TOPLINE:

Children with metabolically healthy obesity at treatment initiation showed an increased incidence of type 2 diabetes (T2D), hypertension, and dyslipidemia, compared with peers in the general population.

METHODOLOGY:

• Researchers conducted a prospective cohort study of 7275 children with obesity (median age, 11.1 years; 55.0% boys) undergoing treatment, as recorded in a Swedish register (1997-2020), along with 35,636 matched comparators from the general population in Sweden.
• Children were categorized as having metabolically healthy obesity (n = 3626) if they did not have high blood pressure, impaired fasting glycemia (≥ 110 mg/dL), elevated alanine aminotransferase or triglyceride levels, or elevated low high-density lipoprotein cholesterol levels; those who met any of these criteria were categorized as having metabolically unhealthy obesity (n = 3649).
• The outcomes assessed were T2D, hypertension, dyslipidemia, and mortality up to the age of 30 years, comparing risks among children with metabolically healthy obesity, those with metabolically unhealthy obesity, and those in the general population.
• Treatment response was measured as the change in BMI z score between the first and last visit among individuals treated for at least 1 year, and the response was categorized as a reduction of ≥ 0.25 units, an increase of ≥ 0.25 units, or a change of < 0.25 units in either direction.

TAKEAWAY:

• By the age of 30 years, the cumulative incidence of T2D was 9.1% among children with metabolically healthy obesity, 16.8% among those with metabolically unhealthy obesity, and 0.5% among those in the general population. The cumulative incidence of hypertension was 10.8%, 18.3%, and 3.7% and that of dyslipidemia was 5.3%, 12.7%, and 0.9% in the respective groups.
• Children with metabolically healthy obesity had a higher incidence of T2D (adjusted incidence rate [aIR], 36.2 vs 2.1 per 10,000 person-years; P < .001), hypertension (aIR, 23.2 vs 8.1 per 10,000 person-years; P < .001), and dyslipidemia (aIR, 11.4 vs 1.9 per 10,000 person-years; P < .001) than those in the general population.
• A reduction of at least 0.25 units in BMI z score was associated with reduced risks for T2D (incidence rate ratio [IRR], 0.22; 95% CI, 0.14-0.35), hypertension (IRR, 0.56; 95% CI, 0.34-0.93), and dyslipidemia (IRR, 0.28; 95% CI, 0.14-0.57) compared with an increase in BMI z score.

IN PRACTICE:

"The present study indicates that even in the absence of early metabolic disturbances, children with obesity still face a markedly elevated long-term risk for cardiometabolic diseases compared with the general population," the authors wrote. "Treatment should also be recommended for children with obesity who appear metabolically healthy," they added.

SOURCE:

The study was led by Resthie R. Putri, PhD, of the Department of Clinical Science, Intervention and Technology at the Karolinska Institutet in Stockholm, Sweden. It was published online on March 23, 2026, in JAMA Pediatrics.

LIMITATIONS: 

The study was restricted to outcomes cases that were diagnosed or treated. Data on the occurrence and timing of transitions from metabolically healthy to unhealthy obesity before the outcomes were measured were lacking. Only a small portion of children in the cohort were 30 years of age at the conclusion of the study.

DISCLOSURES:

The study did not report any specific funding. Two authors reported receiving grants and speaker fees, and a third author reported receiving personal fees from various foundations and companies and serving as chairman of the board. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.