While the prevalence of overweight and obesity continues to rise, so does the need to characterize the risks and identify strategies for combating this important public health issue. As pediatricians, this means determining how we identify at-risk children and implement an effective intervention at the optimal time. Previous data have shown that overweight and obese children continue to have cardiac and metabolic abnormalities that persist into adulthood even if their body mass index (BMI) normalizes. While a growing number of studies have suggested intervention in childhood and adolescence may be essential to preventing these long-term sequelae, few have studied the relationship of the growth trajectory of BMI during childhood to adult obesity. In this month’s Pediatrics, Buscot et. al. (10.1542/peds.2017-2003) analyze longitudinal BMI data obtained from participants in the Cardiovascular Risk in Young Finns Study (YFS) from childhood into adulthood. The study focuses on four a priori groups: individuals with non-obese BMI in youth and adulthood, obese children with non-obese adult BMIs, individuals with an obese BMI in childhood and adulthood, and non-obese children with obese adult BMIs.
As one might expect, non-obese children who later developed obesity in adulthood had higher average BMIs at age 6 compared to those who had non-obese adult BMIs. However, Buscot et. al. also identified that the both the rate of BMI rise and time to plateauing of BMI were greater in these children who later developed obesity. These data confirm previous studies that emphasized the importance of early childhood interventions while contributing a unique longitudinal description of changes in BMI. Interestingly, when studying the BMI growth trajectories for obese children, study authors found that those who were not obese in adulthood exhibited a plateaued BMI rate-of-change much earlier than those with persistent obese BMIs in adulthood. This suggests that puberty may be a critical window for correction of weight status and that secondary interventions targeting the adolescent population may also be important for overcoming obesity in adulthood. While this study’s generalizability to other populations may be limited, it nonetheless contributes important findings for pediatricians to consider when counseling and intervening on childhood obesity.
