Obesity contributes substantially to chronic conditions in US adolescents and young adults

Obesity contributes substantially to chronic conditions in US adolescents and young adults | Image Credit: © 9dreamstudio - stock.adobe.com.

The prevalence of obesity among adolescents and young adults in the United States continues to rise, accompanied by increases in obesity-related conditions (ORCs). A new study published in JAMA Pediatrics evaluated the extent to which obesity and overweight contribute to the burden of ORCs in youth and found that obesity accounted for a substantial proportion of several chronic health conditions in this population.

Investigators conducted a cross-sectional analysis of pooled data from the 2013 to 2023 National Health and Nutrition Examination Survey (NHANES). The study population included 4199 adolescents aged 12 to 17 years and 3200 young adults aged 18 to 25 years, representing nearly 56 million individuals nationwide. Participants who were pregnant or underweight were excluded.

Body mass index (BMI) categories were defined according to clinical standards: normal weight, overweight, and obesity. Obesity-related conditions were identified based on consensus clinical definitions and the availability of NHANES data. Conditions included prediabetes, type 2 diabetes, hypertension, dyslipidemia, asthma, stress urinary incontinence, liver steatosis, kidney hyperfiltration, and probable obstructive sleep apnea.

Relative risks for each condition were calculated by comparing participants with obesity and with overweight to those with normal BMI, adjusting for age, sex, insurance status, health care access, and NHANES cycle. Population attributable fractions (PAFs) were then estimated to determine the proportion of each condition attributable to obesity or overweight.

Results

Among adolescents, 18.7% had overweight and 22.3% had obesity. Among young adults, 25.8% had overweight and 29.7% had obesity. Prevalence of obesity-related conditions varied, ranging from 0.3% for type 2 diabetes in adolescents to 36.4% for liver steatosis in young adults.

Obesity was associated with a significant proportion of disease burden. Among adolescents, 6 of 7 measured conditions had statistically significant PAFs attributable to obesity, ranging from 10.2% for asthma to 49.6% for liver steatosis. Among young adults, 8 of 9 conditions showed significant obesity-attributable fractions, from 10.4% for asthma to 78.9% for type 2 diabetes.

Overweight contributed less to overall disease burden but remained notable. In adolescents, statistically significant PAFs due to overweight ranged from 6.2% for asthma to 13.1% for liver steatosis. In young adults, overweight contributed to 10.0% of hypertension cases and 21.0% of liver steatosis cases.

The study authors wrote, “Large portions of ORCs in US adolescents and young adults may be attributable to obesity and, to a lesser extent, overweight”.

Implications

The findings highlight the significant impact of obesity on early-onset chronic disease. The authors noted that ORCs during youth increase the risk of more severe disease in adulthood and that treatment and prevention of obesity may mitigate future morbidity and health care costs. “These PAFs can inform estimates of the potential impact of expanding access to behavioral, surgical, and pharmacotherapeutic interventions, including glucagon-like peptide-1 receptor agonists, on reducing ORCs in US youth,” they stated.

The analysis was limited by its cross-sectional design, which assumed causality between obesity and ORCs. Self-reported data introduced potential recall bias, and misclassification of diabetes subtype could not be excluded. Additionally, the study acknowledged the possibility of confounding by independent precursors of both obesity and obesity-related conditions.

Conclusion

Obesity remains a major contributor to chronic disease burden among adolescents and young adults in the US. While overweight status also contributes, obesity accounted for much larger fractions of conditions such as liver steatosis, hypertension, and type 2 diabetes. The authors emphasized that addressing obesity early in life through prevention and treatment may help reduce the long-term health and economic consequences of these conditions.

Reference:

Chetty AK, Chen AS, Hajduk AM, Sharifi M, Nugent JT. Proportion of Obesity-Related Conditions Attributable to Obesity and Overweight in US Youth. JAMA Pediatrics. Published online August 25, 2025. doi:https://doi.org/10.1001/jamapediatrics.2025.2716