Number 43 n November 9, 2011

Smoothed Percentage Body Fat Percentiles for

U.S. Children and Adolescents, 1999–2004

by Cynthia L. Ogden, Ph.D., Division of Health and Nutrition Examination Surveys, National Center for Health
 

Statistics; Yan Li, Ph.D., Department of Mathematics, University of Texas at Arlington; David S. Freedman, Ph.D.,
 

National Center for Chronic Disease Prevention and Health Promotion; Lori G. Borrud, Dr.P.H., R.D.,
 

Division of Health and Nutrition Examination Surveys, National Center for Health Statistics; and
 

Katherine M. Flegal, Ph.D., Office of the Director, National Center for Health Statistics
 

Abstract

Background—The high prevalence of obesity (defined by body mass index)

among children and adolescents in the United States and elsewhere has prompted

increased attention to body fat in childhood and adolescence.

Objective—This report provides smoothed estimates of major percentiles of

percentage body fat for boys and girls aged 8–19 years in the United States.

Methods—Percentage body fat was obtained from whole-body, dual-energy

x-ray absorptiometry (DXA) scans conducted during the 1999–2004 National

Health and Nutrition Examination Survey. A nonparametric double-kernel method

was employed to smooth percentile curves for the DXA data.

Results—The pattern of body fat development differs between boys and girls

aged 8–19 years. In most age groups, girls have a higher percentage of body fat

than boys. Among boys, there is a drop in body fat percentage in early

adolescence that is especially pronounced at the higher percentiles. Among girls

this pattern is not seen; percentage body fat increases slightly with age.

Conclusions—These results provide a smoothed reference distribution of

percentage body fat for U.S. children and adolescents aged 8–19 years.

Keywords: DXA scan • National Health and Nutrition Examination Survey

Introduction

The high prevalence of obesity,

defined by body mass index (BMI),

among children and adolescents in the

United States (1) and elsewhere has

prompted increased attention to body

composition in childhood. Measurements of body composition for persons

aged 8 years and over using wholebody, dual-energy x-ray absorptiometry

(DXA) scans were included in the

1999–2004 National Health and

Nutrition Examination Survey

(NHANES). These data make it possible

to estimate percentage body fat for the

U.S. pediatric population. This report

provides smoothed estimates of selected

percentiles of total percentage body fat

for boys and girls aged 8–19 years in

the United States in 1999–2004.

Methods

Data were obtained from NHANES,

a complex, multistage probability

sample of the U.S. civilian

noninstitutionalized population (2)

conducted by the Centers for Disease

Control and Prevention’s (CDC)

National Center for Health Statistics

(NCHS). NHANES consists of a

household interview followed by a

physical examination conducted in a

mobile examination center. Data from

three NHANES (1999–2000, 2001–

2002, and 2003–2004) are used in the

present analysis. The overall

examination response rate for children

aged 6–19 years in NHANES 1999–

2004 was 85%. Adolescents aged 12–19

and non-Hispanic black and MexicanAmerican persons were oversampled

during these years.

Fat mass was determined from

whole-body DXA scans using the

Hologic QDR 4500A fan-beam

densitometer (Hologic; Bedford, Mass.),

following the manufacturer’s acquisition

procedures and NHANES study-specific

procedures. Hologic DOS software

version 8.26:a3 was used to acquire all

scans, and scanning was done in the

‘‘fast’’ mode. Hologic Discovery

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 43 n November 9, 2011

software version 12.1 was used to

analyze the scans (3).

Percentage body fat was calculated

by dividing total fat mass by total DXA

mass (fat mass and fat-free mass) and

multiplying by 100. Multiple imputation

methods were used to impute missing

DXA data. Five DXA values were

imputed for each missing DXA data

point. Details of the DXA procedures

and the imputation process for the

NHANES 1999–2004 DXA Multiple

Imputation Data Files have been

published previously (3–6). The analytic

data set consisted of 8,864 boys and

girls aged 8–19. The data set includes

4,520 boys and 4,344 girls. Of these

NHANES participants, percentage body

fat was imputed for 931 girls and 412

boys. In 1999, females aged 8–17 did

not receive DXA examinations because

of concerns about handling the reporting

of pregnancy test results for minors. As

a result, more data were imputed for

girls than for boys. In 2000, this issue

was resolved and females aged 8–17

began receiving DXA scans (4). The

analyses used the five NHANES

1999–2004 DXA Multiple Imputation

Data Files (6). Pregnant females were

excluded.

