A father brings his 2-year-old son to the family doctor’s office with concerns about his child’s weight. He says, “We thought our child was just a good eater, round and healthy. But our son’s teacher weighed and measured him, said that his BMI was too high, and recommended that we talk with the doctor. Do we need to worry that he’ll be overweight as he gets older?” Show
Over recent decades, population-wide increases in the consumption of calorie-dense foods and beverages, and reduction in physical activity, have dramatically increased the prevalence of obesity in children and adults. Obesity increases the risk of limited physical activity, poor self-esteem, type 2 diabetes, cardiovascular disease, and other serious conditions. Because the morbidity and mortality associated with obesity tend to increase from childhood to adulthood, identifying the best age at which to target obesity prevention interventions is critical. In this week’s NEJM, Ward et al. present a simulation model to predict the risk of adult obesity at age 35 for the current population of children in the U. S. The authors pooled height and weight data from five nationally representative longitudinal studies that included more than 40,000 children and adults, and simulated growth trajectories, adjusting for secular trends. Assuming that current trends in childhood obesity continue, the model predicted that 57% of today’s children will be obese at age 35 years. The relative risk of adult obesity increased with age and BMI (from 1.17 for overweight 2-year-olds to 3.10 for severely-obese 19-year-olds). Obese 2-year-olds had a 75% chance of still being obese at age 35 and obese 19-year-olds had an 88% risk. Interestingly, for non-obese children, the risk of becoming obese decreased with age (from 58% at age 2 to 44% at age 19), indicating that avoiding obesity throughout childhood increases the likelihood that a child will not be obese as an adult. The authors conclude that early development of obesity in childhood is a statistically significant risk factor for future obesity in adulthood, especially for children with severe obesity. Therefore, clinical and public health interventions to promote obesity prevention should target early childhood. Returning to the father’s concern about his overweight 2-year-old, the physician should thank the parent for sharing his concern about his son’s weight and health, and offer to work with the family to get the child on a healthier weight trajectory. Optimally, the health care team — which may include nutritionists, nurses, and community health workers — should chart the child’s height and weight, review his diet and physical activity, and work closely with the family to identify practical strategies to minimize excess calories and boost physical activity. Strategies may include serving milk or water instead of sugar-sweetened beverages, playing daily at the park, and limiting screen time. Above all, parents need the support of health professionals, childcare providers, schools, government programs, and businesses to advocate for and create environments that promote optimal child nutrition and physical activity. Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MDBoston, MA – If current trends in child obesity continue, more than 57% of today’s children in the U.S. will have obesity at age 35, according to a new study from Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland Search for articles by this authorRema Ramakrishnan Affiliations The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UKUNSW, Sydney, NSW, Australia Search for articles by this authorStanley Lemeshow Affiliations College of Public Health, The Ohio State University, Columbus, OH, USA Search for articles by this authorMarkus Juonala Affiliations Department of Medicine, University of Turku, Turku, FinlandDivision of Medicine, Turku University Hospital, Turku, Finland Search for articles by this authorTrudy L Burns Affiliations Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA Search for articles by this authorJessica G Woo Affiliations Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USADepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Search for articles by this authorDavid R Jacobs Jr Affiliations Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA Search for articles by this authorStephen R Daniels Affiliations University of Colorado School of Medicine, Aurora, CO, USA Search for articles by this authorAlison Venn Affiliations Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia Search for articles by this authorJulia Steinberger Affiliations Department of Pediatric Cardiology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA Search for articles by this authorElaine M Urbina Affiliations The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USADepartment of Pediatrics, University of Cincinnati, Cincinnati, OH, USA Search for articles by this authorLydia Bazzano Affiliations Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, New Orleans, LA, USA Search for articles by this authorMatthew A Sabin Affiliations The Royal Children's Hospital