As the epidemic of childhood obesity in high income countries has developed over the past 20 years, questions have emerged about the implications of adiposity in children and adolescents for current and future health. In a linked systematic review (doi:10.1136/bmj.e4759), Friedemann and colleagues report that obese children and adolescents aged 5-15 years have raised serum lipids, blood pressure, glucose, and insulin as well as increased left ventricular mass compared with children with a healthy weight.1 This is worrying, but what exactly does it mean?

The long term outcomes for the current generation’s obese children and adolescents remain to be seen. However, the current study will help build a more accurate picture of the cardiometabolic risk that these young people are likely to face. Most worrying is that these findings indicate that end organ effects in the form of increased left ventricular mass are already present in obese children. Despite high heterogeneity in many of the meta-analyses, the current review provides a stark illustration of the probable threat that childhood obesity poses to disease …