Adolescent obesity may not be just a phase1,2
As many as 80% of adolescents with obesity will continue to have obesity as adults.1* Adolescent obesity may increase the risk of developing certain weight-related conditions.3
*Based on a meta-analysis of 15 prospective cohort trials including over 200,000 individuals aged 7-18 years in which BMI values were recorded from childhood into adolescence or adulthood.
Adolescent obesity
Adolescent obesity may increase the risk of developing certain weight-related conditions3
Among youth in the United States4*:
Since 1970s
*Data of individuals aged 2-19 years from the National Health and Nutrition Examination Survey (NHANES).
Weight-related conditions typically observed in adults are being seen in adolescents with obesity, including3:
- Dyslipidemia
- Prediabetes
- Type 2 diabetes (T2D)
- Polycystic ovary syndrome (PCOS)
- Nonalcoholic fatty liver disease (NAFLD)
- Hypertension
- Obstructive sleep apnea (OSA)
While usually developing in people older than 45 years, type 2 diabetes is increasingly developing in adolescents and young adults.5
A large epidemiologic cohort study encompassing over 12,000 participants aged 3-19 years in the United States prospectively assessed the risk of adult obesity using childhood BMI, finding that adolescents with BMIs above the 85th percentile are more likely to have obesity in adulthood compared to their normal weight counterparts.2
There is an adolescent obesity epidemic in the US3
The obesity prevalence among adolescents aged 12-19 years in the United States is 22.2%.6 Obesity in adolescence is classified as having a BMI value at the 95th percentile or higher for age and sex, and overweight in adolescence is classified as having a BMI value at or above the 85th percentile for age and sex.7 Severe obesity is defined as having a BMI that is 120% of the 95th percentile or greater, or a BMI of 35 kg/m2 or greater.7 Since many adolescents with obesity go on to become adults with obesity, adolescence may be a critical time to address their excess weight.3
Because obesity is a chronic disease that often has associated comorbidities, long-term strategies, ongoing monitoring, and treatment may be required. Obesity management—including health-behavior coaching, lifestyle-modification plans, pharmacotherapy when indicated, and, for those patients aged 13 years and older with severe obesity, bariatric surgery evaluation—should be considered.3
Elevated risk for some adolescents
Certain adolescents may be at higher risk for obesity3
Factors that are associated with increased prevalence of obesity among adolescents include:
Having parents with obesity3,8
Certain ethnic backgrounds—eg, Mexican American, Hispanic, or non-Hispanic Black3,9
Lower income households3
Lower head-of-household education level3,9
Finally, obesity rates may be affected by the types of food adolescents eat. Fast-food consumption, lack of access to fresh food, and sugar-sweetened beverages have been associated with obesity in children.3
See what some experts in obesity care have to say.
Social impact
Obesity can have a negative social impact on adolescents3
Adolescents—whether living with obesity or not—are constantly navigating challenging social circumstances. In simple terms: being a teenager isn't easy.3
Part of assessing adolescents with obesity is to determine if their weight is affecting them beyond their physical health. Adolescents with obesity may experience weight stigma, teasing, and bullying. They may feel social isolation, have reduced physical activity, or even avoid seeking help from a health care provider for their weight.3
Feel social isolation3
Have reduced physical activity3
Avoid seeking help for their weight3
When speaking with your adolescent patients, keep in mind the weight stigma and bias they may have experienced in previous healthcare interactions. Acknowledging their experiences and speaking to them and their caregivers from a place of understanding can help improve relations between the patient, family, and healthcare team.3
Don't hesitate to ask your adolescent patients if they have experienced teasing or bullying based on their weight, and remember to suggest available resources at stopbullying.gov or refer them to counseling.3
Patient conversations
There may be a disconnect between HCPs and adolescents with obesity
In a global study of 5,275 adolescents with obesity* who completed an online survey about their weight:
Percentage of adolescents getting their information about weight management from YouTube10
Percentage of adolescents getting their information about weight management from other social media10
Percentage of adolescents getting their information about weight management from their HCPs10
Acknowledge how complex obesity is and the difficulty that may be encountered in trying to maintain a healthy weight. Also, it is helpful to utilize people-first language, such as saying “adolescents with obesity” instead of “obese adolescents.”3
It is imperative to also evaluate your adolescent patients for potential disordered eating or unhealthy weight-control behaviors and to use the clinical measures taken at annual health visits to see if any of them signal the presence of an eating disorder.3
*Based on data from a cross-sectional, survey-based global study aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care among adolescents with obesity (n=5,275), their caregivers (n=5,389), and their HCPs (n=2,323). Participants were residents of the following 10 countries: Australia, Colombia, Italy, Mexico, Saudi Arabia, South Korea, Spain, Taiwan, Turkey, and the United Kingdom.
