Working toward precision medicine approaches to treat severe obesity in adolescents: report of an NIH workshop

Article metrics


Adolescent severe obesity is a prevalent, chronic, and serious disease with few effective and safe treatment options. To address this issue, a National Institutes of Health-sponsored workshop entitled “Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents,” was convened, bringing together a multidisciplinary group of experts to review the current state of the science and identify (1) what is known regarding the epidemiology and biopsychosocial determinants of severe obesity in adolescents, (2) what is known regarding effectiveness of treatments for severe obesity in adolescents and predictors of response, and (3) gaps and opportunities for future research to develop more effective and targeted treatments for adolescents with severe obesity. Major topical areas discussed at the workshop included: appropriate BMI metrics, valid measures of phenotypes and predictors, mechanisms associated with the development of severe obesity, novel treatments informed by biologically and psychosocially plausible mechanisms, biopsychosocial phenotypes predicting treatment response, standardization of outcome measures and results reporting in research, and improving clinical care. Substantial gaps in knowledge were identified regarding the basic behavioral, psychosocial, and biological mechanisms driving the development of severe obesity and the influence of these factors on treatment response. Additional exploratory and observational studies are needed to better understand the heterogeneous etiology of severe obesity and explain the high degree of variability observed with interventions. Tailored treatment strategies that may be developed by achieving a better understanding of individual differences in genetic endowment, clinical, metabolic, psychological, and behavioral phenotypes, and response to environmental exposures need to be tested. It is anticipated that these recommendations for future research, including strategies to enhance methodological rigor, will advance precision medicine approaches to treat severe obesity in adolescents more effectively.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Farpour-Lambert NJ, Baker JL, Hassapidou M, Holm JC, Nowicka P, O’Malley G, et al. Childhood obesity is a chronic disease demanding specific health care--a position statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obes Facts. 2015;8:342–9.

  2. 2.

    Skinner AC, Perrin EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999-2014. Obesity (Silver Spring). 2016;24:1116–23.

  3. 3.

    Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics, (in press).

  4. 4.

    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017;288:1–8.

  5. 5.

    Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015-2016. JAMA. 2018;319:1723–5.

  6. 6.

    Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128:1689–712.

  7. 7.

    Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315:2292–9.

  8. 8.

    Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med. 2015;373:1307–17.

  9. 9.

    Norris AL, Steinberger J, Steffen LM, Metzig AM, Schwarzenberg SJ, Kelly AS. Circulating oxidized LDL and inflammation in extreme pediatric obesity. Obesity (Silver Spring). 2011;19:1415–9.

  10. 10.

    Fox CK, Gross AC, Rudser KD, Foy AM, Kelly AS. Depression, anxiety, and severity of obesity in adolescents: is emotional eating the link? Clin Pediatr (Phila). 2016;55:1120–5.

  11. 11.

    Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007;150:12–7.

  12. 12.

    Lo JC, Chandra M, Sinaiko A, Daniels SR, Prineas RJ, Maring B, et al. Severe obesity in children: prevalence, persistence and relation to hypertension. Int J Pediatr Endocrinol. 2014;2014:3.

  13. 13.

    Danielsson P, Kowalski J, Ekblom O, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med. 2012;166:1103–8.

  14. 14.

    Kalarchian MA, Levine MD, Arslanian SA, Ewing LJ, Houck PR, Cheng Y, et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics. 2009;124:1060–8.

  15. 15.

    Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes. 2015;10:7–14.

  16. 16.

    Kelly AS, Fox CK, Rudser KD, Gross AC, Ryder JR. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. Int J Obes (Lond). 2016;40:1043–50.

  17. 17.

    Sherafat-Kazemzadeh R, Yanovski SZ, Yanovski JA. Pharmacotherapy for childhood obesity: present and future prospects. Int J Obes (Lond). 2013;37:1–15.

  18. 18.

    Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr. 2014;168:47–53.

  19. 19.

    Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374:113–23.

