A reduction in BMI z score of at least 0.25 was associated with similar cardiometabolic risk reductions for children with both metabolically healthy and unhealthy obesity.
Cohort
Does metabolically healthy obesity in children increase the risk of long-term cardiometabolic outcomes compared to the general population, and does obesity treatment reduce this risk?
Children with metabolically healthy obesity have a substantially increased risk of cardiometabolic diseases by young adulthood compared to the general population, but weight loss treatment significantly reduces this risk.
ImportanceMetabolically healthy obesity (MHO) in children has been considered a low-risk phenotype, potentially not requiring treatment. However, their long-term cardiometabolic outcomes remain unclear. ObjectiveTo compare the occurrence of type 2 diabetes, hypertension, dyslipidemia, and mortality up to young adulthood in children with metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), and general population peers, and to investigate the association between obesity treatment response and disease risk. Design, Setting, and ParticipantsThis was a prospective cohort study including children undergoing obesity treatment recorded in the Swedish Childhood Obesity Treatment Register (BORIS) between 1997 and 2020 and their general population comparators, linked with national registers. Children in the cohort with obesity were aged 7 to 17 years at obesity treatment initiation and had complete cardiometabolic data. General population comparators were matched (ratio 1: 5) based on sex, birth year, and residential area. Study data were analyzed from February to March 2025. ExposuresExposures included metabolically healthy obesity (MHO), defined as the absence of high blood pressure, impaired fasting glycemia, elevated transaminases, elevated triglycerides, and low high-density lipoprotein cholesterol; otherwise, children were categorized as having metabolically unhealthy obesity (MUO). Main Outcomes and MeasuresType 2 diabetes, hypertension, dyslipidemia, and mortality up to age 30 years. ResultsA total of 7275 children (median first quartile Q1-third quartile Q3 age, 11. 1 9. 1-13. 5 years; 4004 male 55. 0%) were included, along with 35 636 general population comparators (median Q1-Q3 age, 11. 1 9. 1-13. 5 years; 19 596 male 55. 0%). MHO at baseline was present in 3626 children (49. 8%; median Q1-Q3 age, 10. 6 8. 8-12. 8 years; 1981 male 54. 6%), and MUO was present in 3649 children (50. 2%; median Q1-Q3 age, 11. 6 9. 4-14. 0 years; 2023 male 55. 4%). By age 30 years, cumulative incidences were as follows: type 2 diabetes (MHO, 9. 1%; MUO, 16. 8%; general population, 0. 5%), hypertension (MHO, 10. 8%; MUO, 18. 3%; general population, 3. 7%), and dyslipidemia (MHO, 5. 3%; MUO, 12. 7%; general population, 0. 9%). A reduction of at least 0. 25 body mass index (BMI) zscore was associated with reduced incidence rate ratio (IRR) of type 2 diabetes (IRR, 0. 22; 95% CI, 0. 14-0. 35), hypertension (IRR, 0. 56; 95% CI, 0. 34-0. 93), and dyslipidemia (IRR, 0. 28; 95% CI, 0. 14-0. 57), with similar risk reduction for MHO and MUO. Conclusions and RelevanceResults of this cohort study reveal that a reduction in BMIzscore of at least 0. 25 was associated with similar risk reductions for both MHO and MUO. Children with MHO face a substantially increased cardiometabolic disease risk already as young adults compared with the general population. Hence, obesity treatment should be recommended for all children with obesity, regardless of initial metabolic status.
Putri et al. (2026) conducted a cohort in Metabolically Healthy and Unhealthy Obesity. Reduction in BMI z score of at least 0.25 vs. General population was evaluated on Cardiometabolic disease risk. A reduction in BMI z score of at least 0.25 was associated with similar cardiometabolic risk reductions for children with both metabolically healthy and unhealthy obesity.