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  • Review Article
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Treatment of adolescent obesity

Nature Reviews Endocrinology volume 14, pages 331–344 (2018)Cite this article

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Abstract

The increased prevalence of adolescent obesity and associated short-term and long-term complications emphasize the need for effective treatment. In this Review, we aim to describe the evidence for, and elements of, behaviour management and adjunctive therapies and highlight the opportunities and challenges presented by obesity management in adolescence. The broad principles of treatment include management of obesity-associated complications; a developmentally appropriate approach; long-term behaviour modification (dietary change, increased physical activity, decreased sedentary behaviours and improved sleep patterns); long-term weight maintenance strategies; and consideration of the use of pharmacotherapy, more intensive dietary therapies and bariatric surgery. Bariatric surgery should be considered in those with severe obesity and be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents. Adolescent obesity management strategies are more reliant on active participation than those for childhood obesity and should recognize the emerging autonomy of the patient. The challenges in adolescent obesity relate primarily to the often competing demands of developing autonomy and not yet having attained neurocognitive maturity.

Key points

  • The preferred treatment approach for adolescent patients with obesity includes management of obesity-associated complications, a developmentally appropriate approach, support for long-term behavioural change, long-term weight maintenance strategies and consideration of other therapies.

  • Long-term weight maintenance therapy, through face-to-face or electronic support, phone coaching or group programmes, is likely to be required.

  • Bariatric surgery should be considered in adolescents with severe obesity (BMI >40 kg/m2, or >35 kg/m2 in the presence of complications), and patients should be treated in centres experienced in bariatric surgery.

  • Pharmacotherapy should be used as adjunctive therapy, particularly in the maintenance of weight loss, and for the treatment of obesity-associated complications.

  • Clinicians should understand where the adolescent is in puberty development — age does not equal stage — and not support beliefs that young people will grow out of obesity with the onset of puberty.

  • Clinicians must work within the contexts of both the normal rapid changes in adolescent brain development and the psychosocial tasks of adolescence that are necessary for mature adulthood.

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Fig. 1: Trends in the number of girls (left panel) and boys (right panel) aged 5–19 years with obesity, by region, from 1975 to 2016.
Fig. 2: Traffic light diet categories18,36,37,113.
Fig. 3: Macronutrient distribution of common diet interventions39,42,43.
Fig. 4: Benefits of exercise in adolescents with obesity55,56,57,58,59,60,61,62.
Fig. 5: Management of comorbidities122,129,130,131,132,133,134.

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References

  1. World Health Organization. Health for the world’s adolescents: a second chance in the second decade. WHO http://www.who.int/maternal_child_adolescent/documents/second-decade/en/ (2014).

  2. Ng, M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet 384, 766–781 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 390, 2627–2642 (2017).

    Article  Google Scholar 

  4. Chung, A. et al. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes. Rev. 17, 276–295 (2016).

    Article  CAS  PubMed  Google Scholar 

  5. Skinner, A. C. & Skelton, J. A. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012. JAMA Pediatr. 168, 561–566 (2014).

    Article  PubMed  Google Scholar 

  6. Garnett, S. P., Baur, L. A., Jones, A. M. & Hardy, L. L. Trends in the prevalence of morbid and severe obesity in Australian children aged 7–15 years, 1985–2012. PLoS ONE 11, e0154879 (2016).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Skinner, A. C., Perrin, E. M. & Skelton, J. A. Prevalence of obesity and severe obesity in US children, 1999–2014. Obesity 24, 1116–1123 (2016).

    Article  PubMed  Google Scholar 

  8. Gordon-Larsen, P., Adair, L. S., Nelson, M. C. & Popkin, B. M. Five-year obesity incidence in the transition period between adolescence and adulthood: the national longitudinal study of adolescent health. Am. J. Clin. Nutr. 80, 569–575 (2004).

    CAS  PubMed  Google Scholar 

  9. Patton, G. C. et al. Overweight and obesity between adolescence and young adulthood: a 10-year prospective cohort study. J. Adolesc. Health 48, 275–280 (2011).

    Article  PubMed  Google Scholar 

  10. Baur, L. A., Hazelton, B. & Shrewsbury, V. A. Assessment and management of obesity in childhood and adolescence. Nat. Rev. Gastroenterol. Hepatol. 8, 635–645 (2011).