The nonparametric double-kernel

method of Li et al. (7) was employed to

smooth percentage body fat percentile

curves. This approach extends a method

of Yu and Jones (8) by incorporating

sample weights in the curve estimation,

along with bandwidth selection, so that

the approach is applicable to NHANES

data. In the curve estimation, percentage

body fat for boys and girls is smoothed

separately along both the age axis and

the percentage body fat axis using

kernel smoothing and using local linear

weighting in the age axis direction. In

the bandwidth selection procedure, a

bandwidth for the conditional mean is

selected first and then modified to

obtain the age axis and percentage body

fat axis bandwidths according to the

percentile being estimated. In the

analysis, a bandwidth of 11 years (132

months) is used for the conditional

mean. The approach of Li and

colleagues used in this analysis also

uses a median correction to reduce

smoothing bias and a bandwidth

rescaling procedure to make the

bandwidth selection scale invariant. Age

in months at time of examination was

used in the smoothing process.

Selected smoothed percentiles of

percentage body fat for boys and girls,

by 6-month age groups, are presented.

Every fifth percentile of percentage

body fat is shown.

All analyses, including the initial

smoothing of the body fat percentiles,

were done using SAS version 9.1.2

(SAS Institute, Cary, N.C.) and SAScallable SUDAAN version 9 (RTI

International, Research Triangle Park,

N.C.). Sample examination weights were

used to account for differential

nonresponse and noncoverage and to

adjust for planned oversampling of some

groups. Because of the complex survey

design, standard errors were estimated

with SUDAAN using Taylor series

linearization. All estimates, including the

smoothed percentiles, were calculated

separately from each of the five imputed

data sets and then averaged together to

account for the multiple imputations.

Results

Sample sizes for sex-specific

6-month age groups are presented in

Table 1. The table also contains means

and standard errors for percentage body

fat in these groups. In general, the sex Percentage body fat 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2004. 

Age (years) 

0 

5 

10 

15 

20 

25 

30 

35 

40 

Girls 

Boys 

98 10 11 1918171615141312

Figure 1. Mean percentage body fat, by sex and age: United States, 1999–2004

difference in mean levels of percentage

body fat increased with age after age 12

(Figure 1). The mean levels of

percentage body fat at age 8 were 28%

for boys and 31% for girls, and at age

19 were 23% for boys and 35% for

girls.

Table 2 contains the smoothed

estimates of percentage body fat for

every fifth percentile from the 5th to

95th percentiles for the sex-specific

6-month age groups. Figures 2 and 3

show the smoothed estimates for the

5th, 15th, 50th, 85th, and 95th

percentiles, for boys and girls,

respectively. The pattern of body fat

development differs for boys and girls

between ages 8 and 19. Among boys,

there is a drop in body fat percentage in

early adolescence that is especially

pronounced at the higher percentiles.

Among girls this pattern is not seen;

percentage body fat increases slightly

with age.

Discussion

The shapes of the percentage body

fat curves for children and adolescents

in the U.S. population, based on

NHANES data, match expected changes

in human body composition (9,10).

Normal patterns of body fat include a

decrease in body fat percentage after

infancy and subsequent increase in body
National Health Statistics Reports n Number 43 n November 9, 2011 Page 3 Percentage body fat 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2004. 

Age (years) 

10 

15 

20 

25 

30 

35 

40 

45 

50 

95th 

85th 

50th 

15th 

5th 

98 10 11 1918171615141312

Figure 2. Selected percentiles of smoothed percentage body fat among boys aged 8–19

years: United States, 1999–2004 Percentage body fat 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2004. 

Age (years) 

10 

15 

20 

25 

30 

35 

40 

45 

50 

95th 

85th 

50th 

15th 

5th 

98 10 11 141312 15 19181716

Figure 3. Selected percentiles of smoothed percentage body fat among girls aged 8–19

years: United States, 1999–2004

fat percentage until puberty. In normal

growth and development in children,

males gain more muscle and lean tissue

than fat at puberty while girls gain more

fat. Because the U.S. curves presented

here begin at age 8, they do not show

patterns of body fat percentage during

infancy and early childhood. The

changes that occur at puberty, however,

are reflected in the U.S. curves.

There are differences between the

shape of the smoothed percentage body

fat curves and the BMI curves from the

U.S. population. Compared with

percentage body fat, which decreases

and then remains level in boys, BMI in

boys increases between ages 8 and 19.

