575 - High-Risk Obesity, Diabetes, Blood Pressure, and Cholesterol Among U.S. Children and Adolescents

Publication Number: 4563.575

Julia Viveiros, University of Connecticut, Somerset, MA, United States; Sharon Smith, University of Connecticut School of Medicine, Hartford, CT, United States

Background: Childhood obesity poses a growing threat to pediatric health. Obesity in children is linked to metabolic complications including type 2 diabetes (T2D), hypertension, and dyslipidemia. Prior research established independent associations between obesity and comorbidities, but few studies have examined all three concurrently.

Objective: To evaluate the associations between obesity and three major comorbidities (diabetes, hypertension, and dyslipidemia) among U.S. children and adolescents from 2013–2023.

Design/Methods: This retrospective cohort study utilized data from the National Health and Nutrition Examination Survey from 2013–2023. Participants aged 2–19 years were categorized by BMI as normal weight (15th–84th percentile), overweight (85th–94th percentile), or obese (≥95th percentile). Diabetes status was based on parent-reported physician diagnosis; children using insulin were excluded to approximate type 2 diabetes. Hypertension was defined as systolic blood pressure ≥130 mmHg (available for ages ≥8 years). Dyslipidemia was defined as total cholesterol ≥200 mg/dL (available for ages ≥6 years). Demographic variables included age group, gender, and race/ethnicity. Associations between obesity and each comorbidity were evaluated using Chi-square tests of independence with odds ratios (OR) and relative risks (RR).

Results: Participants categorized as obese had significantly higher prevalence and RR for all three comorbidities compared to non-obese participants (Fig 1). Diabetes: 0.71% of participants categorized as obese had diabetes vs. 0.31% of non-obese (p < 0.01); Likely type 2 diabetes: 0.57% of obese vs. 0.28% of non-obese (p = 0.02); Hypertension: 3.38% of obese vs. 1.03% of non-obese (p < 0.01); High cholesterol: 10.46% of obese vs. 6.01% of non-obese (p < 0.01). Participants categorized as obese had highest risk for comorbidities: RR = 2.3 for diabetes (p < 0.01), 2.1 for likely type 2 diabetes (p = 0.02), 3.5 for hypertension (p < 0.01), and 1.9 for high cholesterol (p < 0.01).
Obesity was most common among Hispanic, non-Hispanic Black versus White (p < 0.01), and adolescents (13–19 years) versus younger (p < 0.01).

Conclusion(s): This study demonstrates strong positive associations between childhood obesity and major metabolic comorbidities, including diabetes, hypertension, and dyslipidemia, among U.S. children and adolescents from 2013–2023. Youth categorized as obese exhibited the highest prevalence and risk across all measured outcomes, particularly for hypertension and dyslipidemia.

Contingency Tables
Figure 1.jpeg

Comorbidity Comparisons Across Weight Categories
Figure 2.jpeg