    Article  CAS  PubMed  Google Scholar 

  11. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. NHMRC www.nhmrc.gov.au/guidelines/publications/n57 (2013).

  12. National Clinical Guideline Centre (UK). Obesity: identification, assessment and management. NICE www.nice.org.uk/guidance/cg189 (2014).

  13. Parkin, P. et al. Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care. CMAJ 187, 411–421 (2015).

    Article  PubMed  Google Scholar 

  14. Styne, D. M. et al. Pediatric obesity — assessment, treatment, and prevention: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 102, 709–757 (2017).

    Article  PubMed  Google Scholar 

  15. Blakemore, S.-J. Imaging brain development: the adolescent brain. Neuroimage 61, 397–406 (2012).

    Article  PubMed  Google Scholar 

  16. Shulman, E. P. et al. The dual systems model: review, reappraisal, and reaffirmation. Dev. Cogn. Neurosci. 17, 103–117 (2016).

    Article  PubMed  Google Scholar 

  17. Al-Khudairy, L. et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst. Rev. 6, CD012691 (2017).

    PubMed  Google Scholar 

  18. Ho, M. et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 130, e1647–e1671 (2012).

    Article  PubMed  Google Scholar 

  19. Patton, G. C. & Viner, R. Pubertal transitions in health. Lancet 369, 1130–1139 (2007).

    Article  PubMed  Google Scholar 

  20. Moran, A. et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 48, 2039–2044 (1999).

    Article  CAS  PubMed  Google Scholar 

  21. Kelsey, M. M. & Zeitler, P. S. Insulin resistance of puberty. Curr. Diab. Rep. 16, 64 (2016).

    Article  PubMed  CAS  Google Scholar 

  22. Pont, S. J., Puhl, R., Cook, S. R. & Slusser, W. Stigma experienced by children and adolescents with obesity. Pediatrics 140, e20173034 (2017).

    Article  PubMed  Google Scholar 

  23. Puhl, R. M. & Latner, J. D. Stigma, obesity, and the health of the nation’s children. Psychol. Bull. 133, 557 (2007).

    Article  PubMed  Google Scholar 

  24. Tang-Péronard, J. & Heitmann, B. Stigmatization of obese children and adolescents, the importance of gender. Obes. Rev. 9, 522–534 (2008).

    Article  PubMed  Google Scholar 

  25. Dietz, W. H. et al. Management of obesity: improvement of health-care training and systems for prevention and care. Lancet 385, 2521–2533 (2015).

    Article  PubMed  Google Scholar 

  26. Berger, S. E., Huggins, G. S., McCaffery, J. M. & Lichtenstein, A. H. Comparison among criteria to define successful weight-loss maintainers and regainers in the action for health in diabetes (Look AHEAD) and diabetes prevention program trials. Am. J. Clin. Nutr. 106, 1337–1346 (2017).

    Article  PubMed  CAS  Google Scholar 

  27. MacLean, P. S. et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity 23, 7–15 (2015).

    Article  PubMed  Google Scholar 

  28. Rajjo, T. et al. The association of weight loss and cardiometabolic outcomes in obese children: systematic review and meta-regression. J. Clin. Endocrinol. Metab. 102, 758–762 (2016).

    PubMed  Google Scholar 

  29. Ho, M. et al. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 167, 759–768 (2013).

    Article  PubMed  Google Scholar 

  30. Ruotsalainen, H., Kyngäs, H., Tammelin, T. & Kääriäinen, M. Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. J. Adv. Nurs. 71, 2461–2477 (2015).

    Article  PubMed  Google Scholar 

  31. Altman, M. & Wilfley, D. E. Evidence update on the treatment of overweight and obesity in children and adolescents. J. Clin. Child Adolesc. Psychol. 44, 521–537 (2015).

    Article  PubMed  Google Scholar 

  32. Webb, V. L. & Wadden, T. A. Intensive lifestyle intervention for obesity: principles, practices, and results. Gastroenterology 152, 1752–1764 (2017).

    Article  PubMed  Google Scholar 

  33. Oude Luttikhuis, H. et al. Interventions for treating obesity in children. Cochrane Database Syst. Rev. 21, CD001872 (2009).

