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Obesity in adolescents

Obesity during adolescence from ages 10 to 19 years is associated with pre-diabetes, type two diabetes, non-alcoholic fatty liver disease, dyslipidemia, polycystic ovary syndrome, obstructive sleep apnea, mental health disorders, and social stigma.

In a study of 2.3 million persons, BMI in late adolescence that went between 85th and 94th percentiles  and above the 95th percentile associated with hazard ratios for sudden death and for death from coronary heart disease, or a stroke during adulthood of 2.5 and 3.5, X respectively. 

Risk factors for obesity and adolescence include: genetic, environmental, lifestyle, and social influences.

Twin studies have estimated the heritability of obesity to be between 40 and 70%.

Polygenic obesity is associated with hundreds of polymorphisms, and more than 750 collectively account for 6% of BMI variation.

Current obesity in one of both parents correlates modestly with obesity by age 15 years, which reflects genetic and environmental risk.

Decreasing adiposity between childhood and adulthood is associated with reductions in cardiometabolic risk factors.

The prevalence of obesity in adolescence has increased since the 1980s: more so in low income communities and communities of color. 

The prevalence of obesity in adolescence age 12 to younger than 18 years old in the US is approximately 21%.

Obesity prevalence in the US differs by race and ethnicity with a higher percentage in Black (28%) and Mexican-American (31%) adolescents as compared with white adolescents at 16%.

Obesity in adolescence strongly predict obesity in adult.

Adolescence who spend two hours and more per day in recreational screen time have an increased risk of overweight or obesity.

Short sleep duration is also associated with higher BMI: for one hour per day, additional increment in sleep duration the risk of overweight or obese decreased by 21% in children and adolescents.

Poverty is a risk factor for adolescent obesity:high availability, and low cost of fast food and sugar sweetened beverages, low neighborhood, walk ability, and household circumstance cause stress, and poor sleep.

Food insecurity is associated with a higher prevalence of obesity among adolescents.

Adverse childhood experiences such as physical abuse, sexual abuse, or incarceration of a parent contributes to obesity risk.

The accumulation of four or more adverse childhood experiences associated with a 1.4 to 1.6 fold increase in risk for severe obesity and young adults.

COVID-19 increased the percentage of obesity among adolescents. 

Recommended laboratory testing in adolescents with obesity include screening for dyslipidemia, fatty liver disease, and diabetes.

Management requires a multidisciplinary, long term model, including lifestyle modification, dietary interventions, physical activity interventions, and anti-obesity medications along with possible bariatric surgery.

Lifestyle treatments appeared to be least effective for adolescents  with the most severe forms of obesity.

Lifestyle modification does not result in the largest BMI reduction as compared with other treatment options, yet it is still recommended for all adolescents with obesity.

Stigmatization is common in adolescent obesity, occurring in school, home, healthcare, sports, and can result in binge eating behaviors, social isolation, and avoidance of healthcare.

GLP –1 receptor agonists liraglutide and semaglutide are approved for adolescent obesity.

Additional agents include phentermine/topiramate.

Anti-obesity medications are safe effective in adolescents.

Metabolic and bariatric surgery is performed at approximately 1300 to 1900 adolescents annually in the US leading to reduction of BMI of up to 30%.

Such surgery is associated with improvements and resolution of hypertension, type two diabetes, dyslipidemia, obstructive, sleep apnea, and improvements in weight related quality of life.

 

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