Strategies in the Management of Adolescent Obesity
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ADOLESCENT MEDICINE (M. GOLDSTEIN, SECTION EDITOR)
Strategies in the Management of Adolescent Obesity Veronica R. Johnson 1,2 & Michelle Cao 1 & Kathryn S. Czepiel 3 & Tasnim Mushannen 4 & LaShyra Nolen 5 & Fatima Cody Stanford 5,6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We review the current options to manage adolescent obesity which include nutrition, physical activity, behavior modification, sleep management, pharmacotherapy, and surgery. Since lifestyle interventions alone are often not effective in adolescents, a multi-disciplinary treatment approach is necessary in management. Recent Findings Medications (often used off-label) and metabolic/bariatric surgery are effective treatment strategies to treat adolescents with severe obesity. Summary The use of pharmacotherapy and surgery is limited due to lack of pediatric obesity tertiary care centers. With more centers, the treatment of adolescent obesity will improve and aid to decrease the prevalence of adult obesity. Keywords Adolescent obesity . Lifestyle modifications . Anti-obesity medications . Pharmacotherapy . Bariatric surgery
Introduction Adolescence is a pivotal time in human development as a young child transitions to early adulthood [1]. Defined as the period between the ages of 11 and 21, adolescence is marked by puberty—a sequence of physical alterations facilitated by genetic, hormonal, and environmental factors [1, 2]. Body size, shape, and composition change significantly during puberty [3]. For example, females have an increase in body fat, This article is part of the Topical Collection on Adolescent Medicine * Veronica R. Johnson [email protected] 1
Center of Obesity Medicine and Metabolic Performance, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
2
UT Center for Obesity Medicine and Metabolic Performance, 6700 West Loop South, Suite 500, Bellaire, TX 77401, USA
3
Department of Pediatrics, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
4
Weill Cornell Medicine—Qatar, Education City, Doha 24144, Qatar
5
Harvard Medical School, Boston, MA, USA
6
Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, MGH Weight Center, Boston, MA, USA
whereas males experience an increase in skeletal muscle mass. These changes are mediated at the hormonal level via gonadotropins, leptin, sex steroids, and growth hormones, including insulin [3]. All adolescents (regardless of weight) have insulin resistance. However, if an adolescent has risk factors for obesity, insulin resistance at onset of puberty may increase the likelihood of obesity being diagnosed [4]. The prevalence of adolescent obesity continues to rise exponentially [5, 6]. Obesity currently affects 20.5% of 12- to 19-year olds in the USA, and 9.5% of adolescents have severe obesity. Obesity disproportionately impacts African
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