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Obesity in Early Childhood Predicts Obesity Into Adulthood
TAKE-HOME MESSAGE
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Height and weight data from five longitudinal studies were pooled to develop a simulation model to predict the future risk of obesity at age 35 years in children in the US. Among today’s children, 57.3% are predicted to be obese at age 35 years. Around half of all obesity will become prevalent during childhood. The relative risk of adult obesity was 1.17 for overweight children aged 2 years, but this increased with increasing age and BMI to 3.10 for severely obese 19-year-olds. The chance of no obesity at the age of 35 years fell from 21.0% in 2-year-olds with severe obesity to 6.1% for 19-year-olds with severe obesity.
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Obesity in childhood continues to be a significant health problem. The onset of obesity at a young age predicts the risk of obesity in adulthood, especially for children with severe obesity.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Although the current obesity epidemic has been well documented in children and adults, less is known about long-term risks of adult obesity for a given child at his or her present age and weight. We developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States.
METHODS
We pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults. We simulated growth trajectories across the life course and adjusted for secular trends. We created 1000 virtual populations of 1 million children through the age of 19 years that were representative of the 2016 population of the United States and projected their trajectories in height and weight up to the age of 35 years. Severe obesity was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or higher in adults and 120% or more of the 95th percentile in children.
RESULTS
Given the current level of childhood obesity, the models predicted that a majority of today's children (57.3%; 95% uncertainly interval [UI], 55.2 to 60.0) will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood. Our simulations indicated that the relative risk of adult obesity increased with age and BMI, from 1.17 (95% UI, 1.09 to 1.29) for overweight 2-year-olds to 3.10 (95% UI, 2.43 to 3.65) for 19-year-olds with severe obesity. For children with severe obesity, the chance they will no longer be obese at the age of 35 years fell from 21.0% (95% UI, 7.3 to 47.3) at the age of 2 years to 6.1% (95% UI, 2.1 to 9.9) at the age of 19 years.
CONCLUSIONS
On the basis of our simulation models, childhood obesity and overweight will continue to be a major health problem in the United States. Early development of obesity predicted obesity in adulthood, especially for children who were severely obese. (Funded by the JPB Foundation and others.).
Additional Info
Disclosure statements are available on the authors' profiles:
Simulation of Growth Trajectories of Childhood Obesity Into Adulthood
N. Engl. J. Med 2017 Nov 30;377(22)2145-2153, ZJ Ward, MW Long, SC Resch, CM Giles, AL Cradock, SL GortmakerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This comprehensive and disturbing analysis puts the weight of the world on all of our shoulders. Never in the history of epidemiology has a study amassed accurate measurements of 128.9 million data points over a 42-year period (1975–2016), 75 million of which are from children ages 5 and up. There are many messages in this study, but two dominate. First, despite the increase in obesity (a 9-fold increase in girls and a 12-fold increase in boys), there are still more undernourished children on the planet than obese. This suggests that efforts to enhance global food security continue to be inadequate. Secondly, the mean BMI of every country has increased—the entire BMI distribution curve has shifted to the right. The only regional area that has remained BMI-stable is Eastern Europe; the areas that have demonstrated the most rapid increases are East and South Asia. Why? Elementary—the “nutrition transition”—they’re eating our food! Yet, BMI is stabilizing in rich Western nations, albeit at a high level.
Despite this exhaustive analysis, big questions remain. Newborn birth weights are up by 200 grams in the US, Israel, South Africa, and Russia in this same interval—and it’s all fat. Does newborn obesity predispose to child obesity, which then predisposes to adult obesity? Also, BMI-dependent metabolic morbidity thresholds are different based on race and ethnicity; for instance, Asians get sick at a lower BMI than Africans. There are no objective measures in this study; in fact, there are no race/ethnic data in this analysis, other than region. Nonetheless, the rapid increase in childhood obesity worldwide without an increase in food security bodes poorly for public health and prevention efforts in the future on both ends of the BMI spectrum.