Pediatric obesity treatment yields lower morbidity, mortality risk in young adults | Image Credit: © Felix Pergande - © Felix Pergande - stock.adobe.com.

A beneficial response to pediatric obesity treatment, observed in a real-world setting, lowered risk of cardiometabolic morbidities in early adulthood, according to a newly-published JAMA Pediatrics Swedish nationwide study.¹

Background

According to the CDC, approximately 1 in 5 children and adolescents have obesity, and from 2017 to March 2020, obesity prevalence among US-children and adolescents was 19.7% (14.7 million) among those aged 2 to 19 years.²

"By 2035, the global prevalence of obesity in individuals aged 5 to 19 years is estimated to be 18% among girls and 20% among boys," noted the study authors, led by Resthie Putri, PhD.¹

"Childhood obesity is associated with hypertension, steatotic liver disease, insulin resistance, and psychosocial issues, such as anxiety, depression, and stigma," added the authors.

Since data involving longer-term impacts of treating childhood obesity and the risk of obesity-related events in young adulthood is limited, investigators sought to evaluate these long-term effect outcomes in a Swedish population.

Study details and results

A prospective cohort of children and adolescents with obesity from The Swedish Childhood Obesity Treatment Register (BORIS) were included, along with general population comparators, linked with national registers.

Participants included children and adolescents aged 6 to 17 years, with outcomes assessed from individuals aged 18 to 30 years (2005 to 2020). The general population comparators were matched on a 1:5 ratio on sex, geographical area, and year of birth, according to study data.

Pediatric obesity treatment response (based on changes in body mass index standard deviation score), and were categorized as poor, intermediate, and good response and obesity remission.

Type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery were the obesity-related events. Mortality was also assessed.

Among the 6713 individuals included in the study (56% male), the median age at obesity treatment was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years).

"For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators," stated the study investigators.

Obesity remission or a good response in obesity treatment, compared with poor responses, was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). In addition, a good response to treatment was linked with lower risk of:

• T2D (HR, 0.42; 95% CI, 0.23-0.77)
• Dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75)
• Bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58)

Obesity remission demonstrated a similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65).

For T2D, 113 individuals developed the condition during follow-up, at a median age of 22.2 years. Overall, intermediate response, good response, and obesity remission were associated with a reduced risk of T2D development compared to poor response.

"Compared with the poor response group, the obesity remission, good response, and intermediate response groups had an adjusted HR of 0.16 (95% CI, 0.07-0.35), 0.42 (95% CI, 0.23-0.77), and 0.55 (95% CI, 0.36-0.85), respectively," according to study results.

There were 216 children and adolescents who developed hypertension at follow-up, at a median age of 23.4 years.

Sixty-six individuals developed dyslipidemia during follow-up at a median age of 22.5 years. Versus the poor response group, a lower risk of dyslipidemia was observed in both the obesity remission (adjusted HR, 0.22; 95% CI, 0.09-0.57) and the good response groups (adjusted HR, 0.31; 95% CI, 0.13-0.75).

Related to bariatric surgery, the BORIS cohort featured 375 individuals who underwent bariatric surgery at a median age of 20.5 years, with lower adjusted HRs observed for all treatment response groups compared to the poor response group.

A total of 21 deaths occurred in the BORIS cohort at a median age of 23.6 years. Lower risk of mortality was observed in the intermediate response group (adjusted HR, 0.30; 95% CI, 0.11-0.78) and in the combined obesity remission/good response groups (adjusted HR, 0.12; 95% CI, 0.03- 0.46).

Conclusion

"In this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood," the authors concluded.

References:

Putri RR, Danielsson P, Ekström N, et al. Effect of pediatric obesity treatment on long-term health. JAMA Pediatrics. JAMA Pediatr. doi:10.1001/jamapediatrics.2024.5552 Published online January 21, 2025.