    Google Scholar 

  34. Samdal, G. B., Eide, G. E., Barth, T., Williams, G. & Meland, E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int. J. Behav. Nutr. Phys. Act. 14, 42 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gow, M. L., Garnett, S. P., Baur, L. A. & Lister, N. B. The effectiveness of different diet strategies to reduce type 2 diabetes risk in youth. Nutrients 8, 486 (2016).

    Article  PubMed Central  CAS  Google Scholar 

  36. Díaz, R. G., Esparza-Romero, J., Moya-Camarena, S. Y., Robles-Sardín, A. E. & Valencia, M. E. Lifestyle intervention in primary care settings improves obesity parameters among Mexican youth. J. Am. Diet Assoc. 110, 285–290 (2010).

    Article  PubMed  Google Scholar 

  37. Epstein, L. H., Wing, R. R., Koeske, R. & Valoski, A. Effects of diet plus exercise on weight change in parents and children. J. Consult. Clin. Psychol. 52, 429 (1984).

    Article  CAS  PubMed  Google Scholar 

  38. Jiang, J. X., Xia, X., Greiner, T., Lian, G. & Rosenqvist, U. A two year family based behaviour treatment for obese children. Arch. Dis. Child. 90, 1235–1238 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Gow, M. L. et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr. Rev. 72, 453–470 (2014).

    Article  PubMed  Google Scholar 

  40. Demol, S. et al. Low-carbohydrate (low and high-fat) versus high-carbohydrate low-fat diets in the treatment of obesity in adolescents. Acta Paediatr. 98, 346–351 (2009).

    Article  CAS  PubMed  Google Scholar 

  41. Kirk, S. et al. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. J. Pediatr. 161, 320–327 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Westerterp-Plantenga, M. S., Nieuwenhuizen, A., Tome, D., Soenen, S. & Westerterp, K. R. Dietary protein, weight loss, and weight maintenance. Annu. Rev. Nutr. 29, 21–41 (2009).

    Article  CAS  PubMed  Google Scholar 

  43. Papadaki, A. et al. The effect of protein and glycemic index on children’s body composition: the DiOGenes randomized study. Pediatrics 126, E1143–E1152 (2010).

    Article  PubMed  Google Scholar 

  44. Schwingshackl, L., Hobl, L. P. & Hoffmann, G. Effects of low glycaemic index/low glycaemic load versus high glycaemic index/ high glycaemic load diets on overweight/obesity and associated risk factors in children and adolescents: a systematic review and meta-analysis. Nutr. J. 14, 87 (2015).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Seimon, R. V. et al. Do intermittent diets provide physiological benefits over continuous diets for weight loss? a systematic review of clinical trials. Mol. Cell. Endocrinol. 418, 153–172 (2015).

    Article  CAS  PubMed  Google Scholar 

  46. Headland, M., Clifton, P. M., Carter, S. & Keogh, J. B. Weight-loss outcomes: a systematic review and meta-analysis of intermittent energy restriction trials lasting a minimum of 6 months. Nutrients 8, 354 (2016).

    Article  PubMed Central  CAS  Google Scholar 

  47. Lister, N. et al. Nutritional adequacy of diets for adolescents with overweight and obesity: considerations for dietetic practice. Eur. J. Clin. Nutr. 71, 646–651 (2017).

    Article  CAS  PubMed  Google Scholar 

  48. Mulholland, Y., Nicokavoura, E., Broom, J. & Rolland, C. Very-low-energy diets and morbidity: a systematic review of longer-term evidence. Br. J. Nutr. 108, 832–851 (2012).

    Article  CAS  PubMed  Google Scholar 

  49. Berkowitz, R. I. et al. Meal replacements in the treatment of adolescent obesity: a randomized controlled trial. Obesity (Silver Spring) 19, 1193–1199 (2011).

    Article  Google Scholar 

  50. Gow, M. L., Baur, L. A., Johnson, N. A., Cowell, C. T. & Garnett, S. P. Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study. Diabetologia 60, 406–415 (2016).

    Article  PubMed  CAS  Google Scholar 

  51. Willi, S. M., Martin, K., Datko, F. M. & Brant, B. P. Treatment of type 2 diabetes in childhood using a very-low-calorie diet. Diabetes Care 27, 348–353 (2004).

