Prevalence of Preclinical and Clinical Obesity Among US Children and Adolescents Aged 5 to 18 Years: NHANES 2017-2023.
Level 4 - case-series / case-control
Cross-sectional epidemiological survey analysis
PubMed 42002413 · doi:10.1002/oby.70198
What was done
Researchers evaluated the prevalence of preclinical versus clinical pediatric obesity using the Lancet Diabetes & Endocrinology Commission staging framework in a cross-sectional sample of 5,513 US children and adolescents aged 5 to 18 years from NHANES (2017–2023). Participants were classified into: no obesity (BMI < 95th percentile and/or waist-to-height ratio [WHtR] < 0.5), preclinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 without clinical impairment or functional limitation), and clinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 with at least one clinical impairment or functional limitation).
What was found
The weighted prevalence was 8.3% for preclinical obesity and 12.5% for clinical obesity, yielding a combined prevalence of 20.8% (comparable to ~22% when using standard BMI percentiles alone). Clinical obesity was more prevalent in older youth and racial/ethnic minority groups, with no difference by sex. Among youth with clinical obesity, the most frequent impairments were low HDL cholesterol (60.3%), asthma (24.8%), early menarche in girls (18.0%), elevated blood pressure (16.2%), prediabetes or diabetes (9.1%), walking limitations (7.7%), and self-care limitations (4.1%).
Why it matters
Classifying pediatric obesity beyond BMI alone reveals that over half of youth meeting obesity thresholds already display measurable metabolic, physiological, or functional dysfunction. This staging approach helps differentiate children who require immediate clinical intervention from those needing preventive management.
Limits
The study is cross-sectional, precluding longitudinal causal assessment of when preclinical obesity progresses to clinical dysfunction. Staging relied on routinely collected NHANES variables, which may not capture the complete spectrum of clinical and functional impairments defined by the consensus framework.
Cited by
- partial Approximately 40% of children in the United States are overweight.