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Although the prevalence and comorbidities of standard obesity classes (classes 1\u20133, BMI 30\u201349.9\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) have been described, the characteristics of obesity classes 4 and 5 (BMI \u2265\u00a050 to\u00a0&lt;\u00a060\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and BMI \u2265\u00a060\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively), representing the most extreme end of the obesity spectrum, remain poorly defined.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to determine the prevalence of obesity classes 4 and 5, or extremely severe obesity, in adults over time and to investigate the relationship between extremely severe obesity and metabolic comorbidities and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from nationally representative samples from National Health and Nutrition Examination Surveys from 2000 through 2023 involving 54,793 adults aged 18\u201365\u00a0years in the US were analyzed, including mortality data from 43,454 adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of obesity classes 4 and 5 increased by over 250% from 0.6% in 2000 to 2.2% in 2023 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Extremely severe obesity was particularly prevalent among females and non\u2010Hispanic Blacks. Subjects with obesity classes 4 and 5 had an odds ratio of 6.7\u201378.7 and 2.1\u201310.9 of metabolic comorbidities, and a 10\u2010year mortality hazard ratio of 2.2 (95% CI 1.6\u20133.0) and 1.8 (95% CI 1.3\u20132.4) compared with subjects without obesity and with obesity classes 1\u20133, respectively (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings highlight the rise of a so far insufficiently characterized obesity entity, extremely severe obesity, and underline the strong association of extremely severe obesity with severe metabolic complications including death. These results emphasize the need for immediate public health interventions to address obesity, particularly obesity classes 4 and 5.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/osp4.70171","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:01:02Z","timestamp":1784775662000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence, Comorbidities, and Mortality of Obesity Classes 4 and 5 in Adults"],"prefix":"10.1002","volume":"12","author":[{"given":"Katelynn","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Bioinformatics Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-3335","authenticated-orcid":false,"given":"Phillipp","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Diego  La Jolla California USA"},{"name":"Division of Gastroenterology Hepatology &amp; 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