The utility of childhood and adolescent obesity assessment in relation to adult health.

BACKGROUND

High childhood obesity prevalence has raised concerns about future adult health, generating calls for obesity screening of young children.

OBJECTIVE

To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults.

DESIGN

Longitudinal statistical analyses; microsimulations combining multiple data sets.

DATA SOURCES

National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys.

METHODS

The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race.

RESULTS

Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6.

LIMITATION

Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future.

CONCLUSION

Early childhood obesity assessment adds limited information to later childhood assessment. Targeted later childhood approaches or universal strategies to prevent unhealthy weight gain should be considered.