    Article  PubMed  Google Scholar 

  52. Moldovan, A. R. & David, D. Effect of obesity treatments on eating behavior: psychosocial interventions versus surgical interventions. a systematic review. Eat Behav. 12, 161–167 (2011).

    Article  PubMed  Google Scholar 

  53. Webber, L., Hill, C., Saxton, J., Van Jaarsveld, C. & Wardle, J. Eating behaviour and weight in children. Int. J. Obes. 33, 21 (2009).

    Article  CAS  Google Scholar 

  54. Ho, M. et al. Effect of a prescriptive dietary intervention on psychological dimensions of eating behavior in obese adolescents. Int. J. Behav. Nutr. Phys. Act 10, 119 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  55. O´Malley, G. et al. Physical activity and physical fitness in pediatric obesity: what are the first steps for clinicians? Expert conclusion from the 2016 ECOG workshop. Int. J. Exerc. Sci. 10, 487–496 (2017).

    Google Scholar 

  56. Ekelund, U. et al. Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study. Diabetologia 50, 1832–1840 (2007).

    Article  CAS  PubMed  Google Scholar 

  57. Janssen, I. & LeBlanc, A. G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int. J. Behav. Nutr. Phys. Act. 7, 40 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lubans, D. et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics 33, e20161642 (2016).

    Article  Google Scholar 

  59. Raitakan, O. T. et al. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults the cardiovascular risk in young Finns study. Am. J. Epidemiol. 140, 195–205 (1994).

    Article  Google Scholar 

  60. Centers for Disease Control and Prevention. The association between school-based physical activity, including physical education, and academic performance. CDC. https://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf (2010).

  61. Paes, S. T., Marins, J. C. B. & Andreazzi, A. E. Metabolic effects of exercise on childhood obesity: a current view. Rev. Paul Pediatr. 33, 122–129 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  62. Gow, M. L. et al. Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention. Obes. Res. Clin. Pract. 10, 178–188 (2016).

    Article  PubMed  Google Scholar 

  63. Australian Government Department of Health. Australia’s physical activity and sedentary behaviour guidelines. Australian Government Department of Health. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines (2014).

  64. Department of Health (UK). UK physical activity guidelines. GOV.UK https://www.gov.uk/government/publications/uk-physical-activity-guidelines (2011).

  65. The Public Health Agency of Canada. 24 h movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/physical-activity/24-hour-movement-guidelines-children-youth.html (2016).

  66. Office of Disease Prevention and Health Promotion. Physical Activity Guidelines for Americans. health.gov https://health.gov/paguidelines/guidelines/ (2008).

  67. Stearns, J. A., Carson, V., Spence, J. C., Faulkner, G. & Leatherdale, S. T. The role of peer victimization in the physical activity and screen time of adolescents: a cross-sectional study. BMC Pediatr. 17, 170 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  68. Tsiros, M. et al. Day-to-day physical functioning and disability in obese 10-to 13-year-olds. Pediatr. Obes. 8, 31–41 (2013).

    Article  CAS  PubMed  Google Scholar 

  69. Tsiros, M. D., Coates, A. M., Howe, P., Grimshaw, P. & Buckley, J. D. Obesity: the new childhood disability? Obes. Rev. 12, 26–36 (2011).

    Article  CAS  PubMed  Google Scholar 

  70. Fedele, D. A., Cushing, C. C., Fritz, A., Amaro, C. M. & Ortega, A. Mobile health interventions for improving health outcomes in youth: a meta-analysis. JAMA Pediatr. 171, 461–469 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Cappuccio, F. P. et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 31, 619–626 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Fatima, Y. & Mamun, A. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis. Obes. Rev. 16, 137–149 (2015).

    Article  CAS  PubMed  Google Scholar 

  73. Thomson, C. A. et al. Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity 20, 1419–1425 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Chaput, J.-P. & Tremblay, A. Sleeping habits predict the magnitude of fat loss in adults exposed to moderate caloric restriction. Obes. Facts 5, 561–566 (2012).

