NEW RESEARCH challenges the long-held assumption that metabolically healthy obesity (MHO) in childhood is a benign condition, showing that affected individuals remain at significantly increased risk of cardiometabolic disease into early adulthood.
MHO has traditionally been considered a lower-risk obesity phenotype, characterised by the absence of metabolic abnormalities such as hypertension, dyslipidaemia, and impaired glucose regulation. However, the long-term health implications of this classification have remained uncertain, particularly in paediatric populations.
In this large prospective cohort study, researchers analysed data from 7,275 children with obesity enrolled in a Swedish national treatment register, alongside 35,636 matched individuals from the general population. Participants were followed from childhood through to a maximum age of 30 years to assess the development of type 2 diabetes, hypertension, dyslipidaemia, and mortality.
At baseline, nearly half of the children with obesity were classified as having MHO, while the remainder had metabolically unhealthy obesity (MUO). Despite their favourable metabolic profile in childhood, individuals with MHO still experienced markedly higher rates of cardiometabolic disease compared with their peers in the general population.
Higher Rates of Diabetes, Hypertension, and Dyslipidaemia
By age 30 years, the cumulative incidence of type 2 diabetes was 9.1% among those with MHO, compared with just 0.5% in the general population. Similarly, hypertension affected 10.8% of the MHO group versus 3.7% of comparators, while dyslipidaemia occurred in 5.3% compared with 0.9%, respectively. As expected, risks were even higher among individuals with MUO.
Importantly, the study also demonstrated that weight reduction during childhood was associated with substantial health benefits. A decrease in body mass index (BMI) z score of at least 0.25 was linked to significantly lower risks of type 2 diabetes, hypertension, and dyslipidaemia. Notably, these benefits were observed regardless of whether children were initially classified as MHO or MUO.
Implications for Paediatric Obesity Management Guidelines
The findings suggest that the concept of “metabolically healthy” obesity in children may be misleading, as it does not confer protection against future cardiometabolic disease. Instead, even in the absence of early metabolic abnormalities, excess weight appears to carry long-term health risks.
Overall, the study supports a shift in clinical practice, emphasising that obesity treatment should be offered to all children with obesity, irrespective of their metabolic status, to reduce the risk of serious health outcomes later in life.
Reference
Putri RR et al. Long-term cardiometabolic outcomes in children with metabolically healthy and unhealthy obesity. JAMA Pediatr. 2026;doi: 10.1001/jamapediatrics.2026.0343.
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