Recently, Silva Arslanian, MD, published new guidelines for the treatment of obesity in adolescents, addressing both the associated ongoing stigma and evidence supporting the various clinical strategies involved. Co-authored with Tamara S. Hannon, MD, of the Department of Pediatrics of the Indiana University School of Medicine in Indianapolis, the guidelines are in response to a clinical case presenting a common clinical problem, and are published in The New England Journal of Medicine.
The presented case focuses on a 12-year-old boy with excessive weight gain over the last several years and his overall health status. Arslanian and Hannon begin by noting the long-term consequences of obesity during adolescence, which can include type 2 diabetes, nonalcoholic fatty liver disease, dyslipidemia, polycystic ovary syndrome (PCOS), obstructive sleep apnea, and mental health disorders, as well as related social stigma.
According to the authors, the prevalence of obesity in adolescents has increased since the 1980s, and especially in low-income communities and communities of color. Both structural inequities and the marketing of unhealthy foods are in large part the drivers of this trend, as was the COVID-19 pandemic over the last few years. These factors together, according to the authors, absolutely indicate the need for obesity interventions among these populations in order to encourage healthier habits and improve overall health in adolescence and beyond.
Arslanian and Hannon proceed to list a series of clinical and laboratory assessments to determine definitions of overweight and obesity in adolescents. Beyond traditional BMI measurements the authors note the importance of medical and medication history, family history, diet, physical activity, systemic conditions, and physical examinations that include skin, musculoskeletal, and hepatomegaly evaluations, among others.
Ultimately, in regarding the management of obesity in adolescents, Arslanian and Hannon note that a multidisciplinary long-term care model that includes lifestyle and dietary modification and considers pharmacologic and surgical therapies may be the most comprehensive approach. Appropriate communication is essential, as is motivational interviewing, and the understanding that positive outcomes can be achieved even if BMI or cardiometabolic outcomes remain relatively unchanged.
The authors conclude that there are still unknowns about the rise of obesity, such as the effects of environmental drivers (pollution). However, with a multidisciplinary approach, the inherent complexity and variety of factors behind adolescent obesity can be at least broadly managed over time.
Arslanian is the Richard L. Day Professor of Pediatrics and Clinical and Translational Science, the Director of the Pediatric Clinical and Translational Research Center (PCTRC), and the Scientific Director of the Center for Pediatric Research in Obesity and Metabolism (CPROM). She was recently awarded the 2023 Outstanding Achievement in Clinical Diabetes Research Award from the American Diabetes Association (ADA).
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