European Journal of Pediatrics

, Volume 167, Issue 1, pp 9–16 | Cite as

Treatment of adolescent overweight and obesity

  • Margarita D. Tsiros
  • Natalie Sinn
  • Alison M. Coates
  • Peter R. C. Howe
  • Jonathan D. Buckley


Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12–19 years), published from 1982–2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction; however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent sample. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed.


Weight loss Lifestyle Surgery Pharmacology Exercise Diet Behavioural therapy Treatment outcome 

Supplementary material


  1. 1.
    Amador M, Flores P, Pena M (1990) Normocaloric diet and exercise: a good choice for treating obese adolescents. Acta Paediatr Hung 30(1):123–138PubMedGoogle Scholar
  2. 2.
    Amador M, Ramos LT, Morono M, Hermelo MP (1990) Growth rate reduction during energy restriction in obese adolescents. Exp Clin Endocrinol 96(1):73–82PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson AE, Soper RT, Scott DH (1980) Gastric bypass for morbid obesity in children and adolescents. J Pediatr Surg 15(6):876–881PubMedCrossRefGoogle Scholar
  4. 4.
    Arnett JJ (1999) Adolescent storm and stress, reconsidered. Am Psychol 54(5):317–326PubMedCrossRefGoogle Scholar
  5. 5.
    Atlantis E, Barnes EH, Singh MA (2006) Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes (Lond) 30(7):1027–1040CrossRefGoogle Scholar
  6. 6.
    Becque MD, Katch VL, Rocchini AP, Marks CR, Moorehead C (1988) Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics 81(5):605–612PubMedGoogle Scholar
  7. 7.
    Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL (2003) Behavior therapy and sibutramine for the treatment of adolescent obesity. A randomized controlled trial. JAMA 289(14):1805–1812PubMedCrossRefGoogle Scholar
  8. 8.
    Blair SN, Church TS (2004) The fitness, obesity, and health equation: is physical activity the common denominator? JAMA 292(10):1232–1234PubMedCrossRefGoogle Scholar
  9. 9.
    Braet C, Van Winkel M, Van Leeuwen K (1997) Follow-up results of different treatment programs for obese children. Acta Paediatr 86:397–402PubMedGoogle Scholar
  10. 10.
    Braet C, Van Winckel M (2000) Long-term follow-up of a cognitive behavioral treatment program for obese children. Behav Ther 31:55–74CrossRefGoogle Scholar
  11. 11.
    Brownell KD, Kelman JH, Stunkard AJ (1983) Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 71(4):515–523PubMedGoogle Scholar
  12. 12.
    Butler AC, Chapman JE, Forman EM, Beck AT (2006) The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 26(1):17–31PubMedCrossRefGoogle Scholar
  13. 13.
    Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J (2005) Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 293(23):2873–2883PubMedCrossRefGoogle Scholar
  14. 14.
    Coates TJ, Killen JD, Slinkard LA (1982) Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1:37–48CrossRefGoogle Scholar
  15. 15.
    Coates TJ, Jeffrey RW, Slinkard LA, Killen JD, Danaher BG (1982) Frequency of contact and monetary reward in weight loss, lipid change and blood pressure reduction with adolescents. Behav Ther 13:175–185CrossRefGoogle Scholar
  16. 16.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243PubMedCrossRefGoogle Scholar
  17. 17.
    Collins CE, Warren J, Neve M, McCoy P, Stokes BJ (2006) Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med 160(9):906–922PubMedCrossRefGoogle Scholar
  18. 18.
    Cooper Z, Fairburn CF, Hawker DM (2003) Cognitive-behavioral treatment of obesity: a clinician’s guide. Guilford Press, New YorkGoogle Scholar
  19. 19.
    Cooper Z, Fairburn CG (2001) A new cognitive behavioural approach to the treatment of obesity. Behav Res Ther 39:449–511CrossRefGoogle Scholar
  20. 20.
