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

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.

Automated summary

This review provides an overview of the current knowledge on child and adolescent obesity, including its epidemiology, causes, assessment considerations, and management approaches. Prevalence of obesity had plateaued in high-income countries but increased in low-income and middle-income countries before the COVID-19 pandemic. However, weight gain among children and adolescents has increased during the pandemic. Obesity is associated with various health issues and premature mortality. The development and persistence of obesity can be explained by a bio-socioecological framework. The first-line treatment approaches involve family-based behavioral interventions addressing diet, physical activity, sedentary behaviors, and sleep quality. Additional therapies such as intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery are emerging, but access to them is limited. Personalized treatment approaches and their translation to clinical practice still require further research.