and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia Search for articles by this authorTian Hu Affiliations Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA Search for articles by this authorRonald J Prineas Affiliations Division of Public Health Sciences, Wake Forest University School of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA Search for articles by this authorAlan R Sinaiko Affiliations Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA Search for articles by this authorKatja Pahkala Affiliations Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, FinlandPaavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, FinlandCentre for Population Health Research, Turku University Hospital, Turku, Finland Search for articles by this authorOlli Raitakari Affiliations Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, FinlandDepartment of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, FinlandCentre for Population Health Research, Turku University Hospital, Turku, Finland Search for articles by this authorTerence Dwyer CorrespondenceCorrespondence to: Prof Terence Dwyer, The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX1 2BQ, UK Affiliations The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK Search for articles by this authorPublished:August 23, 2019DOI:https://doi.org/10.1016/S2352-4642(19)30204-4 Predicting overweight and obesity in young adulthood from childhood body-mass index: comparison of cutoffs derived from longitudinal and cross-sectional data Previous ArticleUnderdetection of laboratory-confirmed influenza-associated hospital admissions among infants: a multicentre, prospective study Next ArticleNeurodevelopment of HIV-exposed uninfected children in South Africa: outcomes from an observational birth cohort study
 Historically, cutoff points for childhood and adolescent overweight and obesity have been based on population-specific percentiles derived from cross-sectional data. To obtain cutoff points that might better predict overweight and obesity in young adulthood, we examined the association between childhood body-mass index (BMI) and young adulthood BMI status in a longitudinal cohort. In this study, we used data from the International Childhood Cardiovascular Cohort (i3C) Consortium (which included seven childhood cohorts from the USA, Australia, and Finland) to establish childhood overweight and obesity cutoff points that best predict BMI status at the age of 18 years. We included 3779 children who were followed up from 1970 onwards, and had at least one childhood BMI measurement between ages 6 years and 17 years and a BMI measurement specifically at age 18 years. We used logistic regression to assess the association between BMI in childhood and young adulthood obesity. We used the area under the receiver operating characteristic curve (AUROC) to assess the ability of fitted models to discriminate between different BMI status groups in young adulthood. The cutoff points were then compared with those defined by the International Obesity Task Force (IOTF), which used cross-sectional data, and tested for sensitivity and specificity in a separate, independent, longitudinal sample (from the Special Turku Coronary Risk Factor Intervention Project [STRIP] study) with BMI measurements available from both childhood and adulthood. The cutoff points derived from the longitudinal i3C Consortium data were lower than the IOTF cutoff points. Consequently, a larger proportion of participants in the STRIP study was classified as overweight or obese when using the i3C cutoff points than when using the IOTF cutoff points. Especially for obesity, i3C cutoff points were significantly better at identifying those who would become obese later in life. In the independent sample, the AUROC values for overweight ranged from 0·75 (95% CI 0·70–0·80) to 0·88 (0·84–0·93) for the i3C cutoff points, and the corresponding values for the IOTF cutoff points ranged from 0·69 (0·62–0·75) to 0·87 (0·82–0·92). For obesity, the AUROC values ranged from 0·84 (0·75–0·93) to 0·90 (0·82–0·98) for the i3C cutoff points and 0·57 (0·49–0·66) to 0·76 (0·65–0·88) for IOTF cutoff points. The childhood BMI cutoff points obtained from the i3C Consortium longitudinal data can better predict risk of overweight and obesity in young adulthood than can standards that are currently used based on cross-sectional data. Such cutoff points should help to more accurately identify children at risk of adult overweight or obesity. None. To read this article in full you will need to make a payment One-time access price info Access any 5 articles from the Lancet Family of journals Subscribe:Subscribe to The Lancet Child & Adolescent HealthAlready a print subscriber? Claim online access Already an online subscriber? Sign in Register: Create an account Institutional Access: Sign in to ScienceDirect References
Article InfoPublication HistoryPublished: August 23, 2019 IdentificationDOI: https://doi.org/10.1016/S2352-4642(19)30204-4 Copyright© 2019 Elsevier Ltd. All rights reserved. ScienceDirectAccess this article on ScienceDirectLinked Articles
|
