November 19, 2013Open Access

The Effect of Obesity in Adolescence on Adult Health Status

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe obesity (n=1502). Intervention: Class 2 or 3 obesity at age 18 vs. Healthy weight at age 18. Primary outcome: Lower-extremity venous edema with skin manifestations (RR 5.35, 95% CI 2.57-11.14, p=<0.0001).

Key Result

Compared with healthy weight at age 18, class 2 or 3 obesity at age 18 independently increased the risk of lower-extremity venous edema by 435% (RR 5.35) in adults undergoing bariatric surgery.

Study Design

Type

Observational (n=1,502)

Multicenter

Yes

PICO

Population

1,502 adults with severe obesity undergoing bariatric surgery who could reliably recall their weight at age 18, with a median age of 47 years.

Exposure / Comparator

Class 2 or 3 obesity at age 18 vs Healthy weight at age 18

Primary Outcome

Lower-extremity venous edema with skin manifestations — RR 5.35 (2.57-11.14), p=<0.0001

Main Result

Relative Risk: 5.35 (95% CI 2.57–11.14)

p-value: p=<0.0001

Limitations

Highly selected cohort of patients seeking bariatric surgery, limiting generalizability to the broader obese population.
Lack of information on the actual duration of obesity or weight cycling between age 18 and surgery.
Reliance on self-reported, recalled height and weight from age 18, which may underestimate true adolescent BMI.

Abstract

OBJECTIVE: To test the hypothesis that adolescent obesity would be associated with greater risks of adverse health in severely obese adults. METHODS: Before weight loss surgery, adult participants in the Longitudinal Assessment of Bariatric Surgery-2 underwent detailed anthropometric and comorbidity assessment. Weight status at age 18 was retrospectively determined. Participants who were ≥80% certain of recalled height and weight at age 18 (1502 of 2308) were included. Log binomial regression was used to evaluate whether weight status at age 18 was independently associated with risk of comorbid conditions at time of surgery controlling for potential confounders. RESULTS: Median age and adult body mass index (BMI) were 47 years and 46, respectively. At age 18, 42% of subjects were healthy weight, 29% overweight, 16% class 1 obese, and 13% class ≥2 obese. Compared with healthy weight at age 18, class ≥2 obesity at age 18 independently increased the risk of lower-extremity venous edema with skin manifestations by 435% (P < .0001), severe walking limitation by 321% (P < .0001), abnormal kidney function by 302% (P < .0001), polycystic ovary syndrome by 74% (P = .03), asthma by 48% (P = .01), diabetes by 42% (P < .01), obstructive sleep apnea by 25% (P < .01), and hypertension (by varying degrees based on age and gender). Conversely, the associated risk of hyperlipidemia was reduced by 61% (P < .01). CONCLUSIONS: Severe obesity at age 18 was independently associated with increased risk of several comorbid conditions in adults undergoing bariatric surgery.

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