Does Childhood Weight Alter Health Risks in Adults?

Self-perceived weight as a 10-year-old may influence risks for all-cause mortality and incident cardiovascular disease (CVD) in adults who are overweight or obese, research presented on May 12, 2024, at the 31st European Congress on Obesity in Venice, Italy, suggested.

The new study follows earlier work on the association of obesity with disease outcomes due to body size trajectories, presenter William Johnson, PhD, an expert in epidemiology and public health based at Loughborough University, Loughborough, United Kingdom, told Medscape Medical News.

The UK Biobank cohort analysis of 191,181 men and 242,806 women aged 40-69 years at baseline found that adulthood overweight and obesity may confer greater risks for all-cause mortality and incident CVD among individuals who perceived themselves to have been thinner or plumper than the average child.

Thinner, Average, or Plumper?

The authors measured body mass index (BMI) at baseline (categorized as normal weight, overweight, or living with obesity) and self-reported perceived body weight at age 10 years (about average, thinner, plumper). They then developed computer models, adjusting for age, ethnicity, relative age voice break (males) or age at beginning periods (females), and comparative height at age 10 years.

Participants living with obesity had been asked the following question as part of their recruitment into the UK Biobank between 2005-2010: “When you were 10 years old, compared to average, would you describe yourself as: Thinner, about average, or plumper?” About half (51%) reported being normal weight; a third (33%) reported being thinner; and one in six (16%) reported being plumper.

Participants were followed until an event occurred or until December 19, 2022, to assess all-cause mortality; until September 1, 2023, for incident CVD; and until March 15, 2022, for incident obesity-related cancer and breast cancer. 

Overall, 8% of participants died during follow up, 35% developed CVD, and 2% of the cohort (both sexes) developed an obesity-related cancer — including cancers of the colon, uterus, esophagus, gallbladder, stomach, kidney, pancreas, rectum, thyroid, brain (meningioma), and multiple myeloma. Five percent of women developed breast cancer.

Compared with having normal weight in adulthood, living with obesity in both sexes was associated with a 15% increased risk for all-cause mortality. But there was no significantly increased risk in those living with overweight.

The associations of obesity with all-cause mortality and incident CVD were stronger in those who reported being thinner at age 10 years. For example, obesity was associated with a 28% increased risk for all-cause mortality in men who reported being average weight in childhood but 63% among men who reported being thinner as children. 

For adult women who reported having a normal weight at 10 years old, living with obesity was associated with a 38% increased risk for all-cause mortality compared with those living with normal weight.

For women who said they were thinner at age 10, living with obesity was associated with a 60% increased risk for all-cause mortality compared with women of normal weight. Those who reported being plumper at age 10 had a 32% increased risk for all-cause mortality if they were living with obesity as adults compared with living with normal weight.

Except for incident CVD in women, the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being plumper at 10 years. 

Furthermore, among women, living with overweight as an adult was associated with higher hazards of obesity-related cancer for those reporting average and thinner childhood weights — but for those who were plumper in childhood, it was associated with a 0.92 times lower hazard.

For incident breast cancer, associations did not differ among the three types of weight at 10 years old.

“Asking adult patients whether they were about average, thinner, or plumper as a child may help with risk stratification for some, but not all, diseases,” the authors concluded.

Clinical Implications

“Adults who said they were plumper than average at age 10 years were likely to have had higher childhood BMI values and obesity rates than adults who reported being about average body size at 10 years,” Johnson explained. “We would, therefore, expect [their] mortality and disease risk to be higher because children living with obesity are at increased risk of also having obesity in adulthood.” 

Finding that those who reported being thinner as children were also at increased risk “is harder to understand,” he acknowledged, “but is likely partly due to excess weight gain during adolescence and early adulthood (ie, after age 10 years), which we know is related to harmful gains in visceral fat.”

His team is now “re-running the analysis using previously developed and validated genetic risk scores for childhood body size,” he said. “This will help address some of the issues of childhood body size being self-reported and our estimated associations being subject to residual confounding.”

Commenting for Medscape Medical News, Jason C. G. Halford, PhD, head of the school of psychology at the University of Leeds, Leeds, United Kingdom, and president of the European Association for the Study of Obesity, called the findings “interesting” but noted that they are based on “retrospective, self-reported data.”

Additional research might look at whether these phenomena occur in existing longitudinal cohort studies that have actual weight trajectories, he suggested. Meanwhile, clinicians should be aware that “weight history is an important part of people living with obesity’s current experience of trying to manage their body weight.”

Johnson declared no conflicts of interest. Halford disclosed that the University of Leeds has received funding in the last 24 months from Novo Nordisk and Boehringer Ingelheim for speakers fees and consultancy. He does not take personal income, he said. The money supports research. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health. 

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