• Asheley C Skinner, Eliana M Perrin, Leslie A Moss, and Joseph A Skelton.
• From the Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, School of Medicine (A.C.S., E.M.P.), Department of Health Policy and Management, Gillings School of Global Public Health (A.C.S.), and Injury Prevention Research Center (L.A.M.), University of North Carolina at Chapel Hill, Chapel Hill, and the Department of Pediatrics, Wake Forest School of Medicine, and Brenner FIT (Families in Training), Brenner Children's Hospital, Winston-Salem (J.A.S.) - all in North Carolina.
• N. Engl. J. Med. 2015 Oct 1;373(14):1307-17.

BackgroundThe prevalence of severe obesity among children and young adults has increased over the past decade. Although the prevalence of cardiometabolic risk factors is relatively low among children and young adults who are overweight or obese, those with more severe forms of obesity may be at greater risk.MethodsWe performed a cross-sectional analysis of data from overweight or obese children and young adults 3 to 19 years of age who were included in the National Health and Nutrition Examination Survey from 1999 through 2012 to assess the prevalence of multiple cardiometabolic risk factors according to the severity of obesity. Weight status was classified on the basis of measured height and weight. We used standard definitions of abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, glycated hemoglobin, and fasting glucose and report the prevalence of abnormal values in children and young adults according to weight status.ResultsAmong 8579 children and young adults with a body-mass index at the 85th percentile or higher (according to the Centers for Disease Control and Prevention growth charts), 46.9% were overweight, 36.4% had class I obesity, 11.9% had class II obesity, and 4.8% had class III obesity. Mean values for some, but not all, cardiometabolic variables were higher with greater severity of obesity in both male and female participants, and the values were higher in male participants than in female participants; for HDL cholesterol, the mean values were lower with greater severity of obesity. Multivariable models that controlled for age, race or ethnic group, and sex showed that the greater the severity of obesity, the higher the risks of a low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglyceride and glycated hemoglobin levels.ConclusionsSevere obesity in children and young adults was associated with an increased prevalence of cardiometabolic risk factors, particularly among boys and young men.

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