Pediatric obesity remission linked to better cardiovascular outcomes in adulthood

Key takeaways:

• Good response to obesity treatment or achieving remission reduced the risk for cardiovascular outcomes.
• Obesity treatment response did not affect the odds of developing anxiety, depression or fractures.

Achieving obesity remission reduced children’s and teens’ risk for developing type 2 diabetes, hypertension and dyslipidemia in adulthood, according to findings from a study published in JAMA Pediatrics.

“Beneficial response to behavioral lifestyle obesity treatments in children and adolescents improves short- and long-term health,” Resthie R. Putri, MD, PhD, a postdoctoral researcher in the department of medical epidemiology and biostatistics at Karolinska Institutet in Solna, Sweden, and colleagues wrote. “However, the extent of weight loss necessary to mitigate, or even eliminate, long-term obesity-related outcomes remains to be determined.”

Putri and colleagues conducted a prospective cohort study of 6,713 children and adolescents (56.3% boys; median age, 12.1 years; interquartile range [IQR], 10.1-14.3 years) who underwent obesity treatment in Sweden for at least 1 year between 1996 and 2019. They matched each participant to five members of the general population (n = 32,402) to compare the prevalence of cardiovascular outcomes, like type 2 diabetes, hypertension and dyslipidemia in adulthood. The researchers followed up until the participants turned 30 or Dec. 31, 2020.

At baseline, the median BMI standard deviation score was 2.82 (IQR, 2.56-3.14). After a median treatment duration of 3 years (IQR, 1.8-4.9), 22.4% of youth achieved obesity remission; 15.9% had a good response to treatment, meaning they lost 5% or more of their BMI; 18.2% of youth had a poor response, meaning their BMI increased by 5% or more; and 43.4% had an intermediate response with a BMI increase or decrease of less than 5%.

The incidence of type 2 diabetes, hypertension, dyslipidemia, weight loss bariatric surgery, depression and anxiety were lowest among the general population, Putri and colleagues reported. Outcomes occurred less frequently among participants who achieved obesity remission or had a good response to obesity treatment, whereas those with a poor response experienced the highest incidence.

Compared with the poor response group, participants in the obesity remission (adjusted HR = 0.16; 95% CI, 0.07-0.35), good response (aHR = 0.42; 95% CI, 0.23-0.77) and intermediate response (aHR = 0.55; 95% CI, 0.36-0.85) groups were less likely to be diagnosed with type 2 diabetes as adults.

Additionally, participants in the remission (aHR = 0.14; 95% CI, 0.08-0.25), good response (aHR = 0.42; 95% CI, 0.3-0.58) and intermediate response (aHR = 0.49; 95% CI, 0.3-0.63) groups experienced reduced risk for bariatric surgery compared with the poor response group.

Obesity remission reduced participants’ risk for developing hypertension and dyslipidemia compared with the poor response group (aHR = 0.4; 95% CI, 0.24-0.65, and aHR = 0.22; 95% CI, 0.09-0.57, respectively), and participants who had a good response to treatment also were less likely to be diagnosed with dyslipidemia (aHR = 0.31; 95% CI, 0.13-0.75).

At follow-up, 21 participants had died. Compared with the poor response group, those in the intermediate response group were less likely to experience premature mortality (aHR = 0.3; 95% CI, 0.11-0.78), as well as the good response and obesity remission groups combined (aHR = 0.12; 95% CI, 0.03-0.46).

The researchers that obesity treatment response did not affect the risk for depression, anxiety or fractures.

“While this is an exemplary study with wide-ranging implications, there are limitations to consider, some of which may be available in their data but not presented,” Leonard H. Epstein, PhD, SUNY Distinguished Professor and division chief of behavioral medicine at the University of Buffalo Jacobs School of Medicine and Biosciences in Buffalo, New York, and colleagues wrote in a related editorial. “The authors did not provide data on the type of treatment, which is important since different types of treatment can have different effects on treatment outcome.”

They noted that the AAP recommends intensive treatment over the course of 3 months to 1 year, which is much shorter than the 3-year median duration of treatment among participants in the study. This makes it difficult to compare the results to U.S. studies, Epstein and colleagues wrote.

References:

• Epstein LH, et al. JAMA Pediatr. 2025;doi:10.1001/jamapediatrics.2024.5559.
• Putri RR, et al. JAMA Pediatr. 2025;doi:10.1001/jamapediatrics.2024.5552.