Children and adolescents with more severe obesity show a higher prevalence of cardiometabolic abnormalities than those with less severe obesity, so differentiating among levels of obesity is important in the pediatric population, according to a report published online Oct. 1 in New England Journal of Medicine.
Current screening guidelines for pediatric patients use only a single category for obesity, which doesn’t take into account their varying levels of risk for obesity-related disorders. To assess the distribution of cardiometabolic risk factors in obese children and adolescents, researchers performed a cross-sectional analysis of data from the National Health and Nutrition Examination Survey for 2011-2012.
They assessed a nationally representative sample of 8,579 participants aged 3-19 years, categorizing them by age- and gender-specific body mass index percentiles: overweight (85th-94th percentile), class I obesity (95th percentile to 119% of the 95th percentile), class II obesity (120% to 139% of the 95th percentile, or BMI of 35-39, whichever was lower), or class III obesity (140% of the 95th percentile, or BMI of 40 or greater, whichever was lower).
A total of 47% of the study participants were overweight, 36% had class I obesity, 12% had class II obesity, and 5% had class III obesity. The prevalence of abnormal values for total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic BP, diastolic BP, glycated hemoglobin, and fasting glucose all increased with increasing severity of obesity, at most ages and across both genders. The correlations were more pronounced in boys than in girls, said Asheley C. Skinner, Ph.D., of the department of pediatrics and the department of health policy and management, University of North Carolina at Chapel Hill, and her associates.
The findings indicate that distinguishing among at least three levels of obesity severity “provides a more fine-tuned approach to identifying patients with the greatest risk of potential complications and death,” allowing targeted interventions to those at greatest risk. This is especially important because resources are too limited to provide services for every child with obesity, the investigators said (N Engl J Med. 2015 Oct 1. doi:10.1056/NEJMoa1502821). “As older adolescents transition to young adulthood, the recognition that teens with obesity have increased cardiometabolic risk will be important,” they added.
This study did not specify a source of funding. Dr. Skinner reported having no relevant financial disclosures; one of her associates reported receiving personal fees from Nestle unrelated to this work.