Childhood Obesity and the Future Burden of Adult Cardiometabolic Disease: A Narrative Review

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Childhood obesity is a growing public health concern with significant long-term implications for cardiometabolic health. Without effective intervention, the global burden of childhood and adolescent obesity is projected to increase substantially in the coming decades. This study aimed to synthesise current evidence on the epidemiology, pathophysiology, causal mechanisms, longitudinal outcomes, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease from a public health perspective. A narrative review was conducted and reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was identified through searches of PubMed/MEDLINE, Scopus, and Google Scholar from January 2000 to January 31, 2026. A total of 348 records were identified, of which 38 sources were retained for citation. Landmark pre-2000 studies were additionally identified through targeted hand searching. This review examined the epidemiology, pathophysiology, longitudinal tracking, causal mechanisms, metabolic phenotyping, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease. Consistent evidence was identified linking childhood obesity to elevated long-term cardiometabolic risk. Both metabolically healthy and metabolically unhealthy obesity phenotypes in childhood are associated with increased cardiometabolic risk in adulthood. Socioeconomic and ethnic inequalities in childhood obesity continue to widen across diverse settings, while emerging evidence highlights a growing dual burden of undernutrition and excess adiposity in transitional populations. Weight normalisation before adulthood appears to substantially reduce future cardiometabolic risk and remains an important clinical objective. Childhood obesity is associated with an increased risk of adult cardiometabolic disease through interconnected biological, social, environmental, and commercial pathways. Clinical practice should incorporate systematic cardiometabolic risk assessment in children with obesity regardless of current metabolic status. Future research should prioritise trans-ethnic causal studies, long-term cardiometabolic outcome trials in paediatric populations, and evaluation of structural policy interventions.