In this issue of Pediatrics, Zhao et al report a small but significant increase in the prevalence of severe obesity among the 16.6 million children aged 2 to 4 years participating in the Women, Infants, and Children (WIC) program between 2016 and 2020. This represents a reversal of previous decreases in severe obesity among this same group from 2010 to 2016. Severe obesity in childhood is defined as having a BMI ≥120% of the 95th percentile, which approximates 2 SDs above the mean. It is critical to note that the development of severe obesity this early in life is nearly irreversible.

Gesserick et al modeled accelerated BMI increase in early childhood and risk of sustained obesity, finding that 90% of children who develop obesity by age 3 will still have obesity by adolescence. Severe early-onset obesity is correlated with earlier and more severe risk for chronic disease;...

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