Purpose: Childhood obesity threatens the future health of America's adults. Recently, the U.S. Preventive Services Task Force recommended childhood obesity screening to better target preventive interventions. Others advocate universal childhood interventions. Projections of the impact of childhood obesity on future adult health are needed to guide policy decisions.
Method: We developed the Stanford Childhood Obesity Projection and Evaluation (SCOPE) model to simulate body mass index (BMI) dynamics for children starting at age 2. The SCOPE model follows children as they grow into adulthood, tracking their BMI and obesity status. The SCOPE model projects outcomes including BMI at ages 18 and 40, and diabetes and hypertension prevalence at age 40. The parameters of the SCOPE model were informed by nationally representative, longitudinal data: the National Health and Nutrition Examination Survey (NHANES 2006), National Longitudinal Survey of Youth (NLSY) Children and Young Adult samples; and Panel Study of Income Dynamics (PSID). Using the SCOPE model, we evaluated the following strategies: childhood obesity screening (at age 5, 10, or 15) with interventions for children at risk; and universal school-based obesity interventions (e.g., interventions such as Planet Health).
Result: Without intervention, 33% of U.S. children currently aged 5 through 10 will be overweight (BMI 25-30) or obese (BMI ≥30) by age 18. For obese 18 year-olds, the probability at age 40 of being obese is 70%, of being diabetic is 23%, and of being hypertensive is 39%. By contrast, for thin (BMI <25) 18 year-olds, the probability of being obese is 24%, of being diabetic is 1%, and of being hypertensive is 22%. Obesity screening in children under 10 misses more than 40% of those who become obese 18-year olds. Screening at age 15 misses less than 15%. Universal school-based interventions have greater health benefits than screening-guided interventions, reducing the number of 40 year-olds with BMI ≥30, diabetes, and hypertensions by as much as 1,000,000, 200,000, and 500,000, respectively.
Conclusion: Results from the SCOPE model support the role of universal school-based interventions as promising tools to address adult obesity-related illness compared to childhood obesity screening. If universal interventions are infeasible, targeting obesity screening in early teen years has a greater potential benefit than screening for young children. Such interventions complement the continued importance of obesity interventions during adulthood.