  20. 20.

    Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol. 2017;5:174–83.

  21. 21.

    O’Connor EA, Evans CV, Burda BU, Walsh ES, Eder M, Lozano P. Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US preventive services task force. JAMA. 2017;317:2427–44.

  22. 22.

    Parkin P, Connor GS, Shaw E, Bell N, Jaramillo A, Tonelli M, et al. Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care. Can Med Assoc J. 2015;187:411–21.

  23. 23.

    Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric obesity-assessment, treatment, and prevention: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:709–57.

  24. 24.

    Holm JC, Nowicka P, Farpour-Lambert NJ, O’Malley G, Hassapidou M, Weiss R, et al. The ethics of childhood obesity treatment - from the Childhood Obesity Task Force (COTF) of European Association for the Study of Obesity (EASO). Obes Facts. 2014;7:274–81.

  25. 25.

    Wilfley DE, Staiano AE, Altman M, Lindros J, Lima A, Hassink SG, et al. Improving access and systems of care for evidence-based childhood obesity treatment: conference key findings and next steps. Obesity (Silver Spring). 2017;25:16–29.

  26. 26.

    Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol. 1994;13:373–83.

  27. 27.

    Johnston CA, Tyler C, Palcic JL, Stansberry SA, Gallagher MR, Foreyt JP. Smaller weight changes in standardized body mass index in response to treatment as weight classification increases. J Pediatr. 2011;158:624–7.

  28. 28.

    Savoye M, Shaw M, Dziura J, Tamborlane WV, Rose P, Guandalini C, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA. 2007;297:2697–704.

  29. 29.

    Savoye M, Nowicka P, Shaw M, Yu S, Dziura J, Chavent G, et al. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics. 2011;127:402–10.

  30. 30.

    Luca P, Dettmer E, Khoury M, Grewal P, Manlhiot C, McCrindle BW, et al. Adolescents with severe obesity: outcomes of participation in an intensive obesity management programme. Pediatr Obes. 2015;10:275–82.

  31. 31.

    Unick JL, Beavers D, Bond DS, Clark JM, Jakicic JM, Kitabchi AE, et al. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Am J Med. 2013;126:236–42, 242.

  32. 32.

    Dietz WH, Solomon LS, Pronk N, Ziegenhorn SK, Standish M, Longjohn MM, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff (Millwood). 2015;34:1456–63.

  33. 33.

    Kelly AS, Fox CK. Pharmacotherapy in the management of pediatric obesity. Curr Diab Rep. 2017;17:55.

  34. 34.

    Rajjo T, Mohammed K, Alsawas M, Ahmed AT, Farah W, Asi N, et al. Treatment of pediatric obesity: an uumbrella systematic review. J Clin Endocrinol Metab. 2017;102:763–75.

  35. 35.

    Fidler MC, Sanchez M, Raether B, Weissman NJ, Smith SR, Shanahan WR, et al. A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: the BLOSSOM trial. J Clin Endocrinol Metab. 2011;96:3067–77.

  36. 36.

    Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010;363:245–56.

  37. 37.

    Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377:1341–52.

  38. 38.

    Apovian CM, Aronne L, Rubino D, Still C, Wyatt H, Burns C, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity (Silver Spring). 2013;21:935–43.

  39. 39.

    Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010;376:595–605.

  40. 40.

    Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373:11–22.

  41. 41.

    Kuhnen P, Clement K, Wiegand S, Blankenstein O, Gottesdiener K, Martini LL, et al. Proopiomelanocortin deficiency treated with a melanocortin-4 receptor agonist. N Engl J Med. 2016;375:240–6.

  42. 42.

    Saber AA, Shoar S, Almadani MW, Zundel N, Alkuwari MJ, Bashah MM, et al. Efficacy of first-time intragastric balloon in weight loss: a systematic review and meta-analysis of randomized controlled trials. Obes Surg. 2017;27:277–87.

  43. 43.

