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Child and adolescent obesity

Nature Reviews Disease Primers volume 9, Article number: 24 (2023) Cite this article

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Abstract

The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive–emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.

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Fig. 1: Prevalence of paediatric overweight or obesity.
Fig. 2: Childhood obesity comorbidities.
Fig. 3: Control circuits of weight regulation.
Fig. 4: Suggested diagnostic work-up in children or adolescents with obesity.
Fig. 5: Prevention of childhood obesity within a socioecological model.

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Author information

Authors and Affiliations

  1. Children’s Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

    Natalie B. Lister & Louise A. Baur

  2. Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia

    Natalie B. Lister

  3. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

    Louise A. Baur

  4. Weight Management Services, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia

    Louise A. Baur

  5. The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands

    Janine F. Felix

  6. Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands

    Janine F. Felix

  7. Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK

    Andrew J. Hill

  8. Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

    Claude Marcus

  9. Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany

    Thomas Reinehr

  10. Department of Sport and Exercise Sciences, Durham University, Durham, UK

    Carolyn Summerbell

  11. Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany

    Martin Wabitsch

Authors
  1. Natalie B. Lister
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  2. Louise A. Baur
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  3. Janine F. Felix
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  4. Andrew J. Hill
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  5. Claude Marcus
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  6. Thomas Reinehr
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  7. Carolyn Summerbell
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  8. Martin Wabitsch
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Contributions

Introduction (L.A.B., J.F.F. and N.B.L.); Epidemiology (L.A.B. and J.F.F.); Mechanisms/pathophysiology (L.A.B., J.F.F., T.R. and M.W.); Diagnosis, screening and prevention (L.A.B., N.B.L., T.R., C.S. and M.W.); Management (L.A.B., N.B.L., A.J.H., C.M. and T.R.); Quality of life (L.A.B., N.B.L. and A.J.H.); Outlook (L.A.B., N.B.L., J.F.F., A.J.H., C.M., T.R., C.S. and M.W.); Overview of the Primer (L.A.B. and N.B.L.).

Corresponding author

Correspondence to Louise A. Baur.

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A.J.H. reports receiving payment for consultancy advice for Slimming World (UK). L.A.B. reports receiving honoraria for speaking in forums organized by Novo Nordisk in relation to management of adolescent obesity and the ACTION-Teens study, which is sponsored by Novo Nordisk. L.A.B. is the Australian lead of the study. T.R. received funding from the German Federal Ministry of Education and Research (BMBF; 01GI1120A/B) as part of the German Competence Network Obesity (Consortium ‘Youth with Extreme Obesity’). T.R. receives payment for consultancy advice related to pharmacological treatment of obesity from Novo Nordisk and Lilly, as well as honoraria for lectures in symposia organized by Novo Nordisk, Novartis and Merck. C.M. receives payments for consultancy advice and advisory board participation from Novo Nordisk, Oriflame Wellness, DeFaire AB and Itrim AB. C.M. also receives honoraria for speaking at meetings organized by Novo Nordisk and Astra Zeneca. C.M. is a shareholder and founder of Evira AB, a company that develops and sells systems for digital support for weight loss, and receives grants from Novo Nordisk for epidemiological studies of the effects of weight loss on future heath. M.W. received funding from the German Federal Ministry of Education and Research (BMBF; 01GI1120A/B) as part of the German Competence Network Obesity (Consortium ‘Youth with Extreme Obesity’). M.W. receives payment for consultancy advice related to pharmacological treatment of obesity from Novo Nordisk, Regeneron, Boehringer Ingelheim and LG Chem, as well as honoraria for speaking in symposia organized by Novo Nordisk, Rhythm Pharmaceuticals and Infectopharm. M.W. is principal investigator in phase II and phase III studies of setmelanotide sponsored by Rhythm Pharmaceuticals. N.B.L., J.F.F. and C.S. declare no competing interests.

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Lister, N.B., Baur, L.A., Felix, J.F. et al. Child and adolescent obesity. Nat Rev Dis Primers 9, 24 (2023). https://doi.org/10.1038/s41572-023-00435-4

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