Examining the Impact of Treating and Preventing Obesity to Prevent Obesity-Related Conditions

A new research letter published Aug. 25 in JAMA Pediatrics estimates the extent to which obesity-related conditions (ORCs) are tied to obesity and overweight in adolescents and young adults in the United States. In this paper, lead author and medical student, Ashwin Chetty used publicly available data from the National Health and Nutrition Examination Survey (NHANES) to quantify how much obesity can cause obesity-related conditions and what the impact of preventing or treating obesity could be.

We know that obesity can cause ORCs, but not all ORCs are caused by obesity. Chetty explains, “Obesity can cause hypertension, for example, but many people have hypertension who don’t have obesity. So, we want to know how many hypertension cases are caused by obesity. And that’s important because that gives us an estimate of the impact obesity has on hypertension and diseases like it and by extension, the impact that treating or preventing obesity can have on those diseases.”

Chetty had previously done a similar study using the same methods that was focused on older adults ages 65+ while working with Alissa Chen, MD, MPH, instructor of general internal medicine, and Alexandra Hajduk, PhD, MPH, research scientist in geriatrics.

After meeting James Nugent, MD, MPH at a pediatrics interest group meeting in late 2024, Chetty began to think that a lot of the questions he and Chen had been looking to answer for older adults could be applied to young adults and adolescents. After realizing that not much research had looked at these questions around obesity-related conditions in the pediatric population, he reached back out to Nugent to get to work.

The two, along with Mona Sharifi, MD, MPH, also an author on this paper, first published a piece in JAMA Pediatrics in early August, “Glucagon-Like Peptide-1 Receptor Agonist Eligibility Among US Adolescents and Young Adults.” Using the disease definitions and design from their previous pediatrics research letter, along with the statistical methods from his work with Chen and Hajduk, Chetty was able to compile data to begin examining ORCs and their causes for this paper.

Part of what makes the work behind this paper so interesting is the intersection of physicians and researchers, some from adult medicine and geriatrics and others from pediatrics, who hadn't previously worked together.

"We’re asking questions that bridge a lot of different populations," says Chetty. "One of the nice things about being a medical student is that I can pivot between research on adults and research in pediatrics. The faculty who I worked with were all really open to taking part in this research. People’s openness to work on ideas that might not be squarely in their field of interest is something I really appreciate about the faculty at Yale."

This latest paper underscores the value of preventing and treating obesity in younger populations. Among cases of prediabetes, hypertension, and dyslipidemia, 20-35% of adolescent cases and 40% of young adult cases are attributable to obesity. Chetty says, “Our interpretation of that statistical conclusion is if you were able to eliminate obesity from this population, you would reduce the prevalence of those obesity-related conditions by that amount.”

The next phase of this research might be estimating the impact of treating obesity early and the cost-benefit analysis of obesity interventions. For example, if certain interventions were made to reduce obesity by a certain amount in the adolescent and young adult population, how much could doctors and researchers expect an ORC like hypertension to be reduced in this age group and how might this short-term investment in pediatric obesity treatment reduce health care costs in the long-term?

Nugent added, “This work is a testament to Ashwin who asked interesting questions and found clever ways to answer them with publicly available data. Not many people get published in JAMA Pediatrics twice in a year, never mind twice in the same month. And he’s not working with a million-dollar grant, he’s asking good questions and finding ways to answer them with NHANES data.”

Chetty echoed his appreciation. "When I talk to prospective students or other medical students and they ask about research, because of my experience with Dr. Nugent and Dr. Chen, I emphasize the value of connecting with early-career faculty who are invested in mentoring. Working with Dr. Nugent and Dr. Chen has been a highlight of my time in medical school so far and it has felt like I’m a partner in the process, and I’ve learned how to ask questions because I've had mentors who’ve allowed me to do that."