Obese Children, Obese Adults: A Troubling Trajectory

By Hannah Stuart
Sunday, July 1, 2018

New research supports the view that obesity in early childhood is a predictor of adult obesity.

Since the 1970s, the incidence of childhood obesity in the United States has more than tripled, with nearly 20 percent of children ages 6 to 19 currently considered obese. Researchers with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project at Harvard University created a simulation model to examine the likelihood of those children remaining obese as adults.

“We pooled five nationally representative data sets that have repeated measures of height and weight for about 40,000 children and adults,” says Zach Ward, MPH, lead author of the study, “Simulation of Growth Trajectories of Childhood Obesity into Adulthood,” which appeared in The New England Journal of Medicine. “In the U.S., we don’t really have a lot of data following kids for a long period of time, so to be able to predict future risks of obesity, ... we needed a new method.”

Ward and his colleagues used quantile regression to update the data, as it was gathered in the 1970s and 1980s and thus doesn’t account for trends in weight gain since then.

Based on their modeling, the team estimates that by age 35:

  • 59 percent of today’s toddlers will be obese
  • 57 percent of all children ages 2 to 19 will be obese
  • 79 percent of 2-year-olds with severe obesity will still be severely obese
  • 94 percent of 19-year-olds with severe obesity will still be severely obese

A Call for Intervention

Ward and his colleagues hope their findings prompt early, school-based interventions, such as healthy meals and screen-time regulation, as well as public-policy changes, such as taxes on high-sugar beverages. They also want to see robust intervention by parents and pediatricians. Given the effect of racial/ethnic and socioeconomic factors on obesity, Ward notes, any solution requires a multipronged approach.

Christopher Bolling, MD, FAAP, Chair for the Section on Obesity at the American Academy of Pediatrics, agrees.

“Nobody can really eat healthy if the family doesn’t have healthy food around — you can’t expect a small child to do this in a vacuum,” Dr. Bolling says. “But then also we need to be paying attention to what’s happening in childcare facilities. We need to be helping schools. We have to do things in communities that make physical activity more accessible.”

It is crucial that pediatricians promote healthy nutrition and activity, Dr. Bolling says, but it is also essential that they partner with patients and their parents when they are ready to make those changes.

No single approach will succeed everywhere, Ward adds.

“We’re working with different local policymakers — so different states and cities — to model ... cost-effective strategies based on their local context,” he says. “States and cities have a big part to play, and they can experiment with ... interventions that might be better for their population.”