Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Prediction of adult class II/III obesity from childhood BMI: the i3C consortium


Background and objectives

Adult class II/III obesity (BMI ≥ 35 kg/m2) has significant adverse health outcomes. Early prevention and treatment are critical, but prospective childhood risk estimates are lacking. This study aimed to define the prospective risk of adult class II/III obesity, using childhood BMI.


Children ages 3–19 years enrolled in cohorts of the International Childhood Cardiovascular Cohort (i3C) consortium with measured BMI assessments in childhood and adulthood were included. Prospective risk of adult class II/III obesity was modeled based on childhood age, sex, race, and BMI.


A total of 12,142 individuals (44% male, 85% white) were assessed at median age 14 [Interquartile range, IQR: 11, 16] and 33 [28, 39] years. Class II/III adult obesity developed in 6% of children with normal weight; 29% of children with overweight; 56% of children with obesity; and 80% of children with severe obesity. However, 38% of the 1440 adults with class II/III obesity (553/1440) were normal weight as children. Prospective risk of adult class II/III obesity varied by age, sex, and race within childhood weight status classifications, and is notably higher for girls, black participants, and those in the United States. The risk of class II/III obesity increased with older adult age.


Children with obesity or severe obesity have a substantial risk of adult class II/III obesity, and observed prospective risk estimates are now presented by age, sex, race, and childhood BMI. Clinical monitoring of children’s BMI for adult class II/III obesity risk may be especially important for females and black Americans.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2


  1. 1.

    Global Burden of Disease 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.

    Article  Google Scholar 

  2. 2.

    Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82.

    CAS  Article  Google Scholar 

  3. 3.

    Gadde KM, Martin CK, Berthoud HR, Heymsfield SB. Obesity: Pathophysiology and Management. J Am Coll Cardiol. 2018;71:69–84.

    Article  Google Scholar 

  4. 4.

    Backholer K, Wong E, Freak-Poli R, Walls HL, Peeters A. Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis. Obes Rev. 2012;13:456–68.

    CAS  Article  Google Scholar 

  5. 5.

    Finkelstein EA, Ostbye T, Malhotra R. Body mass trajectories through midlife among adults with class I obesity. Surg Obes Relat Dis. 2013;9:547–53 e1.

    Article  Google Scholar 

  6. 6.

    Wong ES, Wang BC, Alfonso-Cristancho R, Flum DR, Sullivan SD, Garrison LP, et al. BMI trajectories among the severely obese: results from an electronic medical record population. Obesity. 2012;20:2107–12.

    Article  Google Scholar 

  7. 7.

    Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015;105:e54–9.

    Article  Google Scholar 

  8. 8.

    Gero D, Favre L, Allemann P, Fournier P, Demartines N, Suter M. Laparoscopic Roux-En-Y gastric bypass improves lipid profile and decreases cardiovascular risk: a 5-year longitudinal cohort study of 1048 patients. Obes Surg. 2018;28:805–811.

    Article  Google Scholar 

  9. 9.

    Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5:165–73.

    Article  Google Scholar 

  10. 10.

    Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G. et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol. 2017;5:174–83.

    Article  Google Scholar 

  11. 11.

    Goodman E, Dolan LM, Morrison JA, Daniels SR. Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation. 2005;111:1970–7.

    Article  Google Scholar 

  12. 12.

    Freedman DS, Dietz WH, Tang R, Mensah GA, Bond MG, Urbina EM, et al. The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study. Int J Obes Relat Metab Disord. 2004;28:159–66.

    CAS  Article  Google Scholar 

  13. 13.

    Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. Racial differences in the tracking of childhood BMI to adulthood. Obes Res. 2005;13:928–35.

    Article  Google Scholar 

  14. 14.

    Bayer O, Kruger H, von Kries R, Toschke AM. Factors associated with tracking of BMI: a meta-regression analysis on BMI tracking. Obesity. 2011;19:1069–76.

    Article  Google Scholar 

  15. 15.

    Abdullah A, Wolfe R, Stoelwinder JU, de Courten M, Stevenson C, Walls HL, et al. The number of years lived with obesity and the risk of all-cause and cause-specific mortality. Int J Epidemiol. 2011;40:985–96.

    Article  Google Scholar 

  16. 16.

    Everhart JE, Pettitt DJ, Bennett PH, Knowler WC. Duration of obesity increases the incidence of NIDDM. Diabetes. 1992;41:235–40.

    CAS  Article  Google Scholar 

  17. 17.

