To discuss substantive issues regarding the clinical implications of the study by Putri et al on cardiometabolic trajectories in children with obesity.
Approach:
Clinical Argument: The authors argue that recommending treatment for all patients conflicts with the 2025 Lancet Commission statement on clinical obesity, which designates obesity without organ dysfunction as 'preclinical obesity' and generally not requiring treatment.
Study Limitations: The study's design lacks an untreated comparator group for metabolically healthy obesity (MHO), making it difficult to assess the natural history of untreated children with MHO.
Ethical Considerations: The ethical implications of treating all children with obesity are not addressed, particularly concerning potential psychological harms associated with weight loss interventions.
Key Findings:
Cumulative type 2 diabetes incidence by age 30 was 9.1% in the MHO group compared to 0.5% in the general population.
Type 2 diabetes incidence was reported as 36.2 per 10,000 person-years among children with MHO versus 2.1 in the general population.
MHO prevalence in the cohort was 59.6% among children aged 7 to 8.9 years.
Interpretation:
The study's findings on diabetes incidence among children with MHO may reflect treatment effects rather than the natural progression of untreated MHO.
Limitations:
No untreated comparator group for MHO was included in the study.
Psychosocial harms associated with weight loss interventions were not analyzed.
Conclusion:
The authors commend the study for stimulating important academic dialogue on the implications of treating obesity in pediatric populations.
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