Obesity

Obesity in children and adolescents is a complex, multifactorial disease driven by gene-environment interactions, not simply behavior [e1047-c5, e11602-c1]. Prevalence has reached 18% worldwide and over one-third in the US, with severe obesity (≥99th percentile) increasingly common [e2998-c1, e1047-c3, e11602-c22]. Comorbidities once confined to adults—type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, and metabolic dysfunction-associated steatotic liver disease (MASLD)—now appear in children; over 60% of obese 5–10-year-olds have ≥1 cardiovascular risk factor [e388-c1, e388-c2, e1047-c10, e11602-c20]. Quality of life is comparable to or worse than pediatric cancer . The 2023 AAP guidelines mandate treatment for all children ≥85th percentile, abandoning watchful waiting . Intensive lifestyle intervention (≥26 contact hours over 3–12 months) forms the foundation; non-surgical success rates decline sharply with age, approaching 1% in severely obese teens [e388-c4, e11602-c6]. Pharmacotherapy (orlistat, phentermine/topiramate, GLP-1 agonists like semaglutide) is FDA-approved for adolescents ≥12 years, with semaglutide achieving ~17% weight loss [e11602-c7, e11602-c10]. Bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass) is indicated for adolescents ≥13 years with BMI ≥40 or ≥35 with major comorbidities; Teen-LABS data show sustained 28–30% weight loss and comorbidity resolution at 3–8 years, though weight regain remains a challenge driven by biological and behavioral factors [e388-c5, e388-c44, e388-c49, e11602-c17]. Hypothalamic obesity (post-tumor, hypopituitarism) requires gastric bypass over sleeve due to biologically driven weight gain [e388-c26, e373-c13]. Weight-based stigma from peers, family, teachers, and healthcare providers is pervasive and profoundly harms mental health, school performance, and treatment engagement [e863-c4, e1047-c33, e1047-c40]. Providers should use neutral language ('weight,' 'high BMI') rather than stigmatizing terms ('obese,' 'fat') . Access to effective treatment—especially newer medications—is a health equity issue disproportionately affecting children of color and those in poverty [e11602-c31, e11602-c32].