Challenges in the management of obesity in adolescents: an American perspective: a narrative review

Abstract

Background and Objective: Adolescent obesity is an increasingly concerning clinical problem with lifelong adverse impact on various adult health outcomes. Adolescence is characterized by growth and development in cognitive, physical, and psychosocial dimensions. Health-related behaviors are the most important underlying factors that increase the risk of obesity during adolescence. Preventive and treatment interventions for adolescent obesity should be considered within the context of adolescent growth and development. This discussion provides an overview of the challenges in the management of obesity in adolescents. Our objective is to provide a narrative review of specific developmental and behavioral considerations in the management of obesity in adolescents. Methods: We searched the PubMed online database, limited to years from 2001 to 2020, English language, using search terms adolescent obesity, developmental and behavioral aspects of adolescent obesity, adolescent growth and development, obesity pharmacotherapy, bariatric surgery in adolescents, and adolescent obesity and depression or mental disorders. All article types were included for review. Articles with direct relevance to the developmental and behavioral aspects of management of obesity in adolescents were included for this narrative review. In addition, specific search was conducted to look at behavioral interventions in adolescent obesity. Since the application of behavioral interventions in the treatment of adolescent obesity has gained increased consideration in recent years, we looked at specific literation most recent 5 years, between 2015 and 2020. A search of English language peer-reviewed articles was performed using PubMed's online database. The following search terms were used to locate articles relevant to our study: obese, overweight, pediatric, adolescent, cognitive behavioral therapy, family-based intervention, mindfulness, acceptance-based, sleep, health promotion, and stress management. Variations of these search terms were used, and additional references cited in relevant articles were included in our literature study. Key Content and Findings: This literature review contains discussion on adolescent obesity, its behavioral aspects, impact on adolescent growth and development, available treatments and interventions in adolescent obesity management. Obesity continues to be a hot topic with a breadth of information with ongoing updates to clinical practice. There is a wealth of available data on evidence-based approaches particularly in behavioral interventions to treating adolescent obesity. Conclusions: The adolescent's level of cognitive and psychosocial development affects his or her adaptation of healthy lifestyle recommendations. The home environment and adolescent's peer and family relationships modulate treatment considerations. Behavioral treatment approaches, including cognitivebehavioral therapy, family-based interventions, mindfulness, and acceptance-based therapy have been shown to be useful components of comprehensive treatment plan for obesity in adolescents. Additional, large-scale research, specifically in behavioral management of adolescent obesity is needed. In clinical practice, the focus should be on prevention, based on the application of behavioral strategies that would promote adoption of healthy lifestyle by adolescents.