    Dwyer T, Sun C, Magnussen CG, Raitakari OT, Schork NJ, Venn A, et al. Cohort profile: the international childhood cardiovascular cohort (i3C) consortium. Int J Epidemiol. 2013;42:86–96.

    Article  Google Scholar 

  18. 18.

    Sinaiko AR, Jacobs DR Jr., Woo JG, Bazzano L, Burns T, Hu T, et al. The international childhood cardiovascular cohort (i3C) consortium outcomes study of childhood cardiovascular risk factors and adult cardiovascular morbidity and mortality: Design and recruitment. Contemp Clin Trials. 2018;69:55–64.

  19. 19.

    Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr obesity. 2012;7:284–94.

    CAS  Article  Google Scholar 

  20. 20.

    Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, Gortmaker SL. Simulation of growth trajectories of childhood obesity into adulthood. N Engl J Med. 2017;377:2145–53.

    Article  Google Scholar 

  21. 21.

    Venn AJ, Thomson RJ, Schmidt MD, Cleland VJ, Curry BA, Gennat HC, et al. Overweight and obesity from childhood to adulthood: a follow-up of participants in the 1985 Australian Schools Health and Fitness Survey. Med J Aust. 2007;186:458–60.

    Article  Google Scholar 

  22. 22.

    Crerand CE, Wadden TA, Sarwer DB, Fabricatore AN, Kuehnel RH, Gibbons LM, et al. A comparison of weight histories in women with class III vs. class I-II obesity. Surg Obes Relat Dis. 2006;2:165–70.

    Article  Google Scholar 

  23. 23.

    O’Connell J, Kieran P, Gorman K, Ahern T, Cawood TJ, O’Shea D. BMI > or = 50 kg/m2 is associated with a younger age of onset of overweight and a high prevalence of adverse metabolic profiles. Public Health Nutr. 2010;13:1090–8.

    Article  Google Scholar 

  24. 24.

    Richardson AS, Dietz WH, Gordon-Larsen P. The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the National Longitudinal Study of Adolescent Health. Pediatr Obes. 2014;9:351–61.

    CAS  Article  Google Scholar 

  25. 25.

    Glueck CJ, Morrison JA, Daniels S, Wang P, Stroop D. Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years. J Pediatr. 2011;159:308–13 e2.

    Article  Google Scholar 

  26. 26.

    Salahuddin M, Perez A, Ranjit N, Hoelscher DM, Kelder SH. The effect of prenatal maternal cigarette smoking on children’s BMI z-score with SGA as a mediator. Int J Obes. 2018;42:1008–18.

    CAS  Article  Google Scholar 

  27. 27.

    Salahuddin M, Perez A, Ranjit N, Kelder SH, Barlow SE, Pont SJ, et al. Predictors of severe obesity in low-income, predominantly hispanic/latino children: the Texas Childhood Obesity Research Demonstration Study. Prev Chronic Dis. 2017;14:E141.

    Article  Google Scholar 

  28. 28.

    Salahuddin M, Perez A, Ranjit N, Hoelscher DM, Kelder SH. The associations of large-for-gestational-age and infant feeding practices with children’s body mass index z-score trajectories: the early childhood longitudinal study, birth cohort. Clin Obes. 2017;7:307–15.

    CAS  Article  Google Scholar 

  29. 29.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA. 2012;307:483–90.

    Article  Google Scholar 

Download references


Funded by the National Institutes of Health, National Heart, Lung and Blood Institute, grant number R01 HL121230.

Author information




JGW conceptualized and designed the study and analysis, contributed to the interpretation of data, drafted the initial manuscript, and revised the manuscript for important intellectual content. NZ and MF carried out the analyses, contributed to drafting the initial manuscript, and revised the manuscript for important intellectual content. DRJ, TH, and JRR made substantial contributions to the analysis and interpretation of data, and revised the manuscript for important intellectual content. OR, TD, and AS contributed to the acquisition and interpretation of data, and revised the manuscript for important intellectual content. JS, EMU, TLB, LB, and SRD coordinated and supervised data collection and reviewed and revised the manuscript. RJP, CJ, and MJ contributed to the interpretation of data and reviewed and revised the manuscript. AV conceptualized the study, coordinated, and supervised data collection, contributed to the interpretation of the data, and critically revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jessica G. Woo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Woo, J.G., Zhang, N., Fenchel, M. et al. Prediction of adult class II/III obesity from childhood BMI: the i3C consortium. Int J Obes 44, 1164–1172 (2020).

Download citation

Further reading


Quick links