    Article  PubMed  Google Scholar 

  75. Capers, P. L., Fobian, A. D., Kaiser, K. A., Borah, R. & Allison, D. B. A systematic review and meta-analysis of randomized controlled trials of the impact of sleep duration on adiposity and components of energy balance. Obes. Rev. 16, 771–782 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Yoong, S. L. et al. Systematic review and meta-analysis of interventions targeting sleep and their impact on child body mass index, diet, and physical activity. Obesity 24, 1140–1147 (2016).

    Article  PubMed  Google Scholar 

  77. Chaput, J.-P. & Dutil, C. Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors. Int. J. Behav. Nutr. Phys. Act 13, 103 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  78. Carroll, J. K. et al. Who uses mobile phone health apps and does use matter? a secondary data analytics approach. J. Med. Internet Res. 19, e125 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Jakicic, J. M. et al. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: the IDEA randomized clinical trial. JAMA 316, 1161–1171 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  80. van der Zanden, R., Kramer, J., Gerrits, R. & Cuijpers, P. Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. J. Med. Internet Res. 14, e86 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  81. Mead, E. et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst. Rev. 6, CD012651 (2017).

    PubMed  Google Scholar 

  82. Wiegand, S. et al. Predicting weight loss and maintenance in overweight/obese pediatric patients. Horm. Res. Paediatr. 82, 380–387 (2014).

    Article  CAS  PubMed  Google Scholar 

  83. Gow, M. L. et al. Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial? Int. J. Behav. Nutr. Phys. Act. 13, 1–11 (2016).

    Article  Google Scholar 

  84. Mead, E. et al. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst. Res. 11, CD012436 (2016).

    Google Scholar 

  85. Van Gaal, L. & Scheen, A. Weight management in type 2 diabetes: current and emerging approaches to treatment. Diabetes Care 38, 1161–1172 (2015).

    Article  PubMed  Google Scholar 

  86. Paravattil, B., Wilby, K. J. & Turgeon, R. Topiramate monotherapy for weight reduction in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 114, 9–14 (2016).

    Article  CAS  PubMed  Google Scholar 

  87. Fox, C. K. et al. Meal replacements followed by topiramate for the treatment of adolescent severe obesity: a pilot randomized controlled trial. Obesity 24, 2553–2561 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Joao, A., Reis, F. & Fernandes, R. The incretin system ABCs in obesity and diabetes–novel therapeutic strategies for weight loss and beyond. Obes. Rev. 17, 553–572 (2016).

    Article  CAS  PubMed  Google Scholar 

  89. Tong, J. & Sandoval, D. A. Is the GLP-1 system a viable therapeutic target for weight reduction? Rev. Endocr. Metab. Disord. 12, 187–195 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Davies, M. et al. Effect of oral semaglutide compared with placebo and subcutaneous semaglutide on glycemic control in patients with type 2 diabetes: a randomized clinical trial. JAMA 318, 1460–1470 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Kelly, A. S. et al. The effect of glucagon-like peptide-1 receptor agonist therapy on body mass index in adolescents with severe obesity: a randomized, placebo-controlled, clinical trial. JAMA Pediatr. 167, 355–360 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Vidal, J., Corcelles, R., Jiménez, A., Flores, L. & Lacy, A. M. Metabolic and bariatric surgery for obesity. Gastroenterology 152, 1780–1790 (2017).

    Article  PubMed  Google Scholar 

  93. O’Brien, P. E. et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 303, 519–526 (2010).

    Article  PubMed  Google Scholar 

  94. Ells, L. J. et al. Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst. Res. 6, CD011740 (2015).

    Google Scholar 

  95. Paulus, G. F. et al. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes. Surg. 25, 860–878 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  96. Inge, T. H. et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N. Engl. J. Med. 374, 113–123 (2016).

    Article  CAS  PubMed  Google Scholar 

  97. Beamish, A. J. & Reinehr, T. Should bariatric surgery be performed in adolescents? Eur. J. Endocrinol. 176, D1–D15 (2017).

    Article  CAS  PubMed  Google Scholar 

  98. Inge, T. H. et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics 114, 217–223 (2004).

    Article  PubMed  Google Scholar 

  99. International Pediatric Endosurgery Group. IPEG guidelines for surgical treatment of extremely obese adolescents. J Laparoendosc. Adv. Surg. Tech. 19 (Suppl. 1), xiv–xvi (2009).

