Beyond Metabolically Healthy Obesity

In JAMA Pediatrics, Putri and colleagues report long-term cardiometabolic outcomes among 7275 children who initiated obesity treatment in Sweden and were followed up through young adulthood, alongside more than 35 000 matched peers from the general population. Nearly half of the children with obesity met criteria for metabolically healthy obesity at baseline, defined by the absence of elevated blood pressure, impaired fasting glycemia, elevated transaminases as a marker of hepatic involvement, elevated triglycerides, and low high-density lipoprotein cholesterol.

However, by age 30 years, children classified as having metabolically healthy obesity experienced substantially higher cumulative incidences of type 2 diabetes, hypertension, and dyslipidemia than their peers without obesity. Although their risks were lower than those of children with metabolically unhealthy obesity, the contrast with the general population was striking.

Importantly, even a modest reduction in body mass index z score during treatment was associated with meaningful reductions in cardiometabolic risk in both the metabolically healthy and unhealthy groups. These findings challenge the assumption that the absence of metabolic abnormalities in childhood identifies a group at low long-term risk.