Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference

doi:10.1136/bmj.326.7390.624

BMJ 2003;326:624 ( 22 March )

Papers

Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference

H David McCarthy, senior lecturer, ^a Sandra M Ellis, research student, ^a Tim J Cole, professor of medical statistics. ^b

^a Department of Health and Human Sciences, London Metropolitan University, London N7 8DB, ^b Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH

Correspondence to: H D McCarthy d.mccarthy{at}londonmet.ac.uk

Objective: To compare changes over time in waist circumference(a measure of central fatness) and body mass index (a measureof overall obesity) in Britishyouth.
Design: Representative cross sectional surveys in1977, 1987, and1997.
Setting: GreatBritain.
Participants: Young people aged 11-16 years surveyed in1977 (boys) and 1987 (girls) for the British Standards Institute(n=3784) and in 1997 (both sexes) for the national diet and nutritionsurvey (n=776).
Main outcome measures: Waist circumference, expressed as a standarddeviation score using the first survey as reference, and bodymass index (weight(kg)/height(m)²), expressed as a standard deviation score against the British1990 revised reference. Overweight and obesity were defined asthe measurement exceeding the 91st and 98th centile,respectively.
Results: Waist circumference increased sharply overthe period between surveys (mean increases for boys and girls,6.9 and 6.2 cm, or 0.84 and 1.02 SD score units, P<0.0001). Incentile terms, waist circumference increased more in girls thanin boys. Increases in body mass index were smaller and similarby sex (means 1.5 and 1.6, or 0.47 and 0.53 SD score units, P<0.0001).Waist circumference in 1997 exceeded the 91st centile in 28% (n=110)of boys and 38% (n=147) of girls (against 9% for both sexes in1977-87, P<0.0001), whereas 14% (n=54) and 17% (n=68), respectively,exceeded the 98th centile (3% in 1977-87, P<0.0001). The correspondingrates for body mass index in 1997 were 21% (n=80) of boys and17% (n=67) of girls exceeding the 91st centile (8% and 6% in 1977-87)and 10% (n=39) and 8% (n=32) exceeding the 98th centile (3% and2% in 1977-87).
Conclusions: Trends in waist circumference during the past10-20 years have greatly exceeded those in body mass index, particularlyin girls, showing that body mass index is a poor proxy for centralfatness. Body mass index has therefore systematically underestimatedthe prevalence of obesity in youngpeople.

What is already known on this topic
The prevalence of overweight and obesity in youth based on body mass index has increased over the past 10-20 years

Body mass index gives no indication of body fat distribution

Waist circumference is a marker for central body fat accumulation; a large waist circumference is linked to an increased risk of metabolic complications

What this study adds
Waist circumference in British youth has increased over the past 10-20 years at a greater rate than body mass index, the increase being greatest in females

The accumulation of central body fat has risen more steeply than whole body fatness based on height and weight

Current and future morbidity in British youth may be seriously affected due to accumulation of excess central fat

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain: Jane Wardle, Naomi Henning Brodersen, Tim J Cole, Martin J Jarvis, and David R Boniface
BMJ 2006 332: 1130-1135. [Abstract] [Full Text] [PDF]

Obesity is on the increase in British youth, especially in girls
BMJ 2003 326: 0. [Full Text]

This article has been cited by other articles:

