Prevalence of Preclinical and Clinical Obesity Among US Children and Adolescents Aged 5 to 18 Years: NHANES 2017-2023.

PubMed19 Apr 2026·Obesity (Silver Spring, Md.)● 6/10i

Prevalence of Preclinical and Clinical Obesity Among US Children and Adolescents Aged 5 to 18 Years: NHANES 2017-2023.

Chaudhary P, Yang S, Waldrop S, Katzmarzyk PT, Staiano AE

One in five US youth aged 5-18 have obesity using the new Lancet Diabetes & Endocrinology Commission framework, with 12.5% having clinical obesity that includes physiological dysfunction. Cross-sectional analysis of NHANES 2017-2023 data from 5,513 youth, comparing traditional BMI percentile classification with the new framework that incorporates waist-to-height ratio and clinical impairments. This provides the first US population-level data applying the new obesity framework that shifts focus from BMI alone to physiological dysfunction, potentially expanding the pediatric population eligible for medical intervention. The analysis reveals limitations in routinely collected clinical data for implementing the new classification system in practice.

Strategic signal

The new Lancet framework's emphasis on physiological dysfunction rather than BMI alone could expand the pediatric obesity treatment population by identifying children with clinical obesity at lower BMI thresholds. This would benefit companies developing pediatric obesity therapies, as payers and clinicians increasingly adopt frameworks that prioritize metabolic health over weight metrics. However, the study highlights data collection challenges that could slow adoption in clinical practice, potentially limiting near-term market expansion until healthcare systems adapt their assessment protocols.

Weight lossReal-world evidence

Original Abstract

OBJECTIVE: This study aimed to estimate the prevalence of preclinical and clinical obesity among US youth using the Lancet Diabetes & Endocrinology Commission's framework. METHODS: This cross-sectional study examined NHANES 2017-2023 data from 5513 youth aged 5-18. Obesity classification included: (i) no obesity (BMI < 95th percentile and/or waist to height ratio (WHtR) < 0.5), (ii) preclinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 without clinical impairment or functional limitations), and (iii) clinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 with one or more clinical impairments or functional limitations). RESULTS: The weighted prevalence was 8.3% for preclinical and 12.5% for clinical obesity; combined prevalence (20.8%) was similar to ~22% using BMI percentile alone. Clinical obesity was more common in older children and racial/ethnic minority groups but similar by sex. Impairments associated with clinical obesity included low HDL cholesterol (60.3%), asthma (24.8%), early menarche in girls (18.0%), elevated blood pressure (16.2%), prediabetes/diabetes (9.1%), and functional limitations related to walking (7.7%) and self-care (4.1%). CONCLUSIONS: Applying the Lancet Diabetes & Endocrinology Commission's new definition criteria revealed substantial physiological dysfunction in US youth. Applying preclinical and clinical obesity definitions is challenging, given the limitations of the routinely collected clinical and epidemiological data that make up NHANES and in standard clinical practice.

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