Gender-ethnic disparity in BMI and waist circumference distribution shifts in US adults

Abstract

While obesity has been increasing in the United States, little is known about the variation in recent BMI and waist circumference (WC) distribution shifts across socio-demographic groups. We assessed shifts in BMI and WC distributions and compared between-group differences over the past decade, and projected future BMI and WC distributions and prevalence of obesity and central obesity using National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2004 data. BMI/WC distributional shifts overall and in percentiles were compared across groups. Average yearly shift was calculated and used for projecting future distributions and prevalence. Both BMI and WC increased more in their uppermost percentile distribution, though BMI shift declined toward the uppermost percentiles among women. Heavier Americans gained more adiposity over the past decade. Ethnic (non-Hispanic (NH) white vs. black) disparities in mean BMI and WC became wider. Over the survey period, mean BMI increased by 1.3 units vs. 1.8 units among men and women, whereas WC, by 4.2 cm vs. 4.8 cm. Young adults had the largest increase. Shift in women's WC was stable between the 25th and 75th percentiles, but gained pace at higher WC, while women's BMI and men's BMI and WC shifts increased linearly. NH black women had the largest shifts and would have central obesity and obesity prevalence of 90.8 and 70.7% by 2020. Shifts in BMI and WC distribution varied across age-, gender-, and ethnic groups. Future rise in the obesity and central obesity prevalence rates are expected, but would vary by demographic groups.

Figure 1

BMI and waist circumference (WC) distribution shifts among US men and women between National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 1999–2004. (a) Men and (b) women.

Figure 2

Yearly average change in BMI (kg/m²) and waist circumference (WC, cm) across their distributions by gender: ordinary least square estimate of average yearly shift within percentile groups. (a) Men and (b) women. NHANES, National Health and Nutrition Examination Survey.

Figure 3

Yearly average change in BMI (kg/m²) and waist circumference (WC, cm) across their distributions by gender and race/ethnicity: ordinary least square estimate of average yearly shift within percentile groups. (a) Non-Hispanic (NH) white men, (b) NH white women, (c) NH black men, (d) NH black women, (e) Mexican-American (MA) men, (f) MA women, (g) Other ethnicity, men, and (h) Other ethnicity, women. Distribution shifts may be influenced by the smaller sample size available among “other” ethnic groups. NHANES, National Health and Nutrition Examination Survey.

Figure 4

Projected future mean BMI and waist circumference and the prevalence (%) of obesity and central obesity for 2010 and 2020 among US adults, by gender and race/ethnicity. (a) US men: NH white, NH black, MA and (b) US women: NH white, NH black, MA. The projections were based on mean-difference estimates for National Health and Nutrition Examination Survey (NHANES) 1988–1994 through 1999–2004. NH, Non-Hispanic; MA, Mexican American.