Nearly All US Youth With BMI-Defined Obesity Have Excess Adiposity – The American Journal of Managed Care® (AJMC®)

Report on Youth Obesity and its Implications for Sustainable Development Goals

Introduction: Aligning Public Health Research with Global Development Targets

A recent study published in JAMA Pediatrics provides critical data on the prevalence of obesity among youth in the United States, offering insights that directly impact the achievement of the United Nations Sustainable Development Goals (SDGs). The research evaluates the correlation between Body Mass Index-defined obesity (BDO) and obesity confirmed by excess adiposity, known as commission-defined obesity (CDO). These findings are paramount for shaping public health strategies aligned with SDG 3 (Good Health and Well-being), which aims to combat non-communicable diseases, and SDG 10 (Reduced Inequalities) by examining health outcomes across diverse populations.

Key Findings: A Public Health Challenge to SDG 3

The study’s primary conclusion is that BDO is a highly reliable indicator of excess adiposity in US youth aged 8 to 19. This challenges the necessity of additional complex measurements for diagnosis in this group, a finding crucial for resource allocation in public health systems. However, the overall prevalence of excess adiposity highlights a significant public health crisis that threatens progress toward SDG 3 targets.

• The prevalence of BDO was 20.1%.
• The prevalence of BDO combined with CDO was 20.0%.
• This indicates that 99.5% of youth with BDO also had confirmed excess adiposity (CDO).
• Critically, the overall prevalence of CDO was 46.2%, more than double the BDO rate, revealing a large population of youth with elevated body fat who are not classified as obese by BMI alone.

Methodological Overview and Study Demographics

The report is based on a cross-sectional analysis of pooled data from the National Health and Nutrition Examination Survey (NHANES) for the 2015-2018 cycles. The methodology provides a robust foundation for understanding the scope of the issue.

• Study Population: 3,194 participants aged 8 to 19 years.
• Demographics: The sample included 52% male participants and was racially and ethnically diverse (1017 Hispanic, 928 White, 679 Black, 313 Asian, and 257 multiracial or other).
• Definitions Used:
  1. BDO: BMI at or above the 95th percentile for age and sex.
  2. CDO: Excess adiposity confirmed by at least two elevated anthropometric measures or an elevated body fat percentage measured by dual-energy x-ray absorptiometry (DEXA).

Analysis of Disparities and SDG 10 (Reduced Inequalities)

A significant finding was the consistency of the strong correlation between BDO and CDO across all analyzed subgroups, including age, sex, and race/ethnicity. While this specific metric showed no disparity, the high overall prevalence of obesity is a critical issue within the framework of SDG 10 (Reduced Inequalities). Addressing the root causes of obesity, which are often linked to socioeconomic factors, is essential to ensure equitable health outcomes for all children and prevent the perpetuation of health inequalities into adulthood.

Broader Implications for Sustainable Development

The study’s conclusions extend beyond public health, intersecting with several interconnected SDGs. The high rate of youth obesity, a form of malnutrition, poses a long-term threat to sustainable development.

1. SDG 2 (Zero Hunger): The findings underscore the “double burden” of malnutrition, where obesity coexists with undernutrition. Achieving Target 2.2, which aims to end all forms of malnutrition by 2030, requires addressing overweight and obesity with the same urgency as undernourishment.
2. SDG 3 (Good Health and Well-being): Childhood obesity is a primary risk factor for a range of non-communicable diseases later in life. The high prevalence rates identified in the study signal a major obstacle to achieving Target 3.4, which calls for a one-third reduction in premature mortality from such diseases.
3. SDG 4 (Quality Education): The health and well-being of children are intrinsically linked to their educational outcomes. Poor health associated with obesity can affect school attendance and cognitive performance, thereby hindering progress toward inclusive and equitable quality education.

Conclusion and Recommendations for Achieving SDG Targets

This report confirms that while BMI is a reliable tool for identifying obesity with excess adiposity in US youth, the underlying prevalence of elevated body fat is alarmingly high, affecting nearly half the population studied. The impracticality of widespread DEXA screening means that public health interventions must focus on broad, preventative strategies. To advance the 2030 Agenda for Sustainable Development, it is imperative that policymakers implement integrated strategies that promote healthy diets, physical activity, and health equity. Addressing the youth obesity epidemic is not merely a health objective but a fundamental requirement for building a sustainable, healthy, and equitable future for all.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article directly addresses this goal by focusing on the prevalence of obesity and excess adiposity among youth in the US. Obesity is a significant public health issue and a major risk factor for various non-communicable diseases (NCDs). The research presented, which examines the accuracy of different diagnostic methods like BMI and DEXA scans, is central to improving health outcomes and promoting well-being for children and adolescents.

• SDG 10: Reduced Inequalities

  This goal is relevant because the study explicitly analyzes the prevalence of obesity “across age, sex, and race and ethnicity.” By disaggregating data, the research provides insights into whether health issues like obesity disproportionately affect certain demographic groups. The article mentions the study population included participants who were “Hispanic, White, Black, Asian, and multiracial,” ensuring that the findings could be assessed for consistency across these groups to identify or rule out health disparities.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

  The article’s focus on identifying and measuring obesity in youth is a critical component of preventing NCDs. Childhood obesity is strongly linked to a higher risk of developing conditions like type 2 diabetes, cardiovascular disease, and other chronic illnesses later in life. The study’s finding that “the overall prevalence of CDO was 46.2%” underscores the scale of the problem and the urgency for preventative health measures to meet this target.

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic status or other status.

  The research methodology aligns with this target by ensuring its analysis is inclusive and considers various demographic factors. The article explicitly states that the results on obesity prevalence “were consistent across sex, age, and race and ethnicity.” This type of analysis is essential for creating equitable health policies and interventions that address the needs of all segments of the population, thereby reducing inequalities in health outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator for Target 3.4: Prevalence of overweight and obesity among children and adolescents.

  The article provides direct, quantifiable data for this indicator. It states, “The prevalence of BDO was 20.1% (95% CI, 18.0%-22.3%)” and “the prevalence of BDO with CDO was 20.0% (95% CI, 17.8%-22.2%).” Furthermore, it highlights that “the overall prevalence of CDO was 46.2%.” These statistics serve as a baseline to measure the effectiveness of public health interventions aimed at reducing childhood obesity.

• Indicator for Target 10.2: Prevalence of health issues (obesity) disaggregated by age, sex, and race/ethnicity.

  The article implies this indicator by detailing the demographic composition of its study sample of 3,194 participants. It breaks down the population by sex (“male (n = 1671; 52%)”), age (“weighted mean (SD) age of 13 (3) years”), and race/ethnicity (“1017 were Hispanic, 928 were White, 679 were Black, 313 were Asian, and 257 were multiracial”). Using such disaggregated data is the primary method for monitoring and measuring progress toward reducing health inequalities among different population groups.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com