Prevalence of Extremely Severe Obesity and Metabolic Dysfunction Among US Children and Adolescents
Authors' conclusion
In this nationally representative cross-sectional study of US children and adolescents, prevalence of extremely severe obesity significantly increased over time, particularly among older adolescents and non-Hispanic Black participants. Extremely severe obesity was associated with severe metabolic and cardiovascular complications, including MASLD, prediabetes or diabetes, severe insulin resistance, and metabolic syndrome. These findings emphasize the urgent need for public health interventions and policies to address pediatric obesity broadly.
Study context
- Population
- US children and adolescents aged 2 to 18 years, National Health and Nutrition Examination Survey (NHANES) 2008 through 2023; 51% male, median age 10.0 (IQR, 6.00–15.0) years
- Participants
- 25,847 children
- Exposure
- Extremely severe obesity vs milder obesity
- Outcome
- National trends in prevalence of obesity classes, stratified by gender, age, and ethnicity and race, and odds of metabolic dysfunction conditions in each obesity group
- Follow-up
- 2008 through 2023
Methodological detailsnationally representative, NHANES 2008–2023
- Nationally representative
- NHANES 2008–2023
Main finding
As reported in the abstract
Prevalence of extremely severe obesity · 2008 to 2023
- Prevalence in 2008
- 0.32% (95% CI, 0.17%-0.59%)
- Prevalence in 2023
- 1.13% (95% CI, 0.78%-1.65%)
- Relative increase (highest among obesity classes)
- 253.1%
- Prevalence among adolescents aged 16 to 18 years, 2020 to 2023
- 1.99%; 95% CI, 1.31%-2.99%
- Prevalence among non-Hispanic Black participants, 2020 to 2023
- 2.04%; 95% CI, 1.45%-2.86%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| MASLD | 6.74 (3.30–15.75) | |
| Prediabetes or diabetes | 4.94 (3.41–7.14) | |
| Severe insulin resistance | 8.05 (3.70–17.02) | |
| Metabolic syndrome | 1.99 (1.45–2.73) | |
| 0.050.21520Odds ratio (log scale) |
Original publication
Prevalence of Extremely Severe Obesity and Metabolic Dysfunction Among US Children and Adolescents. JAMA Netw Open. Published 1 July 2025. doi:10.
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