Updated Waist Circumference Percentiles and Central Obesity Prevalence Among U.S. Children and Adolescents, NHANES 2011–2023
Abstract
Background: Pediatric obesity affects 20% of children and adolescents globally. Waist circumference (WC) identifies central adiposity and cardiometabolic risk, yet pediatric WC percentiles are outdated. This study provides updated age- and sex-specific WC percentiles reflecting current trends to improve clinical risk assessment. Methods: We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) 2011–2023 data among U.S. youth aged 2–18 years. Central obesity was defined using International Diabetes Federation criteria. WC percentiles (10th, 25th, 50th, 75th, 90th) were estimated by single-year age and sex, with race and ethnicity comparisons. Quantile regression assessed distributional differences versus NHANES 1999–2008 and examined demographic differences in WC using survey logistic regression. Results: Among 14,763 children and adolescents aged 2-to-18 years, the overall prevalence of central obesity was 14.08%. Mean WC was 52.05 cm (95% confidence interval [CI]: 51.80–52.30) for ages 2–5, 62.04 cm (95% CI: 61.57–62.52) for ages 6–9 years, 76.93 cm (95% CI: 76.31–77.55) for ages 10–15 years, and 84.75 cm (95% CI: 83.87–85.63) for ages 16–18 years. Hispanic youth had higher odds of exceeding WC percentiles compared with non-Hispanic White (NHW) peers (males: odds ratios [ORs] = 1.37–1.89 across 50th–90th percentiles; females: ORs = 1.26–1.35 across 25th–90th percentiles, all P < 0.05). Non-Hispanic Black (NHB) males had lower odds (ORs = 0.41–0.82 across 10th–75th percentiles), while females had higher odds only at upper percentiles (75th: OR = 1.26; 90th: OR = 1.52, all P < 0.05). Non-Hispanic Asian youth had significantly lower odds across all thresholds. Among Hispanic, NHW, and NHB youth, WC percentiles were higher in 2011–2023 than in 1999–2008, with the greatest increases at the upper percentiles. Conclusions: WC percentiles among U.S. youth have increased over time. Updated age- and sex-specific reference values may improve early risk identification and pediatric obesity screening.