Obesity in children and adolescents: epidemiology, causes, assessment, and management

Abstract

This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.

Figure 1

A socioecological model for understanding the dynamic interrelationships between various personal and environmental factors influencing child and adolescent obesity. Adapted from the Centers for Disease Control and Prevention social-ecological model framework for prevention. *Defined as being traversable on foot, compact, physically enticing, and safe.

Figure 2

Short-term and long-term health complications and comorbidities associated with child and adolescent obesity Health complications and comorbidities include neurological, dental, cardiovascular,, , , psychosocial,, , , , respiratory,, , , , endocrine,, , musculoskeletal,, , , renal,, gastrointestinal,, skin, function, and participation.,