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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



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.


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).


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).


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.

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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


  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


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The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Gilad Twig.

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