Article | Published:

Epidemiology and Population Health

Severe obesity and cardio-metabolic comorbidities: a nationwide study of 2.8 million adolescents

International Journal of Obesity (2018) | Download Citation

Abstract

Background

Severe obesity is rising among adolescents, but data on the prevalence of metabolic abnormalities among this group are limited. We assessed the secular trend of severe obesity and its association with major cardio-metabolic morbidities.

Methods

A total of 2,785,227 Israeli adolescents (aged 17.2 ± 0.5 years) who underwent a pre-recruitment medical examination including routine measurements of weight, height and blood pressure between 1967 and 2015 were included. In all, 230,639 adolescents with abnormally excessive BMI were classified into overweight, classes I, II, and III (severe) obesity. Logistic regression was applied to determine the association between BMI groups and prehypertension, high blood pressure and type 2 diabetes (T2DM).

Results

There was 45-fold increase in the prevalence of class III obesity during study period. Severe obesity was recorded in 2060 males and 1149 females, in whom nearly 35 and 43% had prehypertension or high blood pressure, respectively. Compared with adolescents with overweight, the odds ratios (ORs) for high blood pressure in classes II and III obesity groups, respectively, were 2.13 (95% CI, 2.04–2.23) and 2.86 (2.60–3.15) in males, and 2.59 (2.43–2.76) and 3.44 (3.04–3.90) in females, whereas the ORs for T2DM were 19.1 (12.3–29.6) and 38.0 (22.6–64.0) in males, and 15.1 (11.4–20.0) and 24.8 (17.2–35.7) in females. Results persisted in extensive sensitivity analyses including a longitudinal follow-up (median: males, 3.4 years; females, 4.9 years).

Conclusions

Severe obesity showed a marked secular increase and was associated with significantly higher risk for abnormal blood pressure and T2DM than lower degrees of obesity, in both males and females.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018;141:e20173459.

  2. 2.

    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;219:1–8.

  3. 3.

    Rokholm B, Baker JL, Sorensen TI. The levelling off of the obesity epidemic since the year 1999--a review of evidence and perspectives. Obes Rev. 2010;11:835–46.

  4. 4.

    Mayor S. Over a third of children aged 10-11 in England are overweight or obese. BMJ. 2016;355:i5948.

  5. 5.

    Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128:1689–712.

  6. 6.

    Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315:2292–9.

  7. 7.

    Neovius M, Teixeira-Pinto A, Rasmussen F. Shift in the composition of obesity in young adult men in Sweden over a third of a century. Int J Obes. 2008;32:832–6.

  8. 8.

    van Dommelen P, Schönbeck Y, van Buuren S, HiraSing RA. Trends in a life threatening condition: morbid obesity in dutch, Turkish and Moroccan children in the Netherlands. PLoS ONE. 2014;9:e94299.

  9. 9.

    Twig G, Kark JD. Body-mass index in adolescence and cardiovascular death in adulthood. N Engl J Med. 2016;375:1300–1.

  10. 10.

    Twig G, Yaniv G, Levine H, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;374:2430–40.

  11. 11.

    Tirosh A, Shai I, Afek A, et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011;364:1315–25.

  12. 12.

    Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med. 2015;373:1307–17.

  13. 13.

    van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Arch Dis Child. 2012;97:818–21.

  14. 14.

    Zhang YX, Wang SR, Li SY. Prevalence of severe obesity and its association with elevated blood pressure among children and adolescents in Shandong, China. Blood Press Monit. 2017;22:345–50.

  15. 15.

    Lo JC, Chandra M, Sinaiko A, et al. Severe obesity in children: prevalence, persistence and relation to hypertension. Int J Pediatr Endocrinol. 2014;2014:3.

  16. 16.

    Pinhas-Hamiel O, Reichman B, Shina A, et al. Sex differences in the impact of thinness, overweight, obesity, and parental height on adolescent height. J Adolesc Health. 2017;61:233–9.

  17. 17.

    Goldstein A, Haelyon U, Krolik E, Sack J. Comparison of body weight and height of Israeli schoolchildren with the Tanner and Centers for Disease Control and Prevention growth charts. Pediatrics. 2001;108:E108.

  18. 18.

    Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat. 2002;246:1–190.

  19. 19.

    Statistics ICBo. Characterization and classification of local aurhorities by the socioeconomic level of the population.. Jerusalem, Israel: Central Bureau of Statistics; 2006.

  20. 20.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–76.