Caregiver conversations
How caregivers approach the subject of weight is important12
The subject of weight and body image can be sensitive for adolescents.3 An important first step for health care professionals like you is to help caregivers understand and accept that their child has obesity and recognize the potential implications.11 In fact, when caregivers talk to children about weight, it is important to emphasize healthful eating.12
In a global survey of 5,389 caregivers of adolescents with obesity, 34% believed their child’s weight to be normal or below normal.10* Educating them about how increased BMI in younger patients relates to obesity in adulthood might help caregivers understand the potential risks of adolescent obesity2:
Avoid conversations focused on weight or physical characteristics12
Try and talk about the positives of healthful eating and physical activity3,12
HCPs play a critical role in helping parents and caregivers understand weight management3
It is not only on the shoulders of HCPs to help adolescent patients manage their weight. Studies have shown that medium- to high-intensity involvement within the family was associated with improved weight management. By providing support and being positive role models, parents and caregivers can help adolescents develop healthier behaviors for their weight.3
What can families do to address obesity?13
- Create a setting for better eating: Stress that following nutritional guidelines can help adolescents reach and maintain a healthy weight as they get older. In a global survey study, only 9% of caregivers said that there was healthy food in their house available for their children to eat10*
- Be more physically active: Exercising together, including fun activities, can help; don’t forget more active chores either. Physical activity is more effective when there is a combination of aerobic and nonaerobic activities. Within the family, stress noncompetitive, cooperative, fun activities that build motor skills as well as self-confidence3
- Set a sleep schedule: There is a link between poor sleep habits and weight gain in adolescents
- Turn off the screens: Remove screens from bedrooms and stop looking at them at least an hour before bedtime
*Based on data from a cross-sectional, survey-based global study aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care among adolescents with obesity (n=5,275), their caregivers (n=5,389), and their HCPs (n=2,323). Participants were residents of the following 10 countries: Australia, Colombia, Italy, Mexico, Saudi Arabia, South Korea, Spain, Taiwan, Turkey, and the United Kingdom.
References
1. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17:95-107.
2. Woo JG, Zhang N, Fenchel M, et al. Prediction of adult class II/III obesity from childhood BMI: the i3C consortium. Int J Obes (Lond). 2020;44:1164-1172.
3. Hampl S, Hassink S, Skinner A, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640.
4. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020.
5. Centers for Disease Control and Prevention (CDC). Type 2 diabetes. Accessed December 6, 2022. https://www.cdc.gov/diabetes/basics/type2.html
6. Centers for Disease Control and Prevention (CDC). Childhood obesity facts. Accessed December 6, 2022. https://www.cdc.gov/obesity/data/childhood.html
7. Centers for Disease Control and Prevention (CDC). Defining child BMI categories. Accessed December 6, 2022. https://www.cdc.gov/obesity/basics/childhood-defining.html
8. Bahreynian M, Qorbani M, Khaniabadi BM, et al. Association between obesity and parental weight status in children and adolescents. J Clin Res Pediatr Endocrinol. 2017;9:111-117.
9. Ruiz LD, Zuelch ML, Dimitratos SM, Scherr RE. Adolescent obesity: diet quality, psychosocial health, and cardiometabollc risk factor. Nutrfents. 2019;12(1):43.
10. Halford JCG, Bereket A, Bin-Abbas B, et al. Misalignment among adolescents living with obesity, caregivers, and healthcare professionals: ACTION Teens global survey study. Pediatr Obes. 2022;17(11):e12957.
11. Kaufman TK, Lynch BA, Wilkinson JM. Childhood obesity: an evidence-based approach to family-centered advice and support. J Prim Care Community Health. 2020;11:2150132720926279.
12. Berge JM, MacLehose R, Loth KA, Eisenberg M, Bucchianeri MM, Neumark-Sztainer D. Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA Pediatr. 2013;167(8):746-753.
13. Centers for Disease Control and Prevention (CDC). Preventing childhood obesity: 4 things families can do. Accessed March 5, 2023. https://www.cdc.gov/nccdphp/dnpao/features/childhood-obesity/index.html
