A weighty matter: Identification and management of overweight and obesity in adolescents
Overweight and obesity are common in South African boys (18.8%) and girls (26.3%). Considering the potential serious consequences of these conditions, clinicians need to identify overweight and obese adolescents to enable early diagnosis and treatment. The key contributor in adolescents is increased intake of unhealthy foods and lower levels of physical activity. The consequences of overweight and obesity in adolescence are multisystemic and include cardiometabolic (type 2 diabetes mellitus, high blood pressure, dyslipidaemia), respiratory (obstructive sleep apnoea), gastrointestinal (non-alcoholic fatty liver disease), musculoskeletal, psychological (depression) and social (stigmatisation) effects. Body mass index (BMI) is calculated to determine overweight and obesity in adolescents. Numerous expert committees, despite using different methods, classify overweight and obesity in children by age- and gender-specific cut points for BMI. After a diagnosis of overweight and obesity, secondary causes must be excluded, and a history of dietary intake, physical activity and sedentary behaviour obtained. This will identify modifiable behaviours that promote energy imbalance. All obese adolescents should undergo cardiometabolic assessments comprising fasting glucose, lipid and blood pressure measurements every 2 years. Interventions should focus on creating healthier home environments that provide easy access to healthy foods, encourage physical activity and discourage sedentary behaviour. Medication for weight loss or bariatric surgery may be considered for severely obese adolescents who do not respond to other strategies.