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Early onset of obesity is likely to lead to earlier onset of associated complications.26 The rise in adolescent obesity is likely to increase the incidence of type 2 diabetes in adolescents.26

Children and adolescents with obesity are more likely to have multiple cardiovascular risk factors, compared to those without obesity.8 However, data showed that individuals who were overweight or had obesity in childhood but normalised their weight before adulthood had a cardiovascular risk profile similar to those with normal weight during childhood.9

In adolescents, a significant association between excess weight and asthma incidence has been observed.2 Population surveys suggest that asthma is disproportionately prevalent in adolescents with obesity when compared with persons who have never had asthma.2

Orthopedic complications of obesity are believed to be largely mechanical in nature.2 During childhood, slipped capital femoral epiphysis, Legg-Calve-Perthes disease, and genu valgum tend to be more common in adolescents with obesity.2 Orthopedic disorders such as Blount’s disease (tibia vara) and slipped capital femoral epiphysis are frequently seen in adolescents with obesity.2

The prevalence of obstructive sleep apnoea among children and adolescents with obesity can be as high as 59%.10


Lowered self-image, heightened self-consciousness, and impaired social functioning have been noted in individuals who either develop or continue to have obesity as adolescents or remain obese during adolescence.2 Studies of adolescents with obesity have demonstrated an obsession with being overweight, passivity, and withdrawal from social contact.2

Excess abdominal adipose tissue (AT) initiates metabolic and endocrine aberrations that are central in the progression of PCOS.11 Studies show that Polycystic Ovarian Morphology (PCOM) is found in 61.1% of the adolescent girls with obesity, but only in 32.1% of girls without overweight or obesity, suggesting that obesity is a contributing factor.11

The stigma and bias associated with obesity can lead to social problems including but not limited to teasing or bullying about their weight, which can affect academic performance and affect overall quality of life.12-16

Prompt diagnosis

There is a need for multiple approaches to help adolescents with obesity with long-term weight management:17-18
We recommend that clinicians consider and support intensive, age-appropriate, culturally sensitive, family-centered lifestyle modifications (dietary, physical activity, behavioral) to promote a decrease in BMI.7

Remember that assessing the BMI of adolescents is more complicated than for adults because it changes as they grow and mature.19-21 In addition, growth patterns differ between boys and girls.19 Therefore, BMI must always be considered in the context of sex and age percentiles.19-21 First, you must calculate the BMI of the child and then plot it on the gender specific, BMI-for-age percentile graph, to find the child’s weight status.20-21

The child’s weight can be classified as follows:20-23
Overweight: BMI in the 85th to 95th percentile for sex and age
Obesity: BMI 95th percentile for sex and age
Severe obesity: BMI 120% of 95th percentile for sex & age or BMI 35 kg/m2, whichever is lower.
BMI Graph

Although a BMI decrease of 1.5 kg/m2 may seem small, if maintained for the long term, adolescents with overweight or obesity may benefit by maintaining weight as they grow.5

Research has shown that any combination of dietary/exercise or lifestyle interventions have a small but significant effect on BMI.23 Once a diagnosis of overweight or obesity has been made, you should provide counseling to parents and caregivers apart from adolescents themselves.23

Diet
Ensure that you address both the quantity and quality of food:7,24

We recommend that clinicians prescribe and support healthy eating habits in accordance with the following guidelines of the American Academy of Pediatrics and the US Department of Agriculture:7

  • decreased consumption of fast foods
  • decreased consumption of added table sugar and elimination of sugar-sweetened beverages
  • decreased consumption of high-fat, high sodium, or processed foods
  • consumption of whole fruit rather than fruit juices
  • portion control education
  • reduced saturated dietary fat intake for children and adolescents
  • timely, regular meals, and avoiding constant “grazing” during the day
  • recognizing eating cues in the child’s or adolescent’s environment, such as boredom, stress, loneliness, or screen time
  • encouraging single portion packaging and improved food labeling for easier use by consumers7

 

Physical Activity
It is recommended that a child/adolescent should take 60 minutes of physical activity per day, 20 minutes of which should be moderate to vigorous and should include activities enjoyed by the child/adolescent to improve adherence.7

 

Sleep
Healthy sleep patterns in children can decrease the likelihood of developing obesity due to changes in calorie intake and metabolism related to disordered sleep.7 Talk to parents and caregivers about quantity of sleep required and good bedtime routines.7

 

Treatment should be started and monitored in a specialist paediatric setting by experienced multidisciplinary teams.7, 25

 

Anti-obesity medications may play a role in weight management for children and adolescents with obesity and may be considered an important component of a multimodal approach to managing obesity.25

Bariatric surgery can be considered as a treatment option for adolescents with severe obesity, those with a BMI 140% of 95th percentile for age and sex or BMI 120% of 95th percentile with at least one significant obesity-related complication.7



Surgeons should have specific experience with adolescents, and have a dedicated and experienced multidisciplinary team to provide support before and after the surgical procedure.7 Bariatric surgery requires long-term follow-up of the metabolic and psychosocial needs of the patient and family.7 There may be a role for pharmacotherapy post bariatric surgery and medication review.25

Treatment Approaches for Adolescent Obesity

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1.