  21. 21.

    American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.

  22. 22.

    Wareham NJ, O’Rahilly S. The changing classification and diagnosis of diabetes. New classification is based on pathogenesis, not insulin dependence. BMJ. 1998;317:359–60.

  23. 23.

    Kral JG, Kava RA, Catalano PM, Moore BJ. Severe obesity: the neglected epidemic. Obes Facts. 2012;5:254–69.

  24. 24.

    Rozin O. Food, identity, and nation-building in Israel’s formative years. Isr Stud Forum. 2006;21:52–80.

  25. 25.

    Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288:1728–32.

  26. 26.

    Katz E, Haas H, Gurevitch M. 20 years of television in Israel: are there long-run effects on values, social connectedness, and cultural practices? J Commun. 1997;47:3–20.

  27. 27.

    McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150:640–4.

  28. 28.

    Redwine KM, Daniels SR. Pre-hypertension in adolescents: risk and progression. J Clin Hypertens (Greenwich, Conn). 2012;14:360–64.

  29. 29.

    Tirosh A, Afek A, Rudich A, et al. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension. 2010;56:203–9.

  30. 30.

    Leiba A, Twig G, Vivante A, et al. Prehypertension among 2.19 million adolescents and future risk for end-stage renal disease. J Hypertens. 2017;35:1290–6.

  31. 31.

    Shah AS, Dolan LM, Khoury PR, Gao Z, Kimball TR, Urbina EM. Severe obesity in adolescents and young adults is associated with subclinical cardiac and vascular changes. J Clin Endocrinol Metab. 2015;100:2751–7.

  32. 32.

    John VN, Jessica MR, Kevin LH, et al. Severe obesity and high blood pressure among children, Philadelphia Health Centers, 2010. J Prim Care Commun Health. 2013;5:152–5.

  33. 33.

    Propst M, Colvin C, Griffin RL, et al. Diabetes and prediabetes are significantly higher in morbidly obese children compared with obese children. Endocr Pract. 2015;21:1046–53.

  34. 34.

    Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG. Prevalence and determinants of insulin resistance among U.S. adolescents. A population-based study. Diabetes Care. 2006;29:2427–32.

  35. 35.

    Keith SW, Fontaine KR, Pajewski NM, Mehta T, Allison DB. Use of self-reported height and weight biases the body mass index-mortality association. Int J Obes (Lond). 2011;35:401–8.

Download references

Acknowledgements

This work is dedicated to Prof Jeremy D Kark, an outstanding scientist and mentor who has made an immense contribution to epidemiology in Israel and has passed away during the preparation of this work.

Author contributions

GT, OP-H: study concept and design, acquisition and interpretation of data, statistical analyses, and drafting and critical revision of the manuscript; ED: data file management and statistical analysis; BR: interpretation of data, drafting the manuscript. TC-Y: statistical analysis, critical revision of the manuscript. AA, UH, AF, LG, TB, JDK: interpretation of data, critical revision of the manuscript. GT takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Affiliations

  1. Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel

    • Gilad Twig
    • , Estela Derazne
    • , Ariel Furer
    • , Liron Gershovitz
    •  & Tarif Bader
  2. Department of Medicine and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel

    • Gilad Twig
  3. Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel

    • Gilad Twig
    • , Brian Reichman
    • , Arnon Afek
    • , Estela Derazne
    • , Uri Hamiel
    • , Tali Cukierman-Yaffe
    •  & Orit Pinhas-Hamiel
  4. The Women and Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel

    • Brian Reichman
  5. Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel

    • Arnon Afek
  6. Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel

    • Uri Hamiel
  7. Department of Military Medicine, Hebrew University, Jerusalem, Israel

    • Tarif Bader
  8. Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel

    • Tali Cukierman-Yaffe
  9. Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel

    • Jeremy D. Kark
  10. Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel

    • Orit Pinhas-Hamiel

Authors

  1. Search for Gilad Twig in:

  2. Search for Brian Reichman in:

  3. Search for Arnon Afek in:

  4. Search for Estela Derazne in:

  5. Search for Uri Hamiel in:

  6. Search for Ariel Furer in:

  7. Search for Liron Gershovitz in:

  8. Search for Tarif Bader in:

  9. Search for Tali Cukierman-Yaffe in:

  10. Search for Jeremy D. Kark in:

  11. Search for Orit Pinhas-Hamiel in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Gilad Twig.

Electronic supplementary material

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/s41366-018-0213-z