NCHS Data Brief ■ No. 51 ■ December 2010

u.s. department of health and human services

Centers for Disease Control and Preven

National Center for Health Statis

Obesity and Socioeconomic Status in Children and 

Adolescents: United States, 2005–2008

Cynthia L. Ogden, Ph.D.; Molly M. Lamb, Ph.D.; Margaret D. Ca

and Katherine M. Flegal, P

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 2005–

2008

•	 Low income children and 

adolescents are more likely 

to be obese than their higher 

income counterparts, but the 

relationship is not consistent 

across race and ethnicity 

groups.

•	 Most obese children and 

adolescents are not low 

income (below 130% of the 

poverty level).

•	 Children and adolescents 

living in households where 

the head of household has a 

college degree are less likely 

to be obese compared with 

those living in households 

where the household head 

has less education, but the 

relationship is not consistent 

across race and ethnicity 

groups.

•	 Between 1988–1994 and 

2007–2008 the prevalence of 

childhood obesity increased 

at all income and education 

levels.

In 2007–2008 almost 17% of children and adolescents aged 2–19 years were 

obese (1). Childhood obesity often tracks to adulthood (2) and, in the short 

run, childhood obesity can lead to psychosocial problems and cardiovascular 

risk factors such as high blood pressure, high cholesterol, and abnormal 

glucose tolerance or diabetes (3). Studies have suggested that obesity is 

greater in the low income population than in higher income individuals 

(4). This data brief presents the most recent national data on childhood 

obesity and its association with poverty income ratio (PIR) and education of 

household head. Results are presented by sex and race and ethnicity.

Keywords: obesity • children • income • education

Among both boys and girls obesity prevalence decreases 

as income increases, but this relation is not consistent 

across race and ethnicity groups.

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NCHS Data Brief ■ No. 51 ■ December 2010

■  2  ■

The prevalence of obesity among boys living in households with income at or above 350% of the 

poverty level is 11.9%, while 21.1% of those who live below 130% of the poverty level are obese. 

Among girls, 12.0% of those with income at or above 350% of the poverty level are obese while 

19.3% of those with income below 130% of the poverty level are obese. 

The relationship between income and obesity prevalence is significant among non-Hispanic white

boys; 10.2% of those living in households with income at or above 350% of the poverty level 

are obese compared with 20.7% of those in households below 130% of the poverty level. Among 

non-Hispanic white girls, 10.6% of those living at or above 350% of the poverty level are obese,

and 18.3% of those living below 130% of the poverty level are obese. Among non-Hispanic black

and Mexican-American children and adolescents, there is no significant trend in prevalence by

income level for either boys or girls. In fact, the relationship does not appear to be consistent; 

among Mexican-American girls, although the difference is not significant, 21.0% of those living

at or above 350% of the poverty level are obese compared with 16.2% of those living below

130% of the poverty level (Figure 1). 

Most obese children and adolescents are not low income (below 130% of 

the poverty level).

Of the approximately 12 million children and adolescents who are obese, 24% (almost 3 million) 

live in households with income at or above 350% of the poverty level, 38% (approximately 4.5 

million) have incomes between 130% and 350% of the poverty level, and 38% (approximately 

4.5 million) live below 130% of the poverty level. Of the approximately 6 million obese nonHispanic white children and adolescents, the majority (4.4 million) live in households with

income at or above 130% of the poverty level (Figure 2). 

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NCHS Data Brief ■ No. 51 ■ December 2010

■  3  ■

Childhood obesity prevalence decreases as the education of the head of 

household increases, but the relationship is not consistent across race and 

ethnicity groups.

Overall, there is a significant inverse relationship between obesity prevalence and education of

household head. Among boys, 11.8% of those living in households where the household head 

has at least a college degree are obese compared with 21.1% of those living in households where 

the head of the household has less than a high school degree. Among girls, 8.3% of children 

and adolescents in households where the household head has at least a college degree are obese 

compared with 20.4% in households headed by individuals with less than a high school degree. 

Among non-Hispanic white and black girls, the prevalence of obesity is significantly lower in

households headed by individuals with a college degree than in households headed by individuals 

with less than a high school degree (Figure 3). 

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NCHS Data Brief ■ No. 51 ■ December 2010

■  4  ■

Between 1988–1994 and 2007–2008 the prevalence of childhood obesity 

increased at all income levels.

Among boys living at or above 350% of the poverty level, the prevalence of obesity increased 

from 6.5% to 11.9% between 1988–1994 and 2005–2008. Similar increases were seen among

those with income between 130% and 350% of the poverty level and among those with income 

below 130% of the poverty level. 

Among girls, the prevalence of obesity increased from 5.2% to 12.0% among those living at or 

above 350% of the poverty level, from 10.3% to 15.8% among those between 130% and 350% 

of the poverty level, and from 11.9% to 19.3% among those below 130% of the poverty level 

between 1988–1994 and 2005–2008 (Figure 4).

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NCHS Data Brief ■ No. 51 ■ December 2010

■  5  ■

Between 1988–1994 and 2005–2008 childhood obesity prevalence increased 

in households headed by individuals with all levels of education.

In	boys,	the	prevalence	of	childhood	obesity	increased	significantly	between	1988–1994	and	

2005–2008	in	households	at	all	education	levels.	Among	boys	living	in	households	headed	by	

those	with	a	college	degree	the	prevalence	increased	from	4.5%	to	11.8%,	while	in	households	

headed	by	individuals	with	less	than	a	high	school	degree,	the	prevalence	of	obesity	increased	

from	15.3%	to	21.1%	between	1988–1994	and	2005–2008.	