    De PF, Caccamo R, Adorisio O, Ceriati E, Marchetti P, Contursi A, et al. The Obalon swallowable intragastric balloon in pediatric and adolescent morbid obesity. Endosc Int Open. 2017;5:E59–63.

  44. 44.

    Fittipaldi-Fernandez RJ, Guedes MR, Galvao Neto MP, Klein MRST, Diestel CF. Efficacy of intragastric balloon treatment for adolescent obesity. Obes Surg. 2017;27:2546–51.

  45. 45.

    Nobili V, Corte CD, Liccardo D, Mosca A, Caccamo R, Morino GS, et al. Obalon intragastric balloon in the treatment of paediatric obesity: a pilot study. Pediatr Obes. 2015;10:e1–4.

  46. 46.

    Reece LJ, Sachdev P, Copeland RJ, Thomson M, Wales JK, Wright NP. Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; impact on weight, physical activity, cardiorespiratory fitness and psychosocial well-being. Int J Obes (Lond). 2017;41:591–7.

  47. 47.

    Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5:165–73.

  48. 48.

    Kelly AS, Ryder JR, Marlatt KL, Rudser KD, Jenkins T, Inge TH. Changes in inflammation, oxidative stress and adipokines following bariatric surgery among adolescents with severe obesity. Int J Obes (Lond). 2016;40:275–80.

  49. 49.

    Ryder JR, Edwards NM, Gupta R, Khoury J, Jenkins TM, Bout-Tabaku S, et al. Changes in functional mobility and musculoskeletal pain after bariatric surgery in teens with severe obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Pediatr. 2016;170:871–7.

  50. 50.

    Ryder JR, Gross AC, Fox CK, Kaizer AM, Rudser KD, Jenkins TM, et al. Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obes (Lond). 2018;42:102–7.

  51. 51.

    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat. 2002;246:1–190.

  52. 52.

    Freedman DS, Butte NF, Taveras EM, Lundeen EA, Blanck HM, Goodman AB, et al. BMI z-scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014. Obesity (Silver Spring). 2017;25:739–46.

  53. 53.

    Freedman DS, Berenson GS. Tracking of BMI z scores for severe obesity. Pediatrics 2017;140:e20171072.

  54. 54.

    Freedman DS, Butte NF, Taveras EM, Goodman AB, Ogden CL, Blanck HM. The limitations of transforming very high body mass indexes into z-scores among 8.7 million 2- to 4-year-old children. J Pediatr. 2017;188:50–6.

  55. 55.

    Woo JG. Using body mass index Z-score among severely obese adolescents: a cautionary note. Int J Pediatr Obes. 2009;4:405–10.

  56. 56.

    Berkey CS, Colditz GA. Adiposity in adolescents: change in actual BMI works better than change in BMI z score for longitudinal studies. Ann Epidemiol. 2007;17:44–50.

  57. 57.

    Cole TJ, Faith MS, Pietrobelli A, Heo M. What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile? Eur J Clin Nutr. 2005;59:419–25.

  58. 58.

    Flegal KM, Wei R, Ogden CL, Freedman DS, Johnson CL, Curtin LR. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr. 2009;90:1314–20.

  59. 59.

    Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: a new growth chart. Pediatrics. 2012;130:1136–40.

  60. 60.

    Flegal KM, Ogden CL, Yanovski JA, Freedman DS, Shepherd JA, Graubard BI, et al. High adiposity and high body mass index-for-age in US children and adolescents overall and by race-ethnic group. Am J Clin Nutr. 2010;91:1020–6.

  61. 61.

    Peterson CM, Su H, Thomas DM, Heo M, Golnabi AH, Pietrobelli A, et al. Tri-ponderal mass index vs body mass index in estimating body fat during adolescence. JAMA Pediatr. 2017;171:629–36.

  62. 62.

    Bandini LG, Schoeller DA, Cyr HN, Dietz WH. Validity of reported energy intake in obese and nonobese adolescents. Am J Clin Nutr. 1990;52:421–5.

