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The increased prevalence of obesity during the past three decades has alarmed the global health community. Four million deaths and 120 million disability-adjusted life years worldwide are related to excess body weight and, although the trend appears to have stabilized in some developed countries, the problem is spreading in the developing world. If recent trends continue, it has been projected that 60% of the world’s population could be overweight or obese by 2030. The causes and consequences of obesity are complex. A combination of inherited genes that confer susceptibility and an environment that is increasingly characterized by a sedentary lifestyle and consumption of excess calories are thought to be the main predisposing factors. Adipose tissue produces hormones such as leptin and adiponectin, chemical messengers and cytokines that may affect the development of cardiovascular disease (CVD). A number of studies have consistently demonstrated a strong association between obesity, especially visceral adiposity, and insulin resistance, which is the main contributing factor for the development of type 2 diabetes (T2DM), hypertension, and CVD. The most rapid rise in overweight/obesity has occurred in the young, and the majority of overweight/obese children will unfortunately become obese adults. This will add to the population of adults who have become obese by accumulating fat in later years and will have major global public health and economic consequences. Elevated body mass index (BMI) has been associated with adverse cardiometabolic traits in both childhood and adulthood, and data from numerous longitudinal studies, including the Fels Longitudinal Study, the Bogalusa Heart Study, and the Young Finns Study, demonstrate that BMI tracks from childhood to adulthood. As the global health community is focusing on developing and establishing treatments and prevention policies to address obesity, more information about the influence of increased BMI during different periods of life (from childhood to adulthood) and its impact on specific cardiometabolic traits as well as overt CVD is needed. The recent study by Buscot and colleagues, from the Young Finns Study, in this isue of the journal provides novel information on this topic. By using life course analysis, the authors uncover the effects of BMI trajectories from childhood on later cardiovascular outcomes. This type of analysis avoids the limitations of discrete categorization and classification, and can identify heterogenous patterns of individual behaviour. Six distinct trajectories were described to characterize patterns of adiposity progression in their cohort. Consistent with previous reports, trajectories of worsening or persisting obesity, which translate to longer adiposity exposure, were common and were associated with increased risk of adverse cardiovascular outcomes in adulthood (such as dyslipidaemia, hypertension, and risk for T2DM). The higher the BMI trajectory grade, the higher the probability of having at least one elevated CVD risk factor in adulthood. This supports the consensus that exposure to excess BMI years increases both T2DM and CVD risk factor levels. Increased subclinical atherosclerosis as quantified by carotid intima media thickness (cIMT) was also noted with increased adiposity exposure. The BMI was used to describe adiposity status as it is strongly associated with total body fat content in adults and correlates with other adiposity measures in both children and adults. Its use, however, across the life course is more problematic as it does not consider body fat distribution and cannot discriminate between fat mass and lean mass. Rapid changes in body composition occur, especially in adolescence, with increase in fat mass in girls and muscle mass in boys. Waist circumference may be a better marker of central adiposity but it is prone to measurement error. Global and regional fat distribution can be more accurately assessed by dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic

BMI trajectories from childhood: the slippery slope to adult obesity and cardiovascular disease