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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.

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

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Authors and Affiliations



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.

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Correspondence to Jessica G. Woo.

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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).

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