The role of high body mass index (BMI) from infancy forward on clinician-rated pubertal timing in a large US sample
Authors' conclusion
Preventing high BMI in mid- and late childhood, but not in the first 4 years of life, may decelerate pubertal onset.
Study context
- Population
- Full-term singletons born in Kaiser Permanente Northern California affiliated facilities, 2003–2011; 46.6% female46.6% female
- Participants
- 132,452 singletons
- Exposure
- BMI +1SD and +2SD above population mean in infancy, early, mid- and late childhood
- Outcome
- Onset (SMR ≥ 2) of clinician-assessed pubarche, thelarche and gonadarche
Methodological detailsmediation analysis
- Mediation analysis
Main finding
As reported in the abstract
Pubertal onset (SMR ≥ 2) by high BMI period · median onset age
Mid-childhood BMI +2SDEstimate (95% CI)
Lowest of range
controlled direct effect risk difference, male pubarche 0.015(0.013–0.017)
Highest of range
controlled direct effect risk difference, female thelarche 0.112(0.103–0.121)
- Pubertal timing not meaningfully associated with high BMI in infancy and early childhood (risk differences)
- <0.001-0.007
Observational data: associations, not effects.
Original publication
The role of high BMI from infancy forward on clinician-rated pubertal timing in a large US sample. J Clin Endocrinol Metab. Published 11 March 2026. doi:10.
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