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Treatment of adolescent obesity

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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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.

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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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