In girls, both percentage body fat and

BMI increase with age. These

differences can be seen when comparing

the percentage body fat percentile

curves with CDC’s BMI-for-age growth

charts (11).

Body fat percentage reference

curves based on bioelectrical impedance

measurements have been published for

children and adolescents in England (12)

and Turkey (13). These curves have

shapes similar to those based on DXA

data from this nationally representative

sample of U.S. children. The U.S.

values are higher than those published

from England or Turkey, perhaps

because of differences in the population

or because of methodological

differences (12,13).

Reference values based on the

NHANES percentage body fat data from

DXA have been published previously.

Empirical percentiles are available (4),

and Kelly et al. (14) used the LMS

method (15) to smooth a variety of body

composition data, not just percentage

body fat, in both adults and children. In

that report (14), no overall total

population smoothed reference values

are available. The present report

provides smoothed reference values for

percentage body fat for the overall

population of boys and girls.

An analysis of Hologic QDR 4500A

DXA data from seven research

laboratories (16) indicated that the QDR

4500A algorithm underestimated fat

mass and overestimated lean mass.

Because Hologic QDR 4500A was used

in NHANES, NHANES data on lean

soft tissue mass was decreased by 5%

and an equivalent weight (in kilograms)

was added to the fat mass so the total

mass did not change. This adjustment

increased the median level of percentage

body fat by approximately 3 percentage

points.

These results provide a reference

distribution of percentage body fat for

U.S. school-aged children and

adolescents in 1999–2004 when

percentage body fat is measured using

DXA methods. These smoothed curves

were used to show differences in body

fat between racial and ethnic groups at

the same BMI level (17) and in analyses

related to body fat and lipids in children

(18). The association between BMI—an

indirect measure of body fat—and

health conditions in children may be

different than the relationship between

body fat and health outcomes. These

curves provide a tool for examining the
Page 4	 National Health Statistics Reports n Number 43 n November 9, 2011

relationship between directly measured

body fat and health conditions in

children.

References

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Lamb MM, Flegal KM. Prevalence

of high body mass index in U.S.

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www.cdc.gov/nchs/data/ad/ad314.pdf.

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SA, Prentice AM. Body fat reference

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A, Hatipoglu N, Cicek B, Ustunbas

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adolescents: United States, 1999–
National Health Statistics Reports n Number 43 n November 9, 2011 Page 5

Table 1. Mean (SE) percentage body fat, by sex and age: United States, 1999–2004

Boys Girls

Sample Body fat Sample Body fat

Age (years) size (percent) SE size (percent) SE

8.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 27.7 0.9 136 31.0 1.0

8.5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 27.4 1.0 124 31.8 0.9

9.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 27.1 0.8 136 32.3 0.6

9.5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 28.4 0.7 128 32.5 0.7

10.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 28.2 0.8 133 32.7 1.0

10.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 29.1 0.9 124 31.5 0.8

11.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 27.5 0.9 140 33.2 0.9

11.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 29.7 1.0 138 32.0 0.8

12.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 28.2 0.8 205 29.9 0.7

12.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 27.7 0.8 235 31.9 0.6

13.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 25.7 0.7 240 32.8 0.7

13.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 26.8 0.9 235 33.2 0.6

14.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 24.3 0.8 226 32.3 0.7

14.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 24.7 0.7 243 32.7 0.7

15.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 23.2 0.6 180 31.7 0.7

15.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 21.3 0.6 201 34.3 0.6

16.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 23.1 0.6 205 34.8 0.6

16.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 23.7 0.6 182 33.6 0.7

17.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 22.5 0.7 206 33.4 0.5

17.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 22.6 0.6 199 35.3 0.6

18.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 22.6 0.8 198 35.5 0.8

18.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 22.6 0.6 181 34.9 0.8

19.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 23.1 0.7 188 34.6 0.6

19.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 23.6 0.8 161 37.1 0.7

NOTES: SE is standard error. Ages represent the low end of the group (for example, 8.0 is 8.0–8.49 years).

