Treatment for adolescent obesity should be guided by patient age, pubertal status, severity of obesity, psychosocial factors, and comorbidities according to a clinical update published in JAMA.

Clinicians should classify and document weight status using body mass index (BMI) throughout care. Patients in the 85th to 95th percentile for their sex and age are classified as overweight, patients with BMI ≥95th percentile have obesity, and patients with BMI ≥120% of the 95th percentile or with BMI >35 kg/m2 have severe obesity.

If a patient is classified as obese or overweight, clinicians should perform a comprehensive weight, medical, surgical, social, and family history in addition to medication review, physical examination, and laboratory tests.

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For follow-up care, clinicians should ask if patients are open to discussing weight and the diagnosis in an empathetic and respectful manner. Caregivers should also be included in the conversation. Of note, compassionate and patient-first language should be used in these discussions, which should occur at diagnosis of overweight/obesity and as needed thereafter.

If patients are open to discussing weight, clinicians should first recommend behavioral interventions, including dietary modifications, 60 minutes of physical activity, and reduced sedentary activities. Patients who present with psychological issues or problematic family dynamics should be referred to psychologists.

Some patients may benefit from medication combined with lifestyle interventions. Clinicians should consider medication for patients with BMI ≥120% of the 95th percentile for age and sex or BMI ≥95th percentile with ≥1 significant obesity-related comorbidity. Orlistat is approved for long-term used in patients aged ≥12 years and phentermine is approved for short-term use in patients aged ≥17 years.

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Surgical intervention is an option for patients with a BMI ≥140% of the 95th percentile for age and sex or BMI ≥120% of the 95th percentile with ≥1 significant obesity-related comorbidity. Clinicians should refer these patients to a surgeon who has experience performing bariatric surgery on adolescents. A multidisciplinary team with consistent, long-term follow-up is recommended.

“Adolescence is a critical period for managing obesity, owing to the dynamic physiological and psychological changes inherent to this period of growth and development,” wrote the authors of the clinical update. “Adolescents with obesity, if left untreated, will likely face the unrelenting and detrimental consequences of the disease throughout their life.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Cardel MI, Jastreboff AM, Kelly AS. Treatment of adolescent obesity in 2020 [published September 30, 2019]. JAMA. doi:10.1001/jama.2019.14725