ESPE Yearbook of Paediatric Endocrinology

JAMA Pediatr. 2025 Mar 1;179(3):302-309. PMID: 39836390. doi: 10.1001/jamapediatrics.2024.5552. https://pubmed.ncbi.nlm.nih.gov/39836390/

Brief Summary: This large-scale Swedish cohort study investigated how effective paediatric obesity treatment impacts long-term health outcomes in adulthood. The researchers followed over 6,700 children and adolescents (ages 6–17) who had received behavioral-based obesity treatment for at least 1 year. The study analysed the health outcomes as young adults (ages 18–30) and compared them with over 32,000 matched controls. The primary finding was that effective obesity treatment during childhood reduces the risk of serious health complications in adulthood.

Long-term data on the effect of childhood obesity treatment on adulthood are rare, making the present study particularly important given the increasing number of affected children [1,2]. This study adds important evidence: children who achieved obesity remission after treatment had an 86% lower risk of early death, compared to those with poor treatment response. They also had reduced risks of developing type 2 diabetes (HR 0.16), hypertension (HR 0.40) and dyslipidemia (HR 0.22). Participants with a "good response" to treatment (BMI SDS reduction >0.25 without remission) also experienced substantial health benefits and even intermediate responders (BMI SDS reduction -0.24 - +0.24) had better outcomes than poor responders (BMI SDS increase >0.25). Children aged 6–11 were more likely to achieve remission or a good response (~48%) compared to adolescents aged 12–17 (~29%). Interestingly, despite physical health improvements, the study found no impact on adult mental health outcomes like depression or anxiety.

Altogether, the study provides strong evidence that paediatric obesity treatment, particularly when started early and resulting in significant BMI reduction, can substantially lower the risk of chronic disease and early death in adulthood. It emphasizes the importance of early, structured treatment efforts involving family-based behavioural-based approaches and calls attention to the gap in mental health outcomes [3]. However, a critical examination of the numbers reveals that even if childhood obesity resolved, the incidence of comorbidities remains elevated compared to the general population; in the case of type 2 diabetes, the incidence is even 4-times higher. Therefore, preventing the development of obesity is also of great importance.

Key strengths of the study include its large sample size, long follow-up period, and real-world treatment settings. However, limitations include the non-randomized design and lack of standardized treatment protocols, making it difficult to isolate the most effective interventions. Overall, the study adds high-quality evidence in favour of pediatric obesity treatment as a long-term investment in public health.

References: 1. Hagman E, Danielsson P, Lindberg L, Marcus C; BORIS Steering Committee. Paediatric obesity treatment during 14 years in Sweden: Lessons from the Swedish Childhood Obesity Treatment Register-BORIS. Pediatr Obes. 2020 Jul;15(7):e12626. PMID: 32074662.2. Lindberg L, Danielsson P, Persson M, Marcus C, Hagman E. Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLoS Med. 2020 Mar 18;17(3):e1003078. PMID: 32187177.3. Gallagher C et al. The effects of weight change from childhood to adulthood on depression and anxiety risk in adulthood: a systematic review. Obes Rev 2023; 24 (7):e13566. Doi: 10.1111/obr.13566