Treatment of adolescent obesity

• Published in: Nature reviews. Endocrinology Vol. 14; no. 6; pp. 331 - 344
• Main Authors: Steinbeck, Katharine S., Lister, Natalie B., Gow, Megan L., Baur, Louise A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2018; Nature Publishing Group
• Subjects: 692/163/2743/393; 692/700/2817; 692/700/459/284; 692/700/565/1436; 692/700/565/545/2098; Adolescents; Autonomy; Body weight loss; Care and treatment; Child development; Children; Cognition; Disease management; Drug therapy; Endocrinology; Gastrointestinal surgery; Medicine; Medicine & Public Health; Obesity; Obesity in adolescence; Patients; Pediatric research; Physical activity; Puberty; Review Article; Risk factors; Sleep; Surgery; Teenagers; Weight control; Australia
• ISSN: 1759-5029; 1759-5037
• DOI: 10.1038/s41574-018-0002-8

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. The prevalence of obesity in adolescents is increasing, and the management of these patients presents unique challenges not seen in adults. Here, Baur and colleagues review the different options for treating obesity in adolescents. 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/m 2 , or >35 kg/m 2 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.