Obesity is not a universal risk factor in pediatric type 2 diabetes


Dr Meenakshi Verma, Consultant Pediatrics, Sparsh Clinic, Zirakpur, India; Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India;    21 December 2022

Obesity is a key driver of the type 2 diabetes pandemic in adults. But does childhood obesity play a similar significant contributory role in pediatric type 2 diabetes mellitus? It would appear so. Debunking this assumption, a new systematic review and meta-analysis published online Dec. 15, 2022 in JAMA Network Open suggests that not all children with type 2 diabetes are obese. Male sex and White race were potential risk factors as per the meta-analysis.


A team of researchers from Canada, Turkey and Saudi Arabia conducted a meta-analysis of 53 studies from different parts of the world involving 8942 participants to examine the global prevalence of obesity in children with type 2 diabetes. Only observational studies with a minimum of 10 subjects and reporting the prevalence of obesity in children with type 2 diabetes were selected for the meta-analysis. The secondary objectives were to examine the association of sex and race with the risk of obesity as well as the association of obesity with glycemic control and dyslipidemia.


The overall prevalence of obesity was found to be 75.27%. When the prevalence of obesity at the time of diabetes diagnosis was examined 4688 participants, it was found to be 77.24%. Seventy-nine percent boys were obese compared to 59% obese girls with odds ratio (OR) of 2.10.


The assessment of obesity by race and ethnicity revealed the highest prevalence among the White participants at 89.86%; the lowest prevalence was noted among the Asian participants at 64.5%. The highest prevalence of obesity was noted in children from North America at 81% followed by the Middle East region at 78%, Oceania at 74%, Asia 69% and Europe at 68%. Less than 5% of children in the Americas had BMI in the normal range, whereas this percentage among children in Asia was 14% and in Oceania 16.4%.


Researchers observed high heterogeneity across studies including varying degrees of glycemic control and dyslipidemia.


This meta-analysis reaffirms obesity as a significant risk factor for pediatric type 2 diabetes. However, it has also shown that at least one-quarter of children with type 2 diabetes were not obese at the time of diagnosis of type 2 diabetes. The authors therefore concluded that “obesity is not a universal phenotype in children with T2D” and other factors such as genetics, especially in children with a positive family history, are presumed to also play a role in development of pediatric type 2 diabetes. However, their elucidation requires further research, suggest the authors. Relying only on childhood obesity as a screening measure may miss many children with type 2 diabetes.



  1. Ciona M, et al. The prevalence of obesity among children with type 2 diabetes: a systematic review and meta-analysis. JAMA Netw Open. 2022 Dec 1;5(12):e2247186. doi: 10.1001/jamanetworkopen.2022.47186.

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