Prevalence of Extremely Severe Obesity and Metabolic Dysfunction Among US Children and Adolescents

In this nationally representative cross-sectional study of US children and adolescents, prevalence of extremely severe obesity significantly increased over time, particularly among older adolescents and non-Hispanic Black participants. Extremely severe obesity was associated with severe metabolic and cardiovascular complications, including MASLD, prediabetes or diabetes, severe insulin resistance, and metabolic syndrome. These findings emphasize the urgent need for public health interventions and policies to address pediatric obesity broadly.