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. 2025 Jan 27;22(2):171.
doi: 10.3390/ijerph22020171.

Adolescents with Normal Weight Obesity Have Less Dry Lean Mass Compared to Obese Counterparts

Ann F Brown  1 , Ariel J Aguiar Bonfim Cruz  1 , Malayna G Schwartz  2 , Samantha J Brooks  1 , Alexa J Chandler  1
Affiliations

Adolescents with Normal Weight Obesity Have Less Dry Lean Mass Compared to Obese Counterparts

Ann F Brown et al. Int J Environ Res Public Health. .

Abstract

Normal weight obesity (NWO) is a condition characterized by a normal body mass index (BMI; 18.5-24.9 kg·m-2) yet excess body fat. Those with this condition have an increased risk of cardiometabolic diseases associated with obesity. The prevalence of NWO is not well investigated in adolescents, particularly in the United States. This study examined the prevalence of NWO and dietary behaviors among adolescents aged 14-19 years old (n = 139) who live in a rural area in the United States. Data were collected from December 2019 through February 2020. Body composition was assessed via bioelectrical impedance analysis and diet was assessed using an Automated Self-Administered 24 h food recall questionnaire. Participants were categorized by BMI and body fat percentage as NWO, normal weight lean (NWL), or obese (OB). The sample prevalence of NWO was 13.6%, with girls having a higher prevalence (22.2%) than boys (1.8%). Those with NWO had significantly lower dry lean mass than OB (p = 0.02), but there were no differences between NWL and OB (p = 0.08). There was significantly higher caloric intake (p = 0.02) among NWL compared to OB, and NWL consumed more fiber than both NWO (p = 0.02) and OB (p = 0.03). Overall, this study gives us a better understanding of the prevalence of NWO in the adolescent population and the dietary habits associated with each group. Those with NWO may be at increased risk for negative long-term health outcomes commonly associated with obesity. Additionally, the higher caloric intake among NWL was unexpected and should be investigated further.

Keywords: adolescents; dietary intake; normal weight obesity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic of group allocations. 84.9% of participants who completed the study were included in the data analysis (n = 118) based on body mass index.
Figure 2
Figure 2
(A–D) Differences in body composition for the whole sample. * indicates significant difference from OB (p < 0.05) and $ indicates significant difference from NWO (p < 0.05).
Figure 3
Figure 3
(A–D) Differences in body composition for girls only. * indicates significant difference from OB (p < 0.05) and $ indicates significant difference from NWO (p < 0.05).
Figure 4
Figure 4
(A–D) Differences in body composition for boys only. * indicates significant difference from OB (p < 0.05) and $ indicates significant difference from NWO (p < 0.05).
Figure 5
Figure 5
Relative caloric (A) and macronutrient (B) fat, (C) protein, (D) CHO intake by weight classification while accounting for sex. * denotes significant difference from OB (p < 0.001). Estimates and standard errors for NWL versus OB: Kcal·kg−1 = +17.1 (3.5), p < 0.001; Protein = +0.70 g·kg−1 (0.18) g·kg−1, p < 0.001; Fat = +0.73 (0.16) g·kg−1, p < 0.001; CHO = +2.0 (0.46) g·kg−1, p < 0.001.
Figure 6
Figure 6
(A–E) Participants meeting the RDA for each mineral. Triangles represent girls and circles represent boys. Those who fall within the shaded area do not meet the RDA. The difference in RDA between boys and girls is shown by the dark gray shading. The iron RDA is higher for girls while the RDA for magnesium and potassium is higher for boys. For sodium, those in the shaded area are above the RDA.
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