    Google Scholar 

  100. Baur, L. A. & Fitzgerald, D. A. Recommendations for bariatric surgery in adolescents in Australia and New Zealand. J. Paediatr. Child Health 46, 704–707 (2010).

    Article  PubMed  Google Scholar 

  101. Michalsky, M., Reichard, K., Inge, T., Pratt, J. & Lenders, C. ASMBS pediatric committee best practice guidelines. Surg. Obes. Relat. Dis. 8, 1–7 (2012).

    Article  PubMed  Google Scholar 

  102. Pulgarón, E. R. Childhood obesity: a review of increased risk for physical and psychological comorbidities. Clin. Ther. 35, A18–A32 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  103. Agirbasli, M., Tanrikulu, A. M. & Berenson, G. S. Metabolic syndrome: bridging the gap from childhood to adulthood. Cardiovasc. Ther. 34, 30–36 (2016).

    Article  PubMed  Google Scholar 

  104. Cook, S., Weitzman, M., Auinger, P., Nguyen, M. & Dietz, W. H. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third national health and nutrition examination survey, 1988–1994. Arch. Pediatr. Adolesc. Med. 157, 821–827 (2003).

    Article  PubMed  Google Scholar 

  105. Ford, E. S. & Li, C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J. Pediatr. 152, 160–164 (2008).

    Article  PubMed  Google Scholar 

  106. Reinehr, T. Metabolic syndrome in children and adolescents: a critical approach considering the interaction between pubertal stage and insulin resistance. Curr. Diab. Rep. 16, 8 (2016).

    Article  PubMed  CAS  Google Scholar 

  107. Zimmet, P. et al. The metabolic syndrome in children and adolescents–an IDF consensus report. Pediatr. Diabetes 8, 299–306 (2007).

    Article  PubMed  Google Scholar 

  108. Pernia, S. & DeMaagd, G. The new pregnancy and lactation labeling rule. P. T. 41, 713 (2016).

    PubMed  PubMed Central  Google Scholar 

  109. European Medicines Agency. Good pharmacovigilance practices. EMA http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000345.jsp&mid=WC0b01ac058058f32c (2017).

  110. Therapeutic Goods Administration (Australia). Prescribing medicines in pregnancy database. TGA https://www.tga.gov.au/australian-categorisation-system-prescribing-medicines-pregnancy (2017).

  111. Andersen, I. G., Holm, J. C. & Homøe, P. Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment–a systematic review. Int. J. Pediatr. Otorhinolaryngol. 87, 190–197 (2016).

    Article  PubMed  Google Scholar 

  112. Doycheva, I., Watt, K. D. & Alkhouri, N. Nonalcoholic fatty liver disease in adolescents and young adults: the next frontier in the epidemic. Hepatology 65, 2100–2109 (2017).

    Article  PubMed  Google Scholar 

  113. Bitersohl, B., Hosalkar, H. S., Zilkens, C. & Krauspe, R. Current concepts in management of slipped capital femoral epiphysis. Hip. Int. 25, 104–114 (2015).

    Article  Google Scholar 

  114. Lewandowski, R. E. et al. Evidence for the management of adolescent depression. Pediatrics 132, e996–e1009 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  115. Wehry, A. M., Beesdo-Baum, K., Hennelly, M. M., Connolly, S. D. & Strawn, J. R. Assessment and treatment of anxiety disorders in children and adolescents. Curr. Psychiatry Rep. 17, 52 (2015).

    Article  PubMed  Google Scholar 

  116. Zeitler, P. et al. Type 2 diabetes in the child and adolescent. Pediatr. Diabetes 15, 26–46 (2014).

    Article  CAS  PubMed  Google Scholar 

  117. International Society for Pediatric and Adolescent Diabetes. ISPAD clinical practice consensus guidelines 2014. ISPAD http://www.ispad.org/?page=ISPADClinicalPract (2014).

  118. Caprio, S., Perry, R. & Kursawe, R. Adolescent obesity and insulin resistance: roles of ectopic fat accumulation and adipose inflammation. Gastroenterology 152, 1638–1646 (2017).

    Article  CAS  PubMed  Google Scholar 

  119. van Vliet, M. et al. Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J. Pediatr. 156, 923–929 (2010).