Steele, R. M, van Sluijs, E. M., Cassidy, A., Griffin, S. J, Ekelund, U. (2009). Targeting sedentary time or moderate- and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children. Am. J. Clin. Nutr. 90: 1185-1192 [Abstract] [Full text]
Basterfield, L, Adamson, A J, Parkinson, K N, Maute, U, Li, P X, Reilly, J J, the Gateshead Millennium Study Core Team, (2008). Surveillance of physical activity in the UK is flawed: validation of the Health Survey for England Physical Activity Questionnaire. Arch. Dis. Child. 93: 1054-1058 [Abstract] [Full text]
Pirkola, J, Tammelin, T, Bloigu, A, Pouta, A, Laitinen, J, Ruokonen, A, Tapanainen, P, Jarvelin, M-R, Vaarasmaki, M (2008). Prevalence of metabolic syndrome at age 16 using the International Diabetes Federation paediatric definition. Arch. Dis. Child. 93: 945-951 [Abstract] [Full text]
Denney-Wilson, E., Hardy, L. L., Dobbins, T., Okely, A. D., Baur, L. A. (2008). Body Mass Index, Waist Circumference, and Chronic Disease Risk Factors in Australian Adolescents. Arch Pediatr Adolesc Med 162: 566-573 [Abstract] [Full text]
Sollerhed, A.-C., Apitzsch, E., Rastam, L., Ejlertsson, G. (2008). Factors associated with young children's self-perceived physical competence and self-reported physical activity. Health Educ Res 23: 125-136 [Abstract] [Full text]
Stellinga-Boelen, A. A.M., Wiegersma, P. A., Bijleveld, C. M.A., Verkade, H. J. (2007). Obesity in asylum seekers' children in The Netherlands the use of national reference charts. Eur J Public Health 17: 555-559 [Abstract] [Full text]
Garnett, S. P, Baur, L. A, Srinivasan, S., Lee, J. W, Cowell, C. T (2007). Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence. Am. J. Clin. Nutr. 86: 549-555 [Abstract] [Full text]
Bloomgarden, Z. T. (2007). Nonalcoholic Fatty Liver Disease and Insulin Resistance in Youth. Diabetes Care 30: 1663-1669 [Abstract] [Full text]
Kelishadi, R., Gouya, M. M., Ardalan, G., Hosseini, M., Motaghian, M., Delavari, A., Majdzadeh, R., Heidarzadeh, A., Mahmoud-Arabi, M. S., Riazi, M. M., for the CASPIAN Study Group, (2007). First Reference Curves of Waist and Hip Circumferences in An Asian Population of Youths: CASPIAN Study. J Trop Pediatr 53: 158-164 [Abstract] [Full text]
Hussey, J, Bell, C, Bennett, K, O'Dwyer, J, Gormley, J (2007). Relationship between the intensity of physical activity, inactivity, cardiorespiratory fitness and body composition in 7-10-year-old Dublin children. Br. J. Sports. Med. 41: 311-316 [Abstract] [Full text]
Wells, J. C., Treleaven, P., Cole, T. J (2007). BMI compared with 3-dimensional body shape: the UK National Sizing Survey. Am. J. Clin. Nutr. 85: 419-425 [Abstract] [Full text]
Stone, M. A, Bankart, J., Sinfield, P., Talbot, D., Farooqi, A., Davies, M. J, Khunti, K. (2007). Dietary habits of young people attending secondary schools serving a multiethnic, inner-city community in the UK. Postgrad. Med. J. 83: 115-119 [Abstract] [Full text]
Saelens, B. E, Seeley, R. J, van Schaick, K., Donnelly, L. F, O'Brien, K. J (2007). Visceral abdominal fat is correlated with whole-body fat and physical activity among 8-y-old children at risk of obesity. Am. J. Clin. Nutr. 85: 46-53 [Abstract] [Full text]
Ward, K. A, Ashby, R. L, Roberts, S. A, Adams, J. E, Zulf Mughal, M (2007). UK reference data for the Hologic QDR Discovery dual-energy x ray absorptiometry scanner in healthy children and young adults aged 6-17 years. Arch. Dis. Child. 92: 53-59 [Abstract] [Full text]
Li, C., Ford, E. S., Mokdad, A. H., Cook, S. (2006). Recent Trends in Waist Circumference and Waist-Height Ratio Among US Children and Adolescents. Pediatrics 118: e1390-e1398 [Abstract] [Full text]
Psarra, G., Nassis, G. P., Sidossis, L. S. (2006). Short-term predictors of abdominal obesity in children. Eur J Public Health 16: 520-525 [Abstract] [Full text]
Reeves, A. F., Rees, J. M., Schiff, M., Hujoel, P. (2006). Total Body Weight and Waist Circumference Associated With Chronic Periodontitis Among Adolescents in the United States.. Arch Pediatr Adolesc Med 160: 894-899 [Abstract] [Full text]
Reilly, J J (2006). Tackling the obesity epidemic: new approaches.. Arch. Dis. Child. 91: 724-726 [Full text]
Reilly, J J (2006). Obesity in childhood and adolescence: evidence based clinical and public health perspectives.. Postgrad. Med. J. 82: 429-437 [Abstract] [Full text]