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2004.
centage body fat, by sex and age: United States, 1999–2004

Smoothed percentile

15th 20th 25th 30th 35th 40th 45th 50th 55th 60th 65th 70th 75th 80th 85th 90th 95th

Percent

20.2 21.0 21.6 22.3 23.0 23.8 24.7 25.6 26.6 27.8 28.9 30.3 31.7 33.4 35.8 38.9 41.1

20.3 21.1 21.8 22.4 23.1 23.9 24.8 25.7 26.8 27.9 29.2 30.6 32.2 33.9 36.4 39.0 41.6

20.5 21.4 22.0 22.7 23.4 24.2 25.1 26.0 27.1 28.3 29.7 31.2 32.8 34.5 36.8 39.2 42.2

20.7 21.6 22.3 23.0 23.7 24.5 25.4 26.2 27.4 28.7 30.2 31.8 33.4 35.2 37.3 39.5 42.8

20.7 21.7 22.4 23.1 23.9 24.7 25.5 26.3 27.6 29.0 30.5 32.2 33.8 35.7 37.7 39.8 43.2

20.6 21.6 22.4 23.1 23.9 24.7 25.5 26.3 27.6 29.2 30.8 32.5 34.1 36.1 38.0 40.1 43.4

20.4 21.4 22.2 23.0 23.8 24.6 25.4 26.2 27.6 29.2 30.9 32.6 34.3 36.3 38.2 40.4 43.6

20.1 21.1 22.0 22.8 23.6 24.4 25.3 26.1 27.6 29.2 30.8 32.6 34.3 36.3 38.3 40.5 43.7

19.7 20.7 21.6 22.4 23.2 24.1 25.0 25.8 27.3 29.0 30.6 32.3 34.0 36.0 38.1 40.4 43.619.2 20.1 21.0 21.8 22.7 23.5 24.4 25.3 26.8 28.4 30.1 31.7 33.4 35.3 37.5 39.9 43.318.6 19.5 20.3 21.1 21.9 22.7 23.6 24.6 25.9 27.4 29.2 30.9 32.5 34.2 36.5 39.1 42.517.9 18.7 19.5 20.2 21.0 21.8 22.6 23.7 24.9 26.3 28.1 29.9 31.5 33.1 35.2 38.0 41.5

17.1 17.9 18.6 19.3 20.1 20.9 21.7 22.9 23.8 25.2 26.9 28.8 30.4 32.0 33.9 36.7 40.516.5 17.2 17.9 18.6 19.3 20.1 20.9 22.1 22.9 24.2 25.8 27.7 29.5 31.1 32.9 35.6 39.515.9 16.6 17.3 18.0 18.7 19.5 20.3 21.5 22.2 23.3 24.9 26.9 28.6 30.2 32.1 34.7 38.715.6 16.3 17.0 17.7 18.4 19.1 19.9 21.1 21.8 22.9 24.4 26.3 28.1 29.7 31.5 34.1 38.215.4 16.1 16.8 17.5 18.3 19.0 19.8 21.0 21.7 22.8 24.2 26.2 27.9 29.4 31.2 33.8 37.815.4 16.1 16.8 17.5 18.3 19.0 19.9 20.9 21.7 22.9 24.4 26.2 27.8 29.3 31.1 33.7 37.615.4 16.1 16.8 17.6 18.3 19.1 19.9 20.9 21.8 23.0 24.5 26.1 27.7 29.3 31.1 33.6 37.3

15.4 16.2 16.9 17.6 18.3 19.1 19.9 21.0 21.9 23.1 24.6 26.0 27.6 29.2 31.1 33.5 37.2

15.5 16.3 17.0 17.7 18.5 19.2 20.1 21.1 22.1 23.3 24.6 26.0 27.4 29.1 31.1 33.4 37.0

15.7 16.5 17.2 17.9 18.7 19.4 20.3 21.3 22.3 23.5 24.8 26.0 27.4 29.1 31.2 33.5 37.0

15.8 16.6 17.4 18.1 18.9 19.6 20.5 21.5 22.6 23.7 24.9 26.1 27.4 29.1 31.3 33.5 37.0

15.9 16.7 17.5 18.3 19.0 19.8 20.7 21.7 22.7 23.8 25.0 26.1 27.4 29.0 31.2 33.6 36.9

Page 6 National Health Statistics Reports n Number 43 n November 9, 2011
centage body fat, by sex and age: United States, 1999–2004—Con.

