#VisualAbstract: Association of childhood obesity with risk of early all-cause and cause-specific mortality

1. Children with obesity were at greater risk of mortality in early adulthood than a population-based comparison group, suggesting that risks begin earlier than later adulthood.

2. Deaths due to suicide and self-injury are also common in this group, warranting clinical consideration at a primary care level.

Evidence Rating Level: 2 (Good)

The impacts of obesity on premature mortality and further health are ubiquitous. However, limited research has focused on when this risk begins and whether or not young adults are at risk if they were obese during childhood. This prospective cohort study conducted in Sweden investigated individuals between the ages of 3 and 17.9 years through the Swedish Childhood Obesity Treatment Register. A control group was matched by sex, birth year, and area of residence. All-cause and cause-specific mortality were evaluated with Cox proportional hazard ratios adjusted for parental socioeconomic status, Nordic origin, sex, and group. Across 190,752 person-years of follow-up (median = 3.6 years), 104 deaths occurred (median [IQR] age at death = 22.0 [20.0-24.5] years). These deaths were comprised of 39 children (0.55%) in the obesity group and 65 in the comparison group (0.19%; p<0.001). Greater than 25% of obesity-group deaths had obesity reported as the primary or contributing cause. Interestingly, low parental socioeconomic status and male sex were associated with premature all-cause mortality – the main causes of death in this group were suicide and self-harm with unknown intent. The most notable difference between the obesity and non-obesity groups was that children who had a history of obesity treatment experienced a mortality rate ratio 4.04 (95% CI 2.00 to 8.17) compared to the control group (p<0.001). This study suggests that children with obesity are not only at increased risk of morality in early adulthood but that suicide and self-harm are also clinical concerns that should be confronted in primary care. Low socioeconomic status and male sex should be considered risk factors.

Click to read the study in PLOS Medicine

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