Comparison of BMI and Physical Activity Between Old Order Amish Children and Non-Amish Children

  1. Soren Snitker, MD, PHD1
  1. 1University of Maryland School of Medicine, Baltimore, Maryland
  2. 2Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, Maryland
  3. 3University of California at San Francisco School of Medicine, San Francisco, California
  4. 4Yale University School of Medicine, New Haven, Connecticut
  1. Corresponding author: Soren Snitker, ssnitker{at}
  1. K.G.H. and J.L.D. contributed equally to this work.


OBJECTIVE The Old Order Amish (OOA) is a conservative Christian sect of European origin living in Pennsylvania. Diabetes is rare in adult OOA despite a mean BMI rivaling that in the general U.S. non-Hispanic white population. The current study examines childhood factors that may contribute to the low prevalence of diabetes in the OOA by comparing OOA children aged 8 to 19 years with National Health and Nutrition Examination Survey (NHANES) data and children from Maryland’s Eastern Shore (ES), a nearby, non-Amish, rural community. We hypothesized that pediatric overweight is less common in OOA children, that physical activity (PA) and BMI are inversely correlated, and that OOA children are more physically active than ES children.

RESEARCH DESIGN AND METHODS We obtained anthropometric data in 270 OOA children and 229 ES children (166 non-Hispanic white, 60 non-Hispanic black, 3 Hispanic). PA was measured by hip-worn accelerometers in all ES children and in 198 OOA children. Instrumentation in 43 OOA children was identical to ES children.

RESULTS OOA children were approximately 3.3 times less likely than non-Hispanic white ES children and NHANES estimates to be overweight (BMI ≥85th percentile, Centers for Disease Control and Prevention). Time spent in moderate/vigorous PA (MVPA) was inversely correlated to BMI z score (r = −0.24, P = 0.0006). PA levels did not differ by ethnicity within the ES group, but OOA children spent an additional 34 min/day in light activity (442 ± 56 vs. 408 ± 75, P = 0.005) and, impressively, an additional 53 min/day in MVPA (106 ± 54 vs. 53 ± 32, P < 0.0001) compared with ES children. In both groups, boys were more active than girls but OOA girls were easily more active than ES boys.

CONCLUSIONS We confirmed all three hypotheses. Together with our previous data, the study implies that the OOA tend to gain their excess weight relatively late in life and that OOA children are very physically active, both of which may provide some long-term protection against diabetes.

  • Received May 22, 2012.
  • Accepted September 6, 2012.

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  1. Diabetes Care
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