Obesity in Adolescents: Prevalence, Health Effects, and Treatment Options
Adolescent obesity rates have risen in recent years, and a number of treatment options can be taken to help reduce the risk of a variety of associated medical problems.
Adolescent obesity affects 21% of patients aged 12 to 18 years, and it is associated with a number of adverse outcomes, according to a review published in JAMA.1
Obesity in Adolescents: Prevalence, Health Effects, and Treatment Options / Protsenko Dmitriy - stock.adobe.com
Lifestyle modification, antiobesity medications, and surgery represent treatment options for this population that can help reduce adverse outcomes.
In adolescents aged 12 to 18 years, obesity is defined as a body mass index (BMI) in the 95th or greater age- and sex-adjusted percentile. In this review, the researchers sought to summarize the current evidence on adolescent obesity, including epidemiology, pathophysiology, diagnosis, and treatment.
The review included articles published from January 1, 2013 through April 1, 2024, comprised of epidemiological, longitudinal, and cross-sectional studies in addition to randomized clinical trials, comparative effectiveness studies, systematic reviews, meta-analyses, narrative reviews, and clinical practice guidelines. In total, the researchers selected 92 articles: 6 randomized clinical trials, 11 meta-analyses/systematic reviews, 38 studies, 7 clinical practice guidelines, 9 policy guidelines, and 21 narrative reviews.
READ MORE: Pediatric Obesity Treatment Reduced Mortality, Long-Term Morbidity in Young Adults
From 1999 to 2002, the prevalence of adolescent obesity was 16%, which increased to 20.9% in 2015 to 2018. Severe obesity, defined as a BMI of 120% or greater in the 95th percentile or a BMI of ≥35, increased from 5.3% to 7.6% during this time period. The researchers found that adolescent obesity rates varied by race and ethnicity, with a higher prevalence in non-Hispanic Black (28%) and Mexican American (31%) adolescents compared with non-Hispanic White adolescents (16%).
The researchers identified several risk factors for adolescent obesity, including genetic, environmental, lifestyle, and social factors. Adolescents who had ≥2 hours of screen time per day had an increased risk of obesity (OR 1.67); those with shortened sleep duration also had an increased risk, with every 1 hour of additional sleep per night representing a 21% decrease in obesity risk. Poverty, food insecurity, and adverse childhood experiences represented additional risks for adolescent obesity.
Adolescent obesity is associated with a number of adverse health outcomes, including hypertension, metabolic dysfunction-associated steatotic liver disease, dyslipidemia, sleep disorders, musculoskeletal problems, depression, anxiety, and eating disorders. The review also found that, compared with adolescents with overweight, adolescents with obesity had a higher
prevalence of high total cholesterol level (10.8% vs. 19.4%), low high-density lipoprotein cholesterol level (7.8% vs. 23%), high triglyceride level (12.2% vs. 29%), high systolic and diastolic blood pressure (0.3% vs 3.8%), and high glycated hemoglobin level (15.6% vs 24.3%).
Several treatment options exist for adolescent obesity. When used as a first-line monotherapy, lifestyle modification (including dietary, physical activity, and behavioral counseling), requires over 26 contact hours over 1 year to result in a 3% mean BMI reduction. In combination with lifestyle modification, new antiobesity medications like liraglutide, semaglutide, and phentermine/topiramate can result in 5% to 17% BMI reductions in 1 year. For severe adolescent obesity, surgeries like Roux-en-Y gastric bypass and vertical sleeve gastrectomy result in mean BMI reductions of 30% at 1 year. While surgery is the most effective intervention, the researchers found that 15% of patients require reoperation and 8% require hospital readmission.
When broaching the conversation of adolescent obesity with patients, the researchers stress a compassionate approach that does not blame parents or adolescents due to the complex etiology of obesity. “Clinicians should be supportive and compassionate, and engage in nonstigmatizing communication with adolescent patients and their families,” the researchers wrote. However, due to the risks associated with adolescent obesity, the researchers recommend immediate, intensive intervention in this patient population.
READ MORE: Obesity Management Resource Center
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