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Survey Items: Survey instrument item number for children 6-11 years: C4, C5; for children 12-17 years: C5, C6 Variable in public use file: BMICLASS (derived)
Denominator: Children age 6-17 years
Numerator: Obese (95th percentile or above); Underweight, normal weight or overweight
Revisions and Changes: In 2024, the denominator expanded to include 6-9 year old children where previously the measure only included children ages 10-17 years. For more information about the changes, click here. For more information on the Title V MCH Block Grant measures, review this document.
Additional Notes: Assessment of body mass index (BMI) in children and teenagers is approached differently than for adults. Because growth patterns differ, BMI in youth is age and gender specific. BMI-for-age categories are: Underweight – Less than the 5th percentile; Healthy weight – 5th percentile to less than the 85th percentile; Overweight – 85th to less than the 95th percentile; Obese – Equal to or greater than the 95th percentile. Additional information about BMI-for-age is available from the CDC website. The child's age in months is used to calculate BMI-for-age. However, since the NSCH reports age only in years, all children were assumed to be at the midpoint of their age-year for this calculation. In the NSCH, BMI is based on parents' recollection of the selected child's height and weight. Responses to these questions about a child's current height and weight were not independently verified (e.g., measurement, health records, etc.). A study comparing parent-reported height and weight estimates from the 2003 NSCH with results of physical measurement from the National Health and Nutrition Examination Survey (NHANES) revealed that parents typically overestimate height and underestimate weight of children younger than 10 years of age. (Lara J. Akinbami, Cynthia L. Ogden. (2009) Childhood Overweight Prevalence in the United States: The Impact of Parent-reported Height and Weight. Obesity 17:1574-1580); therefore, BMI for children under 10 years of age should be interpreted carefully. See also: Accuracy of parent-reported information for estimating prevalence of overweight and obesity in a race-ethnically diverse pediatric clinic population aged 3 to 12. Gordon NP, Mellor RG. BMC Pediatr. 2015 Feb 12; 15:5. Doi: 10.1186/s12887-015-0320-0. PMID: 25886135 and State-level estimates of childhood obesity prevalence in the United States corrected for report bias. Long MW, Ward ZJ, Resch SC, Cradock AL, Wang YC, Giles CM, Gortmaker SL.Int J Obes (Lond). 2016 Oct; 40(10):1523-1528. Doi: 10.1038/ijo.2016.130. Epub 2016 Jul 27. PMID: 27460603 Please see "Indicator 1.4: Weight status (BMI) in 4 categories, age 6-17 years" for further information and additional categories.
Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For Title V Maternal and Child Health Services Block Grant Measures, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required. Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 5%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.
History and Development: Overview of the Title V Block Grant The Title V Maternal and Child Health (MCH) Services Block Grant Program is a federal-state partnership to improve the health and well-being of mothers, children (including children with special health care needs) and their families in all 59 states and jurisdictions. The Title V MCH Block Grant Performance Measure Framework enables states to demonstrate the impacts of Title V within a state. The performance measurement system utilizes national data sources, including the NSCH, to track the ultimate outcomes of the program -- National Outcome Measures (NOMs) – and the key metrics of health behavior or health care access and quality -- National Performance Measures (NPMs) -- that influence NOMs. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children) and some new measures have been added. Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. Learn more about the NPM and NOM content changes at the MCHB website and DRC website. More information about the Title V MCH Block Grant and performance measurement system can be obtained at the MCHB website. About NSCH The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), is designed to provide annual national and state-level information on the health and well-being of children ages 0-17 years in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final data set of survey results. HRSA’s Maternal and Child Health Bureau (MCHB) develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. In 2016, the NSCH underwent a significant redesign which combined content from both the NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Further information on that redesign can be found in “The Design and Implementation of the 2016 National Survey of Children’s Health”. The NSCH is conducted as a household survey, and one child per household is selected to be the subject for the detailed age-specific questionnaire. The respondent to this questionnaire is a parent or guardian who is living in the home and has knowledge of the sampled child. Survey participants complete either web-based or self-administered paper-and-pencil questionnaires. Data from the NSCH is used for scientific research, federal policy and program development, and state-level planning and performance reporting. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, systems of care for CSHCN, family interactions, parental health, school and after-school experiences, and neighborhood characteristics. More information about the survey can be found in the “About the National Survey of Children's Health” section of this website and HRSA’s MCHB website.
National Outcome Measure: Percent of adolescents, ages 6 through 17, who are obese (BMI at or above the 95th percentile)
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Data Source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau. https://mchb.hrsa.gov/data/national-surveys
Citation: Child and Adolescent Health Measurement Initiative. 2022-2023 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [mm/dd/yy] from [www.childhealthdata.org].