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ARTICLE

The Natural History of the Development of Obesity in a Cohort of Young U.S. Adults between 1981 and 1998

Kathleen M. McTigue, MD, MS, MPH; Joanne M. Garrett, PhD; and Barry M. Popkin, PhD

18 June 2002 | Volume 136 Issue 12 | Pages 857-864

Background: Understanding the natural history of obesity in a population may be a critical step toward developing effective interventions.

Objective: To assess the development of body mass and examine the role of race or ethnicity, sex, and birth year in obesity onset in young U.S. adults.

Design: Prospective cohort study.

Setting: The National Longitudinal Survey of Youth 1979, a national sample with oversampling of minority ethnic groups.

Participants: 9179 persons.

Measurements: Body mass index (BMI) calculated from 12 self-reported height and weight samples recorded between 1981 and 1998. Logistic regression identified predictors of obesity at age 35 to 37 years. Cox proportional-hazards models compared the incidence of obesity by ethnicity and birth year.

Results: Overall, 26% of men and 28% of women were obese (BMI 30 kg/m²) by age 35 to 37 years. Race or ethnicity and baseline BMI were significant predictors of obesity. Obesity onset was 2.1 (95% CI, 1.6 to 2.7) times faster for black women and 1.5 (CI, 1.1 to 2.0) times faster for Hispanic women than for white women. The pattern for men differed: Overall, obesity developed most rapidly in Hispanic men, but relative rates of obesity onset for white men compared with black men varied according to age. The rate of obesity onset increased 26% to 28% over an 8-year span in birth year.

Conclusions: Marked ethnic-based differences were found in rates of weight accumulation in young U.S. adults, with later birth cohorts experiencing earlier onset of obesity. To alter the course of obesity in the United States, interventions should target young adults, especially those of minority ethnic groups.

Editors' Notes Context Studies of the natural history of obesity have had limitations, such as cross-sectional design, short follow-up, or narrowly defined populations. Contribution Using data from a national study of Americans born between 1957 and 1964 and followed for nearly two decades, these investigators found that more than 25% were obese by age 35 years. Obesity developed most quickly in black women, with moderate rapidity in Hispanic women, and most slowly in white women. Hispanic men developed obesity more quickly than other men. More recent birth cohorts became obese faster than earlier cohorts. Implications Understanding ethnic differences in the age of onset and rate of progression of obesity may help efforts to prevent obesity. –The Editors

 

Author and Article Information

From the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Acknowledgments: Dr. McTigue thanks the Robert Wood Johnson Clinical Scholars Program for its support. The authors thank Tom Swasey for graphical assistance.

Grant Support: By the Robert Wood Johnson Clinical Scholars Program and National Institute of Child Health and Human Development (R01-HD39183).

Requests for Single Reprints: Kathleen McTigue, MD, MS, MPH, 5034 Old Clinic Building, CB#7105, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7105; e-mail, kathleen_mctigue@unc.edu.

Current Author Addresses: Dr. McTigue: 5034 Old Clinic Building, CB#7105, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7105.

Dr. Garrett: 5039 Old Clinic Building, #7110, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7105.

Dr. Popkin: Carolina Population Center, University of North Carolina, University Square East, CB#8120, 123 W. Franklin Street, Chapel Hill, NC 27516-3997.

Author Contributions: Conception and design: K.M. McTigue.

Analysis and interpretation of the data: K.M. McTigue, J.M. Garrett.

Drafting of the article: K.M. McTigue.

Critical revision of the article for important intellectual content: K.M. McTigue, J.M. Garrett.

Final approval of the article: K.M. McTigue, J.M. Garrett.

Provision of study materials or patients: K.M. McTigue.

Statistical expertise: K.M. McTigue, J.M. Garrett.

Obtaining of funding: K.M. McTigue.

Administrative, technical, or logistic support: B.M. Popkin.

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