A Clinical Update review published in JAMA detailed current research surrounding the efficacy and safety of obesity treatment for adolescents, including behavioral interventions, pharmacotherapy, and bariatric surgery.

In adolescents, the authors wrote, treatment for obesity should accommodate patient age and pubertal status. Clinicians should conduct a full physical examination upon diagnosis, capturing potential causes and contributors to obesity, medical and family history, medication use, laboratory results, and comorbidities. Treatment options must also be discussed with family. No single treatment sequence is preferable for obesity; rather, authors endorsed an “integrated continuum” of care that begins with the least invasive intervention before escalating to more intense measures.

Proposing lifestyle changes is considered the foundation of obesity treatment in adolescents, although the resulting reduction in body mass index (BMI) is only moderate. Previous research has shown that effective behavioral interventions involve at least 26 contact hours over 2 to 12 months. Treatment should be guided by an interdisciplinary team, integrating feedback from a pediatrician, a dietician, an exercise physiologist, and/or a psychologist, if appropriate. Adherence with lifestyle interventions ranged from 68% to 5%, according to a survey conducted in 2017. Behavioral interventions were associated with positive improvements in “goal setting, problem solving, and stimulus control,” the authors wrote.

Pharmacotherapy options for adolescent obesity are limited. Orlistat, a lipase inhibitor, resulted in a placebo-subtracted reduction in BMI of 0.86 in a 52-week clinical trial. Adverse effects were mild to moderate and often gastrointestinal in nature. No trials have been conducted for phentermine, a norepinephrine reuptake inhibitor, in individuals younger than 17 years, although the drug is approved by the US Food and Drug Administration for the treatment of adolescent obesity.

Given the dearth of pharmacotherapy recommendations for adolescents, many clinicians prescribe medications for off-label use, including metformin, glucagon-like peptide-1 analogs, topiramate, naltrexone/bupropion, and lorcaserin. Additional research on the safety and efficacy of antiobesity medications is necessary, particularly for drugs being prescribed off label.  

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Surgical interventions may also be appropriate for patients with severe obesity. According to data from the Teen Longitudinal Assessment of Bariatric Surgery, patients (<19 years) experienced 3-year mean reductions in BMI of 29% and 27% with Roux-en-Y gastric bypass and vertical sleeve gastrectomy, respectively. Over 5 years, results were largely sustained. However, bariatric surgery presents several risks, including micronutrient deficiencies and the potential need for additional abdominal surgeries. Additionally, there are few data on the long-term safety and efficacy of such treatments.

Adolescence is a critical time for intervention, but safety and efficacy measures for adolescent obesity treatments remain limited. Authors endorsed training in the treatment of medical obesity for primary care physicians and specialists alike. Additionally, they echoed the need for research funding to develop and identify therapeutic interventions for adolescents with obesity.

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

Reference

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