Adolescent obesity is linked to severe obesity in adulthood, according to the results of a prospective cohort study reported in the November 10 issue of the Journal of the American Medical Association.

“Although the prevalence of obesity has increased in recent years, individuals who are obese early in life have not been studied over time to determine whether they develop severe obesity in adulthood, thus limiting effective interventions to reduce severe obesity incidence and its potentially life-threatening associated conditions,” write Natalie S. The, PhD, from the University of North Carolina at Chapel Hill, and colleagues.

The goal of the study was to evaluate the association of adolescent weight with incidence and risk for severe obesity in adulthood, with use of a cohort of 8834 persons 12 to 21 years old who were enrolled in 1996 in wave II of the US National Longitudinal Study of Adolescent Health. Follow-up continued into adulthood during wave III (2001-2002) when participants were 18 to 27 years old and during wave IV (2007-2009) when they were 24 to 33 years old. With use of standardized procedures, height and weight were measured with anthropometry and surveys performed in the participants’ homes.

The investigators determined incident cases of adult-onset severe obesity as a function of sex, race or ethnicity, and adolescent weight status. Adolescence was defined as age younger than 20 years and adulthood as age 20 years or older. Adolescent obesity was defined as body mass index (BMI) in at least the 95th percentile of the sex-specific BMI-for-age growth chart or a BMI of at least 30.0 kg/m². Adult obesity was defined as a BMI of 40.0 kg/m² or more. After adjustment for race or ethnicity and age and weighted for national representation, sex-stratified, discrete time hazard models allowed estimation of the net effect of adolescent obesity on the risk for severe obesity incidence in adulthood.

Of 79 adolescents who were severely obese in 1996 (1.0%; 95% confidence interval [CI], 0.7% – 1.4%), 60 remained severely obese in adulthood (70.5%; 95% CI, 57.2% – 83.9%). By 2009, a total of 703 nonseverely obese adolescents (7.9%; 95% CI, 7.4% – 8.5%) had severe adult obesity, with non-Hispanic black women having the highest rates. Compared with normal-weight or overweight adolescents, obese adolescents were significantly more likely to become severely obese in young adulthood (hazard ratio [HR], 16.0; 95% CI, 12.4 – 20.5).

“In this cohort, obesity in adolescence was significantly associated with increased risk of incident severe obesity in adulthood, with variations by sex and race/ethnicity,” the study authors write. “…Among individuals who were obese as adolescents, incident severe obesity was 37.1 percent in men and 51.3 percent in women. Incident severe obesity was highest among black women at 52.4 percent.”

Limitations of this study include inability to determine causality, use of conventional but somewhat arbitrary BMI cutoff points, and use of a cohort that was not nationally representative of the population aged 24 to 33 years at follow-up.

“In summary, data from a nationally representative, ethnically diverse longitudinal sample suggest a high incidence of severe obesity during the transition from adolescence to adulthood,” the study authors conclude. “The clinical implications of these observed trends are concerning given the comorbidities and chronic disease associated with severe obesity. Findings highlight the need for interventions prior to adulthood to prevent the progression of obesity to severe obesity, which may reduce severe obesity incidence and its potentially life-threatening consequences.”

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