National and Tennessee Trends in the Prevalence of Obesity and Overweight among High School Students Using YRBS Data 1999-2019

Background: Adolescent obesity and overweight in the US continue to be a serious public health issue. Youth obesity and overweight are associated with increased health risks and healthcare utilization costs and have steadily climbed since the 1990s. The national Youth Risk Behavior Survey (YRBS) is administered bi-annually to a representative sample of high school students enrolled in public and private schools throughout the US and is publicly accessible for study. The purpose of this study is to examine risk trends of youth obesity and overweight over 20 years (1999-2019) on a national scale, as well as specifically within the State of Tennessee. Methods: Statistical analyses were performed using SAS 9.4 and SUDAAN 11.0.3. Linear and quadratic analyses specifically examined disparities and risk trends of obesity and overweight prevalence using stratification methods of age (grade 9-12) and race (White, African American, Hispanic/Latino, Other races) to better understand the issue of childhood obesity and overweight. Overweight is defined as a BMI at or above the 85th percentile and below the 95th for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Results: Overall, there were 161,606 cases included in our sample representing 20 years of YBRS survey data. The obesity prevalence of high school students in the US increased 2.38% from 1999 to 2005, decreased 1.15% from 2005 to 2009, then increased 3.65% thereafter. Over the two decades period, youth obesity rates significantly increased (~5%) in the US, based on results of the Cochran-Armitage trend test (Z=16.10, P Conclusion: Except for Hispanics from 2003 to 2009, a higher prevalence of youth overweight or obese among each race were seen in Tennessee each year, and except for 2003, there was a higher prevalence of both males and females in Tennessee who were overweight or obese each year. While national rates increased over the 20-year period, the increase was higher in TN. Rising obesity in the US is a public health crisis. Obesity is a grave public health threat, more serious even than the opioid epidemic or covid19. Obesity-related prevention research should be a priority because there are high costs to individuals and states due to the burden and health care costs the condition presents