Smoothed percentile

15th 20th 25th 30th 35th 40th 45th 50th 55th 60th 65th 70th 75th 80th 85th 90th 95th

Percent

24.2 25.0 25.7 26.4 27.2 28.0 28.9 30.1 31.1 32.3 33.5 34.8 36.1 37.4 38.8 40.6 43.3

24.7 25.6 26.4 27.1 27.9 28.7 29.7 30.7 31.8 32.9 34.1 35.3 36.7 38.0 39.5 41.3 43.7

25.0 26.0 26.9 27.6 28.5 29.4 30.3 31.2 32.5 33.6 34.7 35.9 37.2 38.7 40.2 42.0 44.1

25.0 26.1 27.1 27.9 28.8 29.8 30.8 31.6 33.0 34.1 35.2 36.4 37.7 39.2 40.8 42.4 44.4

24.9 26.0 27.0 27.9 28.9 29.9 30.9 31.7 33.1 34.3 35.4 36.6 38.0 39.5 41.0 42.6 44.5

24.5 25.7 26.7 27.7 28.7 29.7 30.8 31.6 33.0 34.1 35.3 36.5 37.8 39.4 40.9 42.4 44.4

24.2 25.3 26.3 27.3 28.3 29.4 30.4 31.4 32.5 33.7 34.9 36.1 37.4 39.0 40.5 42.1 44.2

23.9 25.0 26.1 27.1 28.1 29.1 30.1 31.3 32.2 33.3 34.5 35.7 37.0 38.5 40.1 41.7 44.0

23.9 25.0 26.1 27.1 28.1 29.1 30.1 31.3 32.1 33.2 34.4 35.6 36.8 38.3 39.9 41.6 44.124.2 25.4 26.5 27.5 28.5 29.4 30.4 31.5 32.3 33.4 34.6 35.8 37.0 38.4 40.0 41.7 44.424.5 25.8 26.9 27.9 28.9 29.9 30.8 31.8 32.7 33.8 34.9 36.1 37.3 38.6 40.2 42.0 44.724.8 26.1 27.2 28.2 29.2 30.2 31.1 32.0 33.0 34.1 35.2 36.3 37.5 38.8 40.4 42.2 45.0

25.1 26.4 27.4 28.4 29.4 30.3 31.3 32.3 33.2 34.2 35.3 36.4 37.6 39.0 40.5 42.4 45.225.5 26.7 27.7 28.7 29.7 30.6 31.5 32.5 33.4 34.4 35.4 36.6 37.7 39.1 40.7 42.6 45.326.0 27.2 28.2 29.2 30.1 31.0 31.9 32.8 33.7 34.7 35.7 36.8 38.0 39.3 41.0 42.9 45.526.5 27.7 28.7 29.7 30.6 31.4 32.3 33.1 34.0 35.0 35.9 37.0 38.2 39.6 41.3 43.2 45.826.9 28.0 29.1 30.0 30.9 31.7 32.5 33.3 34.2 35.2 36.1 37.2 38.3 39.7 41.5 43.5 46.027.1 28.3 29.3 30.2 31.0 31.8 32.6 33.5 34.3 35.3 36.3 37.3 38.4 39.8 41.7 43.7 46.327.3 28.5 29.5 30.3 31.2 31.9 32.7 33.6 34.5 35.4 36.4 37.5 38.6 40.0 41.9 44.1 46.6

27.5 28.7 29.7 30.5 31.3 32.1 32.9 33.8 34.7 35.7 36.7 37.8 38.9 40.4 42.3 44.5 47.1

27.7 28.9 29.9 30.7 31.5 32.3 33.1 34.1 35.0 36.0 37.0 38.1 39.4 40.9 42.8 45.0 47.6

28.0 29.2 30.1 31.0 31.8 32.6 33.4 34.4 35.3 36.4 37.4 38.6 39.9 41.4 43.2 45.4 48.0

28.3 29.5 30.4 31.3 32.1 32.9 33.8 34.8 35.8 36.8 37.9 39.1 40.3 41.8 43.6 45.7 48.3

28.8 30.0 30.8 31.7 32.5 33.3 34.2 35.2 36.3 37.4 38.5 39.7 40.8 42.3 44.0 46.0 48.6

Examination Survey, 1999–2004.

National Health Statistics Reportsn Number 43n November 9, 2011 Page7
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National Health Statistics Reports n Number 43 n November 9, 2011

Acknowledgments

Programming support was provided by Xianfen Li, M.S., and Yang Yu, M.S. (Harris Corporation).

Suggested citation

Ogden CL, Li Y, Freedman DS, et al.

Smoothed percentage body fat percentiles for

U.S. children and adolescents, 1999–2004.

National health statistics reports; no 43.

Hyattsville, MD: National Center for Health

Statistics. 2011.

Copyright information

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source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
 

Jennifer H. Madans, Ph.D., Associate Director
 

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Division of Health and Nutrition
 

Examination Surveys
 

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

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