Extremely Severe Pediatric Obesity Prevalence Increased Over Last 15 Years

Results from a JAMA Network Open study showed that the prevalence of extremely severe obesity has significantly increased over time, especially among older adolescents and patients who are nonHispanic Black. Severe obesity is often associated with metabolic and cardiovascular complications, such as metabolic dysfunction-associated steatotic liver disease (MASLD), prediabetes, diabetes, severe insulin resistance, and metabolic syndrome, according to the study investigators.¹

From 2008 to 2023, the relative increase of pediatric patients with obesity classes 4 to 5 is 253.1%. | Image Credit: yuriygolub - stock.adobe.com

“We further found that extremely severe pediatric obesity was associated with numerous comorbidities, surpassing those associated with lower obesity classes,” the study authors said. “Specifically, children with extremely severe obesity had higher risk of MASLD, advanced fibrosis, prediabetes or diabetes, severe insulin resistance, and metabolic syndrome compared with those with obesity classes 1 to 3.”

In a review earlier in 2025, it was estimated that adolescent obesity affects 21% of patients aged 12 to 18 years. Because obesity is associated with adverse outcomes, lifestyle modifications, antiobesity medications, and surgery have been recommended as treatment options. Risk factors for adolescent obesity include genetic, environmental, lifestyle, and social factors, and 2 hours or more of screentime per day had an increased risk of obesity. Patients included in the review also had higher total cholesterol levels, lower high-density lipoprotein cholesterol levels, high triglyceride levels, high systolic and diastolic blood pressure, and high glycated hemoglobin levels.²

Glucagon-like peptide-1 (GLP-1) receptor agonists keep growing in popularity, and at the American Diabetes Association’s 85th Scientific Sessions, investigators showed the increase in pediatric patients with type 2 diabetes from 2019 to 2024. The GLP-1 prescriptions among this patient population increased from 12.3% in 2019 to 60.9% in 2024, according to the results. Approximately 53.9% of patients studied had obesity and a hemoglobin A_1c greater than 7%.³

In the current review, investigators used data from 25,847 patients from the National Health and Nutrition Examination survey from 2008 to 2023. Approximately 49% of patients were female and the median age was 10 years. Approximately 20.3% were Mexican American, 23.9% were nonHispanic Black, 30%,were nonHispanic White, 11% were other Hispanic, and 14.6% were from other racial backgrounds, according to the study investigators. The median body mass index was 18.4.¹

The prevalence of obesity increased from 19.46% in 2008 to 22.52% in 2024, with rates of obesity class 2 or higher increasing from 5.73% to 8.28%, obesity class 3 or higher increasing from 1.58% to 2.98%, and obesity class 4 to 5 increasing from 0.32% and 1.13%, respectively. The study authors found that the relative increases were 15.7% for any obesity, 44.5% for obesity class 2 or higher, 88.6% for obesity class 3 or higher, and 253.1% for obesity class 4 to 5. Further, they find that the prevalence of classes 4 to 5 increased steadily among adolescents aged 16 to 18 years. When stratified for race, there were no significant correlations, but investigators found that nonHispanic Black patients did have the highest prevalence of classes 4 to 5 obesity from 2020 to 2023.¹

The results showed extremely severe obesity was associated with a higher prevalence of MASLD at 84.62% compared with 44.48% in classes 1 to 3 and 2.8% without obesity. For prediabetes and type 2 diabetes, the prevalence was 46.77% among classes 4 and 5 compared with 15.10% and 5.99% for classes 1 through 3 or without obesity, respectively. However, there was no difference for fasting glucose levels, but patients with obesity classes 4 to 5 did have higher median fasting insulin levels.¹

“The findings of this study with over 25,800 participants provide robust evidence supporting extremely severe obesity specifically as a public health emergency,” the study authors wrote. “The association with metabolic and cardiovascular complications necessitates urgent public health action, such as early prevention, targeted education, and the mobilization of resources.”

READ MORE: Obesity Management Resource Center

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REFERENCES

1. Münte E, Zhang X, Khurana A, Hartmann P. Prevalence of Extremely Severe Obesity and Metabolic Dysfunction Among US Children and Adolescents. JAMA Netw Open. 2025;8(7):e2521170. doi:10.1001/jamanetworkopen.2025.21170

2. Dellabella H. Obesity in Adolescents: Prevalence, Health Effects, and Treatment Options. Drug Topics. January 30, 2025. Accessed July 21, 2025. https://www.drugtopics.com/view/obesity-in-adolescents-prevalence-health-effects-and-treatment-options

3. Meara K. GLP-1 Use Increased Significantly Among Pediatric Patients With T2D in Past 5 Years | ADA 2025. Drug Topics. June 25, 2025. Accessed July 21, 2025. https://www.drugtopics.com/view/glp-1-use-increased-significantly-among-pediatric-patients-with-t2d-in-past-5-years-ada-2025