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Observational Study
. 2022 Sep;46(9):1587-1590.
doi: 10.1038/s41366-022-01153-9. Epub 2022 May 24.

Emergence of the adolescent obesity epidemic in the United States: five-decade visualization with humanoid avatars

Jonathan Bennett  1   2 , Michael C Wong  1   2 , Cassidy McCarthy  3 , Nicole Fearnbach  3 , Katie Queen  4 , John Shepherd  1 , Steven B Heymsfield  5
Affiliations
Observational Study

Emergence of the adolescent obesity epidemic in the United States: five-decade visualization with humanoid avatars

Jonathan Bennett et al. Int J Obes (Lond). 2022 Sep.

Abstract

Background/objectives: Body size and shape have increased over the past several decades with one in five adolescents now having obesity according to objective anthropometric measures such as weight, height, and body mass index (BMI). The gradual physical changes and their consequences may not be fully appreciated upon visual inspection by those managing the long-term health of adolescents. This study aimed to develop humanoid avatars representing the gradual changes in adolescent body size and shape over the past five decades and to align avatars with key BMI percentile cut points for underweight, normal weight, overweight, and obesity.

Participants/methods: Participants included 223 children and adolescents between the ages of 5 and 18 years approximately representative of the race/ethnicity and BMI of the noninstitutionalized US population. Each participant completed a three-dimensional whole-body scan, and the collected data was used to develop manifold regression models for generating humanoid male and female avatars from specified ages, weights, and heights. Secular changes in the mean weights and heights of adolescents were acquired from six U.S. National Health and Nutrition Surveys beginning in 1971-1974 and ending in 2015-2018. Male and female avatars at two representative ages, 10 and 15 years, were developed for each survey and at the key BMI percentile cut points based on data from the 2015-2018 survey.

Results: The subtle changes in adolescent Americans' body size and shape over the past five decades are represented by 24 male and female 10- and 15-year-old avatars and 8 corresponding BMI percentile cut points.

Conclusions: The current study, the first of its kind, aligns objective physical examination weights and heights with the visual appearance of adolescents. Aligning the biometric and visual information may help improve awareness and appropriate clinical management of adolescents with excess adiposity passing through health care systems.

Trial registration: ClinicalTrials.Gov NCT03706612.

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Conflict of interest statement

COMPETING INTERESTS

SBH is on the Medical Advisory Board of Tanita Corporation and he is an Amazon Scholar. The other authors and their close relatives and their professional associates have no financial interests in the study outcome, nor do they serve as an officer, director, member, owner, trustee, or employee of an organization with a financial interest in the outcome or as an expert witness, advisor, consultant, or public advocate on behalf of an organization with a financial interest in the study outcome.

Figures

Fig. 1
Fig. 1. Avatars of 10-year olds at two time points.
Average 10-year-old US male and female avatars generated by manifold regression analysis from weights and heights reported in the 1971–1974 and 2015–2018 NHANES surveys [12, 13].
Fig. 2
Fig. 2. Avatars of 10-year old males at key BMI cutpoints.
The figures were generated using the average male height at age 10 present in the 2015–2018 NHANES survey [12, 13]. The weights in that survey at the 5th, 50th, 85th, and 95th percentiles were then used along with age to generate the avatars and corresponding BMIs. Underweight, normal weight, overweight, and obesity according to the CDC growth charts [16] correspond to <5th, 5th–84th, 85th–94th, and ≥95th percentile, respectively.
Fig. 3
Fig. 3. Avatars of 10 year old females at key BMI cutpoints.
The figures were generated using the average male height at age 10 present in the 2015–2018 NHANES survey [12, 13]. The weights in that survey at the 5th, 50th, 85th, and 95th percentiles were then used along with age to generate the avatars and corresponding BMIs. Underweight, normal weight, overweight, and obesity according to the CDC growth charts [16] correspond to <5th, 5th–84th, and 85th–94th, and ≥95th percentile, respectively.
Fig. 4
Fig. 4. Avatars of 10-year olds at two time points.
Average 15-year-old US male and female avatars generated by manifold regression analysis from weights and heights reported in the 1971–1974 and 2015–2018 NHANES surveys [12, 13].
Fig. 5
Fig. 5. Avatars of 15-year old males at key BMI cutpoints.
The figures were generated using the average male height at age 10 present in the 2015–2018 NHANES survey [12, 13]. The weights in that survey at the 5th, 50th, 85th, and 95th percentiles were then used along with age to generate the avatars and corresponding BMIs. Underweight, normal weight, overweight, and obesity according to the CDC growth charts [16] correspond to <5th, 5th–84th, and 85th–94th, and ≥95th percentile, respectively.
Fig. 6
Fig. 6. Avatars of 15-year old females at key BMI cutpoints.
The figures were generated using the average male height at age 10 present in the 2015–2018 NHANES survey [12, 13]. The weights in that survey at the 5th, 50th, 85th, and 95th percentiles were then used along with age to generate the avatars and corresponding BMIs. Underweight, normal weight, overweight, and obesity according to the CDC growth charts [16] correspond to <5th, 5th–84th, 85th–94th, and ≥95th percentile, respectively.
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