  63. 63.

    Livingstone MB, Robson PJ. Measurement of dietary intake in children. Proc Nutr Soc. 2000;59:279–93.

  64. 64.

    Singh R, Martin BR, Hickey Y, Teegarden D, Campbell WW, Craig BA, et al. Comparison of self-reported, measured, metabolizable energy intake with total energy expenditure in overweight teens. Am J Clin Nutr. 2009;89:1744–50.

  65. 65.

    Vannucci A, Nelson EE, Bongiorno DM, Pine DS, Yanovski JA, Tanofsky-Kraff M. Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems. Psychol Med. 2015;45:2921–36.

  66. 66.

    Schoeller DA. Recent advances from application of doubly labeled water to measurement of human energy expenditure. J Nutr. 1999;129:1765–8.

  67. 67.

    McLeod LD, Coon CD, Martin SA, Fehnel SE, Hays RD. Interpreting patient-reported outcome results: US FDA guidance and emerging methods. Expert Rev Pharm Outcomes Res. 2011;11:163–9.

  68. 68.

    Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813–9.

  69. 69.

    Yanovski SZ, Yanovski JA. Toward precision approaches for the prevention and treatment of obesity. JAMA. 2018;319:223–4.

  70. 70.

    Yanovski JA. Pediatric obesity. Introd Appetite. 2015;93:3–12.

  71. 71.

    Filbey FM, Yezhuvath US. A multimodal study of impulsivity and body weight: integrating behavioral, cognitive, and neuroimaging approaches. Obesity (Silver Spring). 2017;25:147–54.

  72. 72.

    Stice E, Yokum S. Neural vulnerability factors that increase risk for future weight gain. Psychol Bull. 2016;142:447–71.

  73. 73.

    Hjorth MF, Roager HM, Larsen TM, Poulsen SK, Licht TR, Bahl MI, et al. Pre-treatment microbial Prevotella-to-Bacteroides ratio, determines body fat loss success during a 6-month randomized controlled diet intervention. Int J Obes (Lond). 2018;42:284.

  74. 74.

    Balantekin KN, Hayes JF, Sheinbein DH, Kolko RP, Stein RI, Saelens BE, et al. Patterns of eating disorder pathology are associated with weight change in family-based behavioral obesity treatment. Obesity (Silver Spring). 2017;25:2115–22.

  75. 75.

    Bouhlal S, McBride CM, Trivedi NS, Agurs-Collins T, Persky S. Identifying eating behavior phenotypes and their correlates: a novel direction toward improving weight management interventions. Appetite. 2017;111:142–50.

  76. 76.

    Kelly NR, Shomaker LB, Pickworth CK, Brady SM, Courville AB, Bernstein S, et al. A prospective study of adolescent eating in the absence of hunger and body mass and fat mass outcomes. Obesity (Silver Spring). 2015;23:1472–8.

  77. 77.

    Tanofsky-Kraff M, Cohen ML, Yanovski SZ, Cox C, Theim KR, Keil M, et al. A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity. Pediatrics. 2006;117:1203–9.

  78. 78.

    Bryan AD, Jakicic JM, Hunter CM, Evans ME, Yanovski SZ, Epstein LH. Behavioral and psychological phenotyping of physical activity and sedentary behavior: implications for weight management. Obesity (Silver Spring). 2017;25:1653–9.

  79. 79.

    MacLean PS, Rothman AJ, Nicastro HL, Czajkowski SM, Agurs-Collins T, Rice EL, et al. The accumulating data to optimally predict obesity treatment (ADOPT) core measures project: rationale and approach. Obesity (Silver Spring). 2018;26(Suppl 2):S6–15.

  80. 80.

    Jasik CB, King EC, Rhodes E, Sweeney B, Mietus-Snyder M, Grow HM, et al. Characteristics of youth presenting for weight management: retrospective National Data from the POWER Study Group. Child Obes. 2015;11:630–7.