    Dahl RE, Hariri AR (2005) Lessons from G. Stanley Hall: connecting new research in biological sciences to the study of adolescent development. J Res Adolesc 15(4):367–382CrossRefGoogle Scholar
  21. 21.
    Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, Robinson TN, Scott BJ, St Jeor S, Williams CL (2005) Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 111(15):1999–2012PubMedCrossRefGoogle Scholar
  22. 22.
    Dietz WH (1998) Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 101:518–525PubMedGoogle Scholar
  23. 23.
    Duffy G, Spence SH (1993) The effectiveness of cognitive self-management as an adjunct to a behavioural intervention for childhood obesity: a research note. J Child Psychol Psychiatry 34(6):1043–1050PubMedCrossRefGoogle Scholar
  24. 24.
    Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS (2006) Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 117(3):673–680PubMedCrossRefGoogle Scholar
  25. 25.
    Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS (2003) A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 157:773–779PubMedCrossRefGoogle Scholar
  26. 26.
    Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360(9331):473–482PubMedCrossRefGoogle Scholar
  27. 27.
    Emes C, Velde B, Moreau M, Murdod DD, Trussel R (1990) An activity based weight control program. Adapt Phys Activ Q 7:314–324Google Scholar
  28. 28.
    Epstein LH, Myers MD, Raynor HA, Saelens BE (1998) Treatment of pediatric obesity. Pediatrics 101:554–570PubMedGoogle Scholar
  29. 29.
    Epstein LH, Paluch RA, Gordy CC, Dorn J (2000) Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatri Adolesc Med 154(3):220–226Google Scholar
  30. 30.
    Epstein LH, Roemmich JN (2001) Reducing sedentary behavior: role in modifying physical activity. Exerc Sport Sci Rev 29(3):103–108PubMedCrossRefGoogle Scholar
  31. 31.
    Epstein LH, Valoski A, Vara LS, McCurley J, Wisiewski L, Kalarchian MA, Klein KR, Shrager LR (1995) Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 14:109–115PubMedCrossRefGoogle Scholar
  32. 32.
    Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM (1993) Comparison of two hypocaloric diets in obese children. Am J Dis Child 147(2):160–166PubMedGoogle Scholar
  33. 33.
    Fowler-Brown A, Kahwati LC (2004) Prevention and treatment of overweight in children and adolescents. Am Fam Physician 69(11):2591–2598PubMedGoogle Scholar
  34. 34.
    Freemark M, Bursey D (2001) The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics 107(4):55CrossRefGoogle Scholar
  35. 35.
    French SA, Story M, Perry CL (1995) Self-esteem and obesity in children and adolescents and adolescents: a literature review. Obes Res 3(5):479–490PubMedGoogle Scholar
  36. 36.
    Glenny AM, O’Meara S, Melville A, Sheldon TA, Wilson C (1997) The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 21:715–737PubMedCrossRefGoogle Scholar
  37. 37.
    Godoy-Matos A, Carraro L, Viera A, Oliveira J, Guedes EP, Mattos L, Rangel C, Moreira RO, Coutinho W, Appolinario JC (2005) Treatment of obese adolescents with sibutramine: a randomized, double-blind, controlled study. J Clin Endocrinol Metab 90(3):1460–1465PubMedCrossRefGoogle Scholar
  38. 38.
    Goran MI (1998) Measurement issues related to studies of childhood obesity: assessment of body composition, body fat distribution, physical activity, and food intake. Pediatrics 101(3):505–518PubMedGoogle Scholar
  39. 39.
    Greenstein RJ, Rabner JG (1995) Is adolescent gastric-restrictive antiobesity surgery warranted? Obes Surg 5(2):138–144PubMedCrossRefGoogle Scholar
  40. 40.
    Gutin B, Barbeau P, Owens S, Lemmon CR, Bauman M, Allison J, Kang H-S, Litaker MS (2002) Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Am J Clin Nutr 75(5):818–826PubMedGoogle Scholar
  41. 41.
    Herrera EA, Johnston CA, Steele RