how obesity affects actual health outcomes and also how all of these changes in obesity reflect changes in physical activity and diet,” Skinner said.  

Scientists at the Duke Clinical Research Institute and the Duke Center for Childhood Obesity Research are working to assess the most effective strategies in reducing obesity.

“It’s really important when there’s an ongoing epidemic to continually monitor it and provide the public with updates about its severity,” Armstrong said.