Obesity in Young People: Which Chronic Diseases Does It Cause?

Weight Status Among US Youth (NHANES 2013–2023)

These rates make population-level effects (PAF) particularly relevant for the conditions studied.

What Is PAF (Population Attributable Fraction)?

For a risk factor (e.g., obesity), it indicates the adverse outcome proportion in the population attributable to that factor. If PAF = 40%, approximately 40% of cases could theoretically be prevented by removing it.

Findings: “Much Early Chronic Disease Is Attributable to Obesity”

Note: Being overweight (overweight) had weaker associations than obesity.

How Was the Study Conducted?

• Design: Cross-sectional; pooled NHANES 2013–2023.
• Participants: 4,199 adolescents, 3,200 young adults, weighted to represent the US population.
• Conditions: Prediabetes, Type 2 DM, hypertension, dyslipidemia, asthma, obstructive sleep apnea (young adults only), fatty liver, stress urinary incontinence (young adults only), renal hyperfiltration.
• Analysis: Adjusted for age, sex, NHANES cycle, insurance and regular healthcare access, logistic regressionwas used to estimate obesity and overweight PAF .

Clinical and Policy Implications

• Early intervention ≈ high returns: Effective, sustained early obesity treatment may improve hypertension, dyslipidemia, fatty liver and impaired glycemia, increasing the likelihood of improvement/remission of comorbidities .
• “Treat Obesity First”: Antihypertensives, statins and other drugs may be needed, but targeting obesity reduces the underlying driver .
• Policy planning: PAFs help model population effects of behavioral, pharmacological (e.g., GLP-1 RAs) and surgical interventions.
• Inequality: Access, cost and sustainability require, for young people, multidisciplinary care and long-term follow-up .

Study Limitations

• Cross-sectional design: Cannot establish causality; temporal order may be unclear (hypertension → obesity or vice versa).
• Few events: Particularly for adolescent Type 2 DM PAF estimates, wide CIsmean high uncertainty.
• Heterogeneity across consecutive NHANES cycles and self-report may bias some variables.

Expert Emphasis

• A. Chetty (author): “We show that, in this young population, a substantial proportion of chronic disease is attributable to obesity; prevention and treatment are critical.”
• A. Kelly (independent expert): “Treating obesity adequately, successfully and sustainably may lead many comorbidities toward improvement/remission .”

Practical Implications (Clinicians & Policymakers)

1. Early screening and surveillance: BMI, waist circumference and screening for hypertension, dyslipidemia, impaired glycemia and fatty liver in adolescents/young adults.
2. Stepped care: Lifestyle interventions +, in appropriate patients, pharmacotherapy (GLP-1 RAs, etc.) + in selected cases, metabolic surgery.
3. Continuity of care: Multicomponent family, school and community programs, with access and reimbursement as priorities.
4. Reframing comorbidities: Continue hypertension/dyslipidemia management while “treating obesity first” to address the root cause.

About the Article

• Journal: JAMA Pediatrics • Published: August 25, 2025 (online) • Volume/Issue: 179(10):1123–1126 • DOI: 10.1001/jamapediatrics.2025.2716
• Design: Cross-sectional; NHANES 2013–2023; logistic regression adjusted for age/sex/insurance/regular care.
• Sample: 4,199 adolescents, 3,200 young adults; US population-representative weighting.
• Main measure: Obesity- and overweight-attributable PAF.

Final Thoughts

The data indicate that much early cardiometabolic disease is associated with obesity . Clinical decisions and public policy should therefore refocus on obesity prevention and effective treatment . Longitudinal studies are still needed to establish causality, but high PAFs tell us that: “Early, effective intervention may reduce the future burden of severe disease.”