Among	girls,	the	prevalence	of	obesity	increased	significantly	in	households	at	all	levels	

of	education	except	where	the	head	of	the	household	had	a	college	degree.	Among	girls	in	

households	with	less	than	a	high	school	degree,	the	prevalence	increased	from	11.4%	to	20.4%	

(Figure	5).

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NCHS Data Brief ■ No. 51 ■ December 2010

■  6  ■

Summary

Among non-Hispanic white children and adolescents, the prevalence of obesity increases as

income decreases, yet the majority of non-Hispanic white children and adolescents who are obese

do not live below 130% of the poverty level. In fact, overall, the majority of obese children do

not live below 130% of the poverty level. All boys and girls and non-Hispanic white and nonHispanic black girls in highly educated households are less likely to be obese compared with

their counterparts in households where the head has less than a high school degree. Between 

1988–1994 and 2005–2008 the prevalence of obesity increased in children at all levels of income 

and education except among girls in households where the head had at least a college degree. 

Definitions

Obesity: Body mass index (BMI) ≥ age- and sex-specific 95th percentile of the 2000 CDC growth

charts (5). BMI is calculated as weight in kilograms divided by height in meters squared, rounded 

to one decimal place.

Poverty income ratio (PIR): The ratio of household income to the poverty threshold after 

accounting for inflation and family size. In 2008, a PIR of 350% was equivalent to approximately

$77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a 

family of four. In 2008, median household income was approximately $50,000 and 19% of 

children younger than 18 lived below the poverty level (http://www.census.gov/newsroom/

releases/archives/income_wealth/cb09-141.html). The cut point for participation in the

Supplemental Nutrition Assistance Program (SNAP) is 130% of the poverty level.

Data source and methods

The National Health and Nutrition Examination Survey (NHANES) data were used for these

analyses. NHANES is a cross-sectional survey designed to monitor the health and nutritional

status of the civilian, noninstitutionalized U.S. population (6). The survey consists of interviews

conducted in participants’ homes, standardized physical examinations conducted in mobile

examination centers, and laboratory tests utilizing blood and urine specimens provided by

participants during the physical examination. 

The NHANES sample is selected through a complex, multistage design that includes selection

of primary sampling units (counties), household segments within the counties, and finally

sample persons from selected households. The sample design includes oversampling to obtain 

reliable estimates of health and nutritional measures for population subgroups. In 1988–1994 

and 2005–2008, African-American and Mexican-American children and adolescents were

oversampled. In 1999, NHANES became a continuous survey, fielded on an ongoing basis.

Each year of data collection is based on a representative sample covering all ages of the civilian,

noninstitutionalized population. Public-use data files are released in 2-year cycles.

Sample weights, which account for the differential probabilities of selection, nonresponse, 

and noncoverage, were incorporated into the estimation process. The standard errors of the 

percentages were estimated using Taylor Series Linearization, a method that incorporates the

sample weights and sample design.
NCHS Data Brief ■ No. 51 ■ December 2010

■  7  ■

Estimates of the number of obese individuals were calculated using the average Current

Population Survey (CPS) totals for 2005–2006 and 2007–2008 (http://www.cdc.gov/nchs/nhanes/

response_rates_CPS.htm). Differences in prevalence between groups were evaluated using

univariate t-statistic at the p < 0.05 significance level. Tests of trends were done using the

p < 0.05 significance level. All differences reported are statistically significant unless otherwise

indicated. Statistical analyses were conducted using the SAS System for Windows (release 9.1; 

SAS Institute Inc, Cary, N.C.) and SUDAAN (release 9.0; Research Triangle Institute, Research

Triangle Park, N.C.).

About the authors

Cynthia L. Ogden, Molly M. Lamb, and Margaret D. Carroll are with the Centers for Disease

Control and Prevention’s National Center for Health Statistics (NCHS), Division of Health and

Nutrition Examination Surveys. Katherine M. Flegal is with NCHS’ Office of the Director.

References

1. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass

index in U.S. children and adolescents, 2007–2008. JAMA 303:242–9. 2010.

2. Singh AS, Mulder C, Twisk JW, Van MW, Chinapaw MJ. Tracking of childhood overweight

into adulthood: A systematic review of the literature. Obes Rev 9:474–88. 2008.

3. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors

and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J

Pediatr 150:12–7. 2007.

4. Wang Y, Zhang Q. Are American children and adolescents of low socioeconomic status at

increased risk of obesity? Changes in the association between overweight and family income 

between 1971 and 2002. Am J Clin Nutr 84:707–16. 2006.

5. Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States:

Methods and development. National Center for Health Statistics. Vital Health Stat 11(246). 2002.

6.	 Centers for Disease Control and Prevention. National Center for Health Statistics. National

Health and Nutrition Examination Survey. Available from: http://www.cdc.gov/nchs/nhanes/

nhanes_questionnaires.htm. Accessed November 18, 2010.
NCHS Data Brief ■ No. 51 ■ December 2010

Suggested citation

Ogden CL, Lamb MM, Carroll MD, Flegal,

KM. Obesity and socioeconomic status

in children: United States 1988–1994

and 2005–2008. NCHS data brief no 51.

Hyattsville, MD: National Center for Health

Statistics. 2010.

Copyright information

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the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

 Director for Science

Division of Health and Nutrition 

Examination Surveys

Clifford L. Johnson, M.S.P.H., Director

U.S. D

Healt

Centers for Disease Control and Prevention

National Center for Health Statistics

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