The following are key points to remember from a review on obesity in adolescents:

1. An estimated 21% of US adolescents meet the criteria for obesity, a condition associated with insulin resistance, elevated blood pressure, sleep disorders, and depression. Furthermore, obesity in adolescence increases the risk for cardiovascular disease and diabetes in adulthood.
2. A body mass index (BMI) of ≥95th percentile for age and sex is the most common definition of obesity for children aged 12-18 years (i.e., adolescents). A BMI at the 85th to <95th percentile is considered overweight. Screening for obesity is recommended for all annual well-child visits. While BMI does not reflect adiposity, it does allow for additional testing among adolescents who meet BMI criteria for overweight or obesity.
3. Current obesity in one or both parents is correlated with obesity among children by the age of 15 years. It is likely that both genetic and environmental factors influence this relationship.
4. Obesity results from an imbalance between energy intake and expenditure, leading to the accumulation of excess body fat. Function-altering gene variants, such as TMEM18, have been identified, which regulate hunger, satiety, and energy. Hormones such as ghrelin, leptin, peptide YY, gastric inhibitory polypeptide, glucagon-like peptide-1 (GLP-1), pancreatic polypeptide, amylin, and cholecystokinin increase weight gain by influencing appetite, satiety, and food palatability.
5. Lifestyle factors associated with obesity in adolescents, include recreational screen time of ≥2 hours, short sleep duration, poverty or food insecurity, and adverse childhood experiences (e.g., abuse).
6. Treatment options for obesity in adolescents include lifestyle modification, pharmacotherapy, and surgery. The stepped-care approach is no longer recommended, as obesity frequently increases and comorbidities accumulate with age.
7. Lifestyle modification requires >26 contact hours over 12 months for an approximate 3% mean BMI reduction.
8. Anti-obesity medications, including liraglutide, semaglutide, and phentermine/topiramate, can be combined with lifestyle modification to achieve an appropriate 5-17% reduction in mean BMI over a 1-year period. Adverse effects of these medications are rare.
9. Surgical options include Roux-en-Y gastric bypass and vertical sleeve gastrectomy for adolescents with severe obesity (BMI ≥120% of the 95th percentile for age and sex). Surgical treatments are associated with an approximate 30% reduction in mean BMI at 1 year.
10. Clinicians should be supportive and nonjudgmental and include financial considerations. Pharmacologic therapy can be expensive, with variable insurance coverage. An estimated two-thirds of private insurers and most state Medicaid plans cover surgical treatment of obesity for adolescents who meet the criteria.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD and Pediatrics and Prevention, Prevention

Keywords: Obesity, Adolescent

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