    Article  PubMed  Google Scholar 

  120. Kit, B. K. et al. Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999–2012. JAMA Pediatr. 169, 272–279 (2015).

    Article  PubMed  Google Scholar 

  121. Bays, H. E., Jones, P. H., Orringer, C. E., Brown, W. V. & Jacobson, T. A. National lipid association annual summary of clinical lipidology 2016. J. Clin. Lipidol. 10, S1–S43 (2016).

    Article  PubMed  Google Scholar 

  122. Oh, R. C. & Lanier, J. B. Management of hypertriglyceridemia. Am. Fam. Physician. 75, 1365–1371 (2007).

    PubMed  Google Scholar 

  123. Flynn, J. T. et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017).

    Article  PubMed  Google Scholar 

  124. Legro, R. S. et al. Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4565–4592 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Glintborg, D. et al. Body composition is improved during 12 months’ treatment with metformin alone or combined with oral contraceptives compared with treatment with oral contraceptives in polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 99, 2584–2591 (2014).

    Article  CAS  PubMed  Google Scholar 

  126. World Health Organization. Report of the commission on ending childhood obesity. WHO http://www.who.int/end-childhood-obesity/publications/echo-report/en/ (2016).

  127. Steinbeck, K., Towns, S. & Bennett, D. Adolescent and young adult medicine is a special and specific area of medical practice. J. Paediatr. Child Health 50, 427–431 (2014).

    Article  PubMed  Google Scholar 

  128. Shrewsbury, V., Baur, L., Nguyen, B. & Steinbeck, K. Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic. Int. J. Obes. 38, 475 (2014).

    Article  CAS  Google Scholar 

  129. Chapman, L., Darling, A. & Brown, J. Association between metformin and vitamin B 12 deficiency in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Metab. 42, 316–327 (2016).

    Article  CAS  PubMed  Google Scholar 

  130. Gallo, M. F. et al. Combination contraceptives: effects on weight. Cochrane Database Syst. Rev. 25, CD003987 (2014).

    Google Scholar 

  131. Romo, A. & Benavides, S. Treatment options in insulin resistance obesity–related acanthosis nigricans. Ann. Pharmacother. 42, 1090–1094 (2008).

    Article  CAS  PubMed  Google Scholar 

  132. McDonagh, M. S., Selph, S., Ozpinar, A. & Foley, C. Systematic review of the benefits and risks of metformin in treating obesity in children aged 18 years and younger. JAMA Pediatr. 168, 178–184 (2014).

    Article  PubMed  Google Scholar 

  133. Marcus, C. L. et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130, e714–e755 (2012).

    Article  PubMed  Google Scholar 

  134. National Institute for Health Care and Excellence. Depression in children and young people: identification and management: clinical guideline [CG28]. NICE. https://www.nice.org.uk/guidance/cg28 (2017).

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Authors and Affiliations

  1. Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia

    Katharine S. Steinbeck, Natalie B. Lister & Louise A. Baur

  2. Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

    Natalie B. Lister & Megan L. Gow

  3. Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

    Louise A. Baur

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  1. Katharine S. Steinbeck
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All authors contributed to researching data for the article, discussion of content, writing the article and reviewing and/or editing the manuscript before submission.

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Correspondence to Louise A. Baur.

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Review criteria

This narrative review is based upon data from systematic reviews, review papers and individual studies known to the authors. Other studies were identified by a MEDLINE search of English language papers published up to 2017 using the search terms “obesity” and “adolescent” and then further refined using such terms as “bariatric surgery”, “behaviour therapy”, “drug therapy”, “diet”, “exercise”, “physical activity”, “weight maintenance” or “sleep”. Where appropriate, reviews or studies of obesity treatment involving children or adults were included in the Review. Reference lists of key papers were also checked to identify additional papers of interest. We also searched for clinical guidelines on the management of adolescent obesity. For the latter to be considered, the guidelines had to be developed or endorsed by a national or international health professional body or government agency and available in English.

Related links

Australian Government Department of Health: https://www.tga.gov.au/australian-categorisation-system-prescribing-medicines-pregnancy

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Steinbeck, K.S., Lister, N.B., Gow, M.L. et al. Treatment of adolescent obesity. Nat Rev Endocrinol 14, 331–344 (2018). https://doi.org/10.1038/s41574-018-0002-8

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