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Objective: To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults.

Design: Longitudinal statistical analyses; microsimulations combining multiple data sets.

Data Sources: National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys. Methods: The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race.

Results: Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6. Limitation: Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future.

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 schoolbased interventions have greater health benefits than screeningguided 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.