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How Do Treatments for Adolescent Obesity Compare?

How Do Treatments for Adolescent Obesity Compare? 1024 682 Pam Georgiana

A recent review of the literature highlights current treatment strategies for adolescent obesity.

According to the American Academy of Pediatrics (AAP), obesity and severe obesity are chronic health conditions with increasing incidence in adolescents, putting them at risk for associated comorbidities. Obesity affects approximately 21% of adolescents (12 to 18 years of age) in the United States. Severe obesity is defined as 120% or greater of the 95th percentile for the age group or a body mass index (BMI) of 35 or greater. Approximately 8% of adolescents have severe obesity. 

Rising concerns around adolescent obesity prompted an expert panel that included Marc P. Michalsky, MD, MBA, surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children’s and professor of clinical surgery and pediatrics at The Ohio State University College of Medicine, to conduct a review of the available literature to summarize the current research on the diagnosis and treatment of adolescent obesity. The review was recently published in Journal of the American Medical Association (JAMA).   

“This review focuses on current treatment strategies designed to address various forms of obesity, which include lifestyle modification, the use of anti-obesity medications, and the application of metabolic and bariatric procedures,” explains Dr. Michalsky.  

Lifestyle 

Lifestyle modification therapies include supervised changes in nutrition, physical activity, sleep, or other daily habits to reduce BMI and improve overall health. It can also include behavioral counseling or therapy. Lifestyle modification treatment can be individual, group-based, commercial, community-based or provided by a health care system. This type of treatment requires a minimum 26 contact hours over one year. Access to intensive lifestyle modification therapies can be challenging and are noted to achieve an approximately 3% mean BMI reduction. 

Medication 

According to the current review, physicians should consider the use of FDA-approved medications for the treatment of adolescents with obesity aged 12 years or older. Liraglutide, semaglutide, and a phentermine/topiramate combination appear safe and effective in adolescents when combined with lifestyle modification therapy. Together, they can reduce mean BMI by 5% to 17% after one year of treatment. 

“Obesity treatment planning should be individualized while keeping in mind that even moderate amounts of weight loss can have positive effects,” says Dr. Michalsky. “Improvements in health measures, including hypertension, type 2 diabetes and dyslipidemia, can be observed following a 5 to 10% reduction in body weight.” 

All clinical trials of obesity pharmacotherapy to date have included lifestyle modification therapy; no evidence supports anti-obesity medications used alone. Side effects vary, but severe short-term adverse effects are rare. Future research should examine longer-term outcomes of these medications. 

Surgery 

The use of metabolic and bariatric surgery in the pediatric and adolescent population has been shown to be safe and effective, resulting in long-term improvements in health. Studies conducted over the past two decades have shown up to a 30% reduction in weight and BMI as early as 12 months after bariatric surgery, with persistent weight reduction up to 8 years. However, more research is needed to understand the long-term durability of surgical weight loss and potential impact on related health conditions, including postoperative complications and the need for additional operative interventions, long-term monitoring and transition of care. 

Holistic Approach to Weight Management 

According to the recent AAP Clinical Practice Guidelines, determining the eligibility for any anti-obesity treatment for an adolescent requires an individualized approach. Providers should consider their health status, family and support system, community context, and resources to create the best evidence-based treatment plan.  

“There are now clear and concise treatment strategies that all pediatricians and primary care physicians should be familiar with in order to effectively address childhood and adolescent obesity,” says Dr. Michalsky. “In the instance of severe obesity, the decision to pursue metabolic and bariatric surgery is an important one that requires thoughtful discussion between the patient, their family and a multidisciplinary team of providers.”  

 

References:

  1. Kelly AS, Armstrong SC, Michalsky MP, Fox CK. Obesity in Adolescents: A Review. JAMA. Published online August 5, 2024. doi:10.1001/jama.2024.11809
  2. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Edwards KCA, Eneli I, Hamre R, Joseph MM, Lunsford D, Eneida M, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2): e2022060640

 

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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