World Obesity. World Obesity Atlas 2022. Available at: https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022. Last accessed: June 2022

2.

Lifshitz F. Obesity in children. J Clin Res Pediatr Endocrinol. 2008;1(2):53-60. doi: 10.4008/jcrpe.v1i2.35. Epub 2008 Nov 1. PMID: 21318065; PMCID: PMC3005642.

3.

World Health Organization. Taking Action on Childhood Obesity. Available at: https://iris.who.int/bitstream/handle/10665/274792/WHO-NMH-PND-ECHO-18.1-eng.pdf?ua=1. Last Accessed: February 2021.

4.

Wright SM and Aronne LJ. Causes of obesity. Abdom Imaging. 2012; 37:730–732.

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National Institutes of Health. Clinical Guidelines On The Identification, Evaluation, And Treatment Of Overweight And Obesity In Adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Last accessed: February 2021.

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World Health Organization. Obesity and Overweight Factsheet no. 311. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ Last accessed: February 2021.

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Styne DM, Arslanian SA, Connor EL, et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102:709–757.

8.

Freedman DS, Mei Z, Srinivasan SR, et al. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007; 150:12–17 e12.

9.

Juonala M, Magnussen C, Berenson G, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011; 365:1876–1885. doi:10.1056/NEJMoa1010112.

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Verhulst SL, Van Gaal L, de Backer W, et al. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev 2008. 12:339-346.

11.

Vilmann L.S.et al, Development of Obesity and Polycystic Ovary Syndrome in Adolescents - Accessed via https://www.karger.com/Article/Fulltext/345310) It has been shown that 18.4% of obese adolescents had PCOS. (Witchel et al. guideline)

12.

Hampl SH et all. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023;151(2). Available at: https://publications.aap.org/pediatrics/article/151/2/e2022060641/190440/Executive-Summary-Clinical-Practice-Guideline-for. Last accessed: August 2023.

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Sahoo K, Sahoo B, Choudhury AK, et al. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015; 4:187–192.

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Schwimmer JB, Burwinkle TM and Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003; 289:1813–1819.

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Sawyer MG, Harchak T, Wake M, et al. Four-year prospective study of BMI and mental health problems in young children. Pediatrics. 2011; 128:677–684.

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Strauss RS. Childhood obesity and self-esteem. Pediatrics. 2000; 105:e15.

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Cardel MI, Jastreboff AM and Kelly AS. Treatment of Adolescent Obesity in 2020. JAMA. 2019.

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Matson KL, Fallon RM. Treatment of Obesity in Children and Adolescents. The Journal of Pediatric Pharmacology and Therapeutics. 2012; 17(1) 45–57.

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WHO. Obesity: Preventing and managing the global epidemic. Available at: https://apps.who.int/iris/handle/10665/42330. Last accessed: June 2022.

20.

OAC. Boys Weight-for-Age Percentile Chart. Available at: https://www.obesityaction.org/get-educated/understanding-childhood-obesity/what-is-childhood-obesity/boys-weight-for-age-percentile-chart/. Last accessed: June 2022.

21.

OAC. Girls BMI-for-Age Percentile Chart. Available at: https://www.obesityaction.org/get-educated/understanding-childhood-obesity/what-is-childhood-obesity/girls-bmi-for-age-percentile-chart/. Last accessed: June 2022.

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Greydanus DE, Agana M, Kamboj MK, et al. Pediatric obesity: Current concepts. Dis Mon. 2018; 64:98–156.

23.

Kumar S and Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017; 92:251–265.

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Summerbell C and Brown T. Childhood obesity: the guideline for primary care should form part of a whole-system approach. CMAJ. 2015; 187:389–390.

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Czepiel KS, Perez NP, Campoverde Reyes KJ, et al. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne). 2020 May. 13;11:290. doi: 10.3389/fendo.2020.00290. PMID: 32477270; PMCID: PMC7237714.

26.

Twig G, Zucker I, Afek A, et al. Adolescent Obesity and Early-Onset Type 2 Diabetes. Diabetes Care. 2020; 43:1487-1495. doi:10.2337/dc19-1988