Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Oct 1;74(10):1710-1719.
doi: 10.2337/dbi24-0044.

Adipose Tissue as a Target for Precision Medicine Approaches in Childhood Obesity

Bethany R Cartwright  1   2   3 , Philipp E Scherer  3
Affiliations
Review

Adipose Tissue as a Target for Precision Medicine Approaches in Childhood Obesity

Bethany R Cartwright et al. Diabetes. .

Abstract

Following the trends of the adult obesity epidemic, and worsened by school disruptions during the coronavirus disease 2019 pandemic, childhood obesity prevalence has reached unprecedented levels. The health implications for this generation are especially concerning, as childhood-onset obesity has more severe health consequences than weight gain that begins in adulthood, including increased risk of type 2 diabetes and diabetes-related complications. The complexity of obesity treatment has been challenging, including remarkable heterogeneity in obesity phenotypes and treatment responses among both adults and children. Many in the field have therefore highlighted a need for precision medicine approaches in obesity treatment across age-groups. This includes a need for precision risk stratification to better target treatment intensity, which will require a better understanding of the earliest stages of metabolic syndrome pathophysiology. The health, function, and distribution of adipose tissue have been established as important determinants of metabolic health in both childhood- and adult-onset obesity, making adipose tissue a promising target for understanding phenotypic heterogeneity in obesity. Here, we provide a brief overview of the current limited understanding of adipose tissue biology during childhood development and discuss opportunities for further research into adipose-centric precision medicine approaches in childhood-onset obesity and type 2 diabetes.

Article highlights: Treatment options for childhood obesity are expanding, but precision medicine approaches, including strategies for precision risk assessment, are needed to appropriately target treatment intensity. Parameters of adipose tissue dysfunction are better predictors of metabolic syndrome than body size, and therefore adipose tissue represents a prime candidate for research approaches in understanding the pathophysiology of insulin resistance and in identifying biomarkers of future prognosis. Expanded developmental research on pediatric adipose tissue in both mice and humans is needed to understand the pathophysiology of childhood-onset obesity and to develop precision treatment approaches.

PubMed Disclaimer

Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Key questions in obesity precision medicine.
Figure 2
Figure 2
Adipo-centric determinants of health in obesity.
Figure 3
Figure 3
Stages of adipose tissue development in humans.
Figure 4
Figure 4
Research priorities for the study of adipose tissue development and the impacts of childhood-onset obesity.
Figure 5
Figure 5
Clinically available measures and predictors of weight-related health risk among children with obesity.
See this image and copyright information in PMC

References

    1. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. National Center for Health Statistics. Accessed 19 March 2024. Available from https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htm
    1. Wagenknecht LE, Lawrence JM, Isom S, et al.; SEARCH for Diabetes in Youth study . Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol 2023;11:242–250 - PMC - PubMed
    1. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023;151:e2022060640. - PubMed
    1. Berg S. AMA: use of BMI alone is an imperfect clinical measure, 2023. Accessed 8 May 2024. Available from https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone...
    1. Blüher M. Metabolically healthy obesity. Endocr Rev 2020;41:bnaa004. - PMC - PubMed