Clinical measures of obesity and cumulative cardiometabolic risk in adolescents W. P. Jayawardene 1 , D. Lohrmann 1 , S. Dickinson 2 , S. Talagala 3 and M. Torabi 1 What is already known about this subject? • Clustering of risk factors, both biological and behavioural, is the great- est predictor of accelerated atherosclerotic processes; clustering of risk factors in adolescents can persist into adulthood. • Severity of obesity in adolescent males, versus females, had stronger associations with high-risk levels of lipids, glucose and blood pressure. • Waist circumference and waist-to-height ratio are stronger predictors of cardiometabolic risk than body mass index for children because they directly measure central obesity. What this study adds? • More adolescents with obesity can have one or more cardiometabolic variable at borderline-risk level than at high-risk level; gender differ- ence was not significant in borderline-risk levels. • Severity of obesity in Hispanic adolescents, compared to non-Hispanic Whites and Blacks, generally had a stronger association with high-risk levels of lipids, glucose and blood pressure. • Both body mass index and waist circumference performed well for identifying adolescents with at least one borderline-risk or high-risk level measure in lipids, glucose and blood pressure. 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA; 2 Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA; 3 Global Health Communication Center, Indiana University–Purdue University Indianapolis, Bloomington, IN, USA Received 29 July 2016; revised 27 October 2016; accepted 17 November 2016 Address for correspondence: WP Jayawardene, MD, PhD, Applied Health Science, School of Public Health Bloomington, Indiana University, 116 SPH-B, 1025 E 7th Street, Bloomington, IN 47 405, USA. E-mail: wajayawa@indiana.edu Summary Obesity tracks from childhood to adulthood most strongly of all cardiometabolic risk factors. To determine relationship of body mass index (BMI) and waist circum- ference (WC) with cardiometabolic risk (dyslipidemia, hyperglycemia and elevated blood pressure) in a large U.S. population ages 12–19 and demographic subgroups. Pooled 1999–2014 National Health and Nutrition Examination Survey data were analyzed (N = 23 438). In addition to standard cutoffs of BMI and WC, risk levels were identified for each laboratory variable: HDL-cholesterol, LDL-cholesterol, tri- glycerides, total cholesterol (category = lipids); fasting glucose, glycated haemoglo- bin (category = glucose); systolic/diastolic pressures (category =blood pressure). Within each category, being high-risk on any of the variables was high-risk; being borderline-risk on any, without being high-risk on any, was borderline-risk. Obesity severity was strongly associated with increased cardiometabolic risk, with prevalence of borderline-risk greater than high-risk. Anthropometric indicators in males and Hispanics, versus females and Whites/Blacks, respectively, had stronger associations with cardiometabolic risks. BMI and WC performed well for identifying adolescents with at least one borderline-risk or high-risk level measure for lipids, glucose and blood pressure; relationship strength varying by gender and race/ethnicity. Thus, to prevent or better manage clinical diseases of adolescents with elevated BMI and/or WC, all recommended laboratory tests are warranted. Keywords: Adolescents, body mass index, waist circumference, cardiometa- bolic risk. Background Based on body mass index (BMI), 34.5% of U.S. 12–19- year-olds were overweight in 2011–2012; 20.5% were obese (1). In 1988–2012, obesity gender disparities widened, with obesity increasing faster among non-Hispanic White girls and two classifications of boys – non-Hispanic Black and Mexican-American (2). Ethnic disparities also widened, with © 2016 World Obesity Federation Clinical Obesity clinical obesity doi: 10.1111/cob.12171