Obesity is now twice as common among adolescents than it was 30 years ago and is one of the most common reasons for visits to adolescent clinics. Although fewer than one third of obese adults were obese as adolescents, most obese adolescents remain obese in adulthood.
Although most of the complications of obesity occur in adulthood, obese adolescents are more likely than their peers to have high blood pressure. Type 2 diabetes mellitus is occurring with increasing frequency in adolescents due to insulin resistance related to obesity. Because of society’s stigma against obesity, many obese adolescents have a poor self-image and become increasingly sedentary and socially isolated.
The factors that influence obesity among adolescents are the same as those among adults. Most cases are external (eg, consuming too many calories and/or a low-quality diet), often in conjunction with a sedentary lifestyle. Genetic influences are common, and responsible genes are now being identified (see also Obesity and the Metabolic Syndrome).
Parents often are concerned that obesity is the result of some type of endocrine disease, such as hypothyroidism or hyperadrenocorticism, but such disorders are rarely the cause. Adolescents with weight gain caused by endocrine disorders are usually of small stature and have other signs of the underlying disorder.
Determination of the body mass index (BMI) is an important aspect of physical assessment. Adolescents whose BMI is ≥ the 95th percentile for their age and sex are obese.
Primary endocrine (eg, hyperadrenocorticism, hypothyroidism) or metabolic causes are uncommon but should be ruled out if height growth slows significantly. If the child is short and has hypertension, Cushing syndrome should be considered.
Despite many therapeutic approaches, obesity is one of the most difficult problems to treat, and long-term success rates remain low. Intervention for obese adolescents should be focused on developing healthy eating and exercise habits rather than on losing a specific amount of weight. Caloric intake is reduced by
Calorie burning is increased by
Summer camps for obese adolescents may help them lose a significant amount of weight, but without continuing effort, the weight usually is regained. Counseling to help adolescents cope with their problems, including poor self-esteem, may be helpful.
Drugs that help reduce weight are generally not used during adolescence because of concerns about safety and possible abuse. One exception is for obese adolescents with a strong family history of type 2 diabetes. They are at high risk of developing diabetes. The drug metformin, which is used to treat diabetes, may help them lose weight and also lower their risk of becoming diabetic.