  81. 81.

    Kirk S, Armstrong S, King E, Trapp C, Grow M, Tucker J, et al. Establishment of the pediatric obesity weight evaluation registry: a national research collaborative for identifying the optimal assessment and treatment of pediatric obesity. Child Obes. 2017;13:9–17.

Download references


The concepts and ideas presented in this article were conceived by the organizers and participants in a 2017 NIH-sponsored workshop entitled “Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents.” The authors are grateful for the commitment and dedication from the organizing committee members and speakers for participating in pre-workshop conversations to develop the individual sessions and overall themes. They would also like to express their gratitude to the workshop speakers, discussants, facilitators, and attendees for providing insightful and interactive discussions and recommendations regarding the treatment of severe obesity in adolescents throughout the workshop. Funding for the workshop described in this article was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Heart, Lung and Blood Institute, Office of Behavioral and Social Sciences Research and Office of Disease Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the U.S. Public Health Service.

Workshop co-chairs

Aaron S. Kelly, Ph.D., Center for Pediatric Obesity Medicine, University of Minnesota Medical School; Marsha D. Marcus, Ph.D., University of Pittsburgh School of Medicine; and Jack A. Yanovski, M.D., Ph.D., Eunice Kennedy Shriver National Institute of Child Health and Human Development.

NIH organizing committee members

National Institutes of Diabetes and Digestive and Kidney Diseases: Andrew Bremer, M.D., Mary Evans, Ph.D., Robert Kuczmarski, Dr.PH, Barbara Linder, M.D., Ph.D., Stavroula K. Osganian, M.D., Sc.D., M.P.H. (chair), Pamela Thornton, Ph.D., and Susan Yanovski, M.D.; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health: Layla Esposito, Ph.D., M.A.; National Heart, Lung, and Blood Institute: Charlotte Pratt, Ph.D., R.D.; Office of Behavioral and Social Sciences Research: Christine Hunter, Ph.D., ABPP and Deborah Young-Hyman, Ph.D.; and Office of Disease Prevention: Rachel Ballard, M.D., M.P.H.


Kerri Boutelle, Ph.D., University of California, San Diego School of Medicine; Molly Bray, Ph.D., R.D., L.D., The University of Texas at Austin; Charles Burant, M.D., Ph.D., University of Michigan; Stephen Cook, M.D., M.P.H., University of Rochester Medical Center; Eli Sadaf Farooqi, MBChB, Ph.D., University of Cambridge; Ania Jastreboff, M.D., Ph.D., Yale University School of Medicine; Elissa Jelalian, Ph.D., Alpert Medical School of Brown University; Lee Kaplan, M.D., Ph.D., Harvard Medical School, Massachusetts General Hospital; Aaron S. Kelly, Ph.D., University of Minnesota Medical School; Shelley Kirk, Ph.D., R.D., L.D., Cincinnati Children’s Hospital Medical Center; Thomas Inge, M.D., Ph.D., Children’s Hospital Colorado; Marsha D. Marcus, Ph.D., University of Pittsburgh School of Medicine; Cynthia Ogden, Ph.D., Centers for Disease Control and Prevention; and Meg Zeller, Ph.D., Cincinnati Children’s Hospital Medical Center.

Author information

Correspondence to Aaron S. Kelly.

Ethics declarations

Conflict of interest

Dr. Kelly receives research support (drug/placebo) from Astra Zeneca Pharmaceuticals and serves as a consultant for Novo Nordisk, Orexigen, and Vivus Pharmaceuticals but does not accept personal or professional income for these activities. Dr. Marcus serves on the Scientific Advisory Board of Weight Watchers International, Inc. Dr. J.A. Yanovski receives current research support from Rhythm Pharmaceuticals, Inc. and past research support from Zafgen Inc. for clinical treatment trials of patients with obesity and does not accept personal or professional income for these activities. The remaining authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Further reading