Extremely severe obesity in U.S. children and adolescents may be associated with severe cardiovascular and metabolic complications, and there is an urgent need for public health interventions that address pediatric obesity, according to results from a study published July 16 in JAMA.

Eliane Münte, et al., looked at 25,847 participants (51% male) aged 2 to 18 years with a median age of 10 years old from the National Health and Nutrition Examination Survey from 2008 through 2023. The authors note that 20% of participants were Mexican American, 24% were non-Hispanic Black, 30% were non-Hispanic White, 11% were Other Hispanic and 15% were from other racial backgrounds, including multiracial.

Pediatric obesity was defined as obesity classes 1 to 3 (body mass index [BMI] ≥95th percentile to <160% of the 95th percentile), and extremely severe obesity included class 4 (BMI ≥160% to <180% of 95th percentile) and class 5 (BMI ≥180% of 95th percentile).

Results showed that the prevalence of pediatric obesity increased from 2008 to 2023, with the highest increase of 253% observed for extremely severe obesity from 0.32% (95% CI, 0.17%-0.59%) in 2008 to 1.13% (95% CI, 0.78%-1.65%) in 2023. Extremely severe obesity was particularly prevalent among adolescents aged 16 to 18 years and non-Hispanic Black participants between 2020 and 2023.

Extremely severe pediatric obesity was associated with higher odds of metabolic complications including metabolic dysfunction–associated steatotic liver disease, prediabetes or diabetes, severe insulin resistance and metabolic syndrome.

"The findings of this study … provide robust evidence supporting extremely severe obesity specifically as a public health emergency," the authors write. "The association with metabolic and cardiovascular complications necessitates urgent public health action, such as early prevention, targeted education and the mobilization of resources."