Wardle, J., Brodersen, N. H., Cole, T. J, Jarvis, M. J, Boniface, D. R (2006). Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain. BMJ 332: 1130-1135 [Abstract] [Full text]
Hall, D M B, Cole, T J (2006). What use is the BMI?. Arch. Dis. Child. 91: 283-286 [Full text]
Wallis, L A, Maconochie, I (2006). Age related reference ranges of respiratory rate and heart rate for children in South Africa. Arch. Dis. Child. 91: 330-333 [Abstract] [Full text]
Snijder, M., van Dam, R., Visser, M, Seidell, J. (2006). What aspects of body fat are particularly hazardous and how do we measure them?. Int J Epidemiol 35: 83-92 [Full text]
Wills, W., Backett-Milburn, K., Gregory, S., Lawton, J. (2005). The influence of the secondary school setting on the food practices of young teenagers from disadvantaged backgrounds in Scotland. Health Educ Res 20: 458-465 [Abstract] [Full text]
Moreno, L A, Sarria, A, Fleta, J, Marcos, A, Bueno, M (2005). Secular trends in waist circumference in Spanish adolescents, 1995 to 2000-02. Arch. Dis. Child. 90: 818-819 [Abstract] [Full text]
de Simone, G., Devereux, R. B, Kizer, J. R, Chinali, M., Bella, J. N, Oberman, A., Kitzman, D. W, Hopkins, P. N, Rao, D., Arnett, D. K (2005). Body composition and fat distribution influence systemic hemodynamics in the absence of obesity: the HyperGEN Study. Am. J. Clin. Nutr. 81: 757-761 [Abstract] [Full text]
Viner, R, Nicholls, D (2005). Managing obesity in secondary care: a personal practice. Arch. Dis. Child. 90: 385-390 [Abstract] [Full text]
Andersen, L. F., Lillegaard, I. T. L., Overby, N., Lytle, L., Klepp, K.-I., Johansson, L. (2005). Overweight and obesity among Norwegian schoolchildren: Changes from 1993 to 2000. Scand J Public Health 33: 99-106 [Abstract]
Skidmore, P.M.L., Yarnell, J.W.G. (2004). The obesity epidemic: prospects for prevention. QJM 97: 817-825 [Abstract] [Full text]
Stenhouse, E, Wright, D E, Hattersley, A T, Millward, B A (2004). Weight differences in Plymouth toddlers compared to the British Growth Reference Population. Arch. Dis. Child. 89: 843-844 [Abstract] [Full text]
Lawlor, D. A, Ebrahim, S., Whincup, P., Sterne, J., Papacosta, O., Wannamethee, G., Dhanjil, S., Griffin, M., Nicolaides, A. N, Davey Smith, G. (2004). Sex differences in body fat distribution and carotid intima media thickness: cross sectional survey using data from the British regional heart study. J. Epidemiol. Community Health 58: 700-704 [Abstract] [Full text]
Alberti, G., Zimmet, P., Shaw, J., Bloomgarden, Z., Kaufman, F., Silink, M. (2004). Type 2 Diabetes in the Young: The Evolving Epidemic: The International Diabetes Federation Consensus Workshop. Diabetes Care 27: 1798-1811 [Full text]
Wilkin, T., Ludvigsson, J., Greenbaum, C., Palmer, J., Becker, D., Bruining, J. (2004). Future Intervention Trials in Type 1 Diabetes. Diabetes Care 27: 996-997 [Full text]
Bloomgarden, Z. T. (2004). Type 2 Diabetes in the Young: The evolving epidemic. Diabetes Care 27: 998-1010 [Full text]
Rudolf, M C J, Greenwood, D C, Cole, T J, Levine, R, Sahota, P, Walker, J, Holland, P, Cade, J, Truscott, J (2004). Rising obesity and expanding waistlines in schoolchildren: a cohort study. Arch. Dis. Child. 89: 235-237 [Abstract] [Full text]
Fox, K. R (2004). Childhood obesity and the role of physical activity. The Journal of the Royal Society for the Promotion of Health 124: 34-39 [Abstract]
(2003). Obesity: Central to Future Morbidity in Youth. JWatch Pediatrics 2003: 2-2 [Full text]

Rapid Responses:

Read all Rapid Responses

A step towards the primary prevention of most common human diseases.: Sergio Stagnaro
bmj.com, 21 Mar 2003 [Full text]
The increase in obesity: food for thought?: Rachel C Davey
bmj.com, 22 Mar 2003 [Full text]
Why BMI?: Arabella Melville
bmj.com, 22 Mar 2003 [Full text]
Re: Why BMI?: kathleen . R. Ward
bmj.com, 24 Mar 2003 [Full text]
Re: Why BMI?: J C Hamer
bmj.com, 24 Mar 2003 [Full text]
Do videogames contribute to childhood obesity?: Mark D. Griffiths
bmj.com, 28 Mar 2003 [Full text]
What trends can be observed in peripheral overweight among upcoming generations of women?: L�szl� B. Tank�
bmj.com, 28 Mar 2003 [Full text]
junk food vs videogames in obesity...: Sigrid A Gibson, et al.
bmj.com, 28 Mar 2003 [Full text]
Waist circumference, a problem all round.: Janet, L James, et al.
bmj.com, 4 Apr 2003 [Full text]