A significant analysis of nearly 26,000 U.S. children shows that extremely severe obesity has soared 253% since 2008, and now one in every 88 children bears a dangerous excess weight level, which greatly increases their risk of liver disease, diabetes and other serious health complications.
The study, published in JAMA Network Open, tracked children’s weight patterns from 2008 to 2023 using the National Health and Nutrition Examination Survey data. The researchers found that during this period, the extremely severe obesity in all children was at least 160% of BMI and 160% of gender.
Hidden health crisis
What makes this trend particularly shocking is the cascade of metabolic complications accompanied by extreme weight gain. Children with extreme obesity face a significantly higher risk than children with obesity or normal weight.
The study found that 84.6% of obese patients developed metabolic dysfunction-related lipid-schizolid liver disease (MASLD), compared with 44.5% of children with mild obesity and only 2.8% of children with normal weight. Nearly half (46.8%) showed signs of prediabetes or diabetes, while 40.6% had severe insulin resistance.
Perhaps most worrying is that more than one-third of children develop advanced liver fibrosis – which can develop into cirrhosis and liver cancer. “In individuals with obesity levels 4 to 5, liver stiffness values reached 6.4 kPa, which is significantly higher than the 5.1 kPa observed in 1 to 3 individuals with obesity,” the researchers noted.
Who is the most risky
Data reveal differences in who develops extremely severe obesity:
- The highest rate of non-Hispanic black children was 2.04%, almost non-Hispanic white children (0.47%)
- Adolescents aged 16-18 showed 1.99%, significantly higher than young children
- Boys are 1.5 times more likely to develop severe obesity than girls
- Mexican-American children also show higher risks compared to other races
A team of researchers led by UC San Diego analyzed data spanning 15 years to identify these disturbing patterns. They found that over time, the rate of extremely severe obesity has been increasing, with the largest acceleration in recent years.
Overweight: A metabolic storm
The most striking finding of this study is not only weight gain, but the metabolic confusion it causes. Children with extremely obesity had fasting insulin levels of 43.4 μIU/mL, almost twice that of obese children (21.8 μIU/mL), and more than four times that of children with normal weight (9.8 μIU/ml).
Their HBA1C levels are a measure of blood sugar control, reaching 5.6% – toward the edge of diabetes range. Meanwhile, their HDL “good” cholesterol plunged to a dangerously low of 41 mg/dl, while children with normal weight had 54 mg/dl.
The researchers calculated that children with extremely severe liver disease faced an odds of 6.74 compared to children with mild obesity, 4.94 in liver disease or prediabetes, and 8.05 in severe insulin resistance.
Public health emergency
These findings add to the weight of pediatric experts increasingly declared childhood obesity a public health emergency. The study shows that 100% of children with extreme obesity meet the criteria for insulin resistance, while 80.9% of children with mild obesity and 27.5% of children with normal weight.
Systemic inflammation measured by C-reactive protein levels was significantly elevated in these children, suggesting that their bodies were in a constant state of metabolic stress. More than half (53.8%) meet the criteria for metabolic syndrome, which greatly increases the risk of cardiovascular disease.
The researchers stress that these children should prioritize access to new weight loss drugs (such as GLP-1 receptor agonists), which are still in short supply. They believe that medical interventions in this population will “maximize the benefits of life, years of life and healthy years of life” compared to other populations.
expect
The authors of the study noted that their findings were only the beginning of understanding extremely severe childhood obesity. The study relies on noninvasive liver imaging rather than biopsy, while the sample size of children with extremely severe obesity remains relatively small.
However, clear trends and serious health consequences require immediate action. Researchers call for targeted interventions to address racial and racial disparities, early prevention programs, and equitable allocation of limited medical resources.
Since 1990, as childhood obesity rates have quadrupled worldwide, the U.S. data has made it eye-catching what could happen around the world. The study shows that exceeding the size of childhood obesity, extremely severe, represents a complex medical condition that requires urgent, comprehensive intervention.
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