Adolescent to adulthood weight trajectories and the risk of obesity-related cancers, overall and early-onset - a population-based cohort study

Sep 22, 2026

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High body mass index (BMI) is a modifiable cancer risk factor, and the effect of weight change from late adolescence to adulthood on cancer risk is not well established. This population-based cohort study followed 800,024 insured individuals, measuring BMI in adolescence and adulthood across extended time windows and classifying BMI trajectories. Hazard models evaluated obesity-related cancers overall and before age 50, including trajectory- and 5% weight-gain-related risks.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

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Articles Adolescent to adulthood weight trajectories and the risk of obesity-related cancers, overall and early-onset: a populationbased cohort study Cole D. Bendor,a,b,c,d,e,p Aya Bardugo,a,b,c,e,p Avishai M. Tsur,a,b,c,d,f Estela Derazne,g Itay I. Shemesh,h Lotmit Bourvine,i Dror Dicker,g,j Ben Boursi,g,k,l Amir Tirosh,g,m Arnon Afek,c,e Ran S. Rotem,n,o Gabriel Chodick,g,n and Gilad Twigc,d,m,∗ aDepartment of Military Medicine, Hebrew University, Jerusalem, Israel bIsrael Defense Forces Medical Corps, Ramat Gan, Israel cThe Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel dDepartment of Preventive Medicine and Epidemiology, School of Public Health, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel eThe Dina Recanati School of Medicine, Reichman University, Herzliyya, Israel fDepartment of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel gFaculty of Medicine, Tel Aviv University, Tel Aviv, Israel hNovo Nordisk, Kfar Saba, Israel iNovo Nordisk Health Care AG, Zürich, Switzerland jRabin Medical Center, Hasharon Hospital, Department of Internal Medicine D and Obesity Clinic, Petah Tikva, Israel kInstitute of Oncology, Sheba Medical Center, Ramat Gan, Israel lCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USAmDivision of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel nMaccabitech, Maccabi Healthcare Services, Tel Aviv, Israel oDepartment of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA Summary Background High body mass index (BMI) is a modifiable cancer risk factor, projected to surpass smoking as the leading preventable risk factor. The impact of weight change from late adolescence to adulthood on cancer risk remains unclear. We aimed to assess the association between adolescence-to-adulthood BMI trajectories and obesityrelated cancer risk. Methods A population-based cohort study of 800,024 people (45.1% women) insured by a large state-mandated health provider. BMI was measured during military pre-recruitment evaluations during 1967–2018 in adolescence and in subsequent clinic visits in adulthood during 1998–2020. Follow-up began one year after an adult BMI measurement until cancer diagnosis, death, transfer to another health provider, or December 16, 2021. BMI trajectories from adolescence to adulthood were classified as lean-to-lean, lean-to-high, high-to-lean, and high-to-high (cutoff: sex-specific and age-specific 85th percentile in adolescence, defined according to the United States Centers for Disease Control and Prevention growth charts, and 25 kg/m2 in adulthood) . Weight change was also assessed per 5% increments. The primary outcome was obesity-related cancers including esophagus, postmenopausal breast, liver and gallbladder, stomach, pancreas, colon and rectum, kidney, multiple myeloma, thyroid, uterus and ovary. The secondary outcome was obesity-related cancers diagnosed before age 50 years (early-onset cancers) . Cox proportional hazards models were applied. Findings During 7,610,263 person-years, 6,376 people were diagnosed with obesity-related cancers, at a mean age of 53.3 ± 9.8 years. Adjusted hazard ratios (HRs) were 1.31 (95% confidence interval [CI], 1.24–1.39) for lean-to-high, 1.01 (95% CI, 0.78–1.31) for high-to-lean, and 1.47 (95% CI, 1.34–1.61) for high-to-high groups, compared to the lean-to-lean group. Respective HRs for early-onset obesity-related cancers were 1.33 (95% CI, 1.20–1.47), 0.88 (95% CI, 0.60–1.31), and 1.39 (95% CI, 1.20–1.61) . Each 5% weight gain conferred a 3% increased hazard (95% CI, 1.02–1.03), with a similar 3% increase for early-onset cancers (95% CI, 1.02–1.04) . Cancer-specific risks included 3%(95% CI, 1.02–1.04) for postmenopausal breast cancer, 3%(95% CI, 1.01–1.04) for colorectal cancer, 4%(95%

FAQs

How were BMI trajectories from adolescence to adulthood defined in the study?

Trajectories were classified into lean-to-lean, lean-to-high, high-to-lean, and high-to-high using sex- and age-specific adolescent cutoffs based on CDC growth charts, plus an adult threshold of 25 kg/m².

Which cancer outcomes were assessed?

Obesity-related cancers were evaluated overall, including cancers of the esophagus, postmenopausal breast, liver and gallbladder, stomach, pancreas, colon and rectum, kidney, multiple myeloma, thyroid, uterus, and ovary. A secondary analysis focused on early-onset cancers diagnosed before age 50.

What was the relationship between weight gain and cancer risk?

Each 5% weight gain was associated with an increased hazard for obesity-related cancers, and a similar increased hazard was observed for early-onset obesity-related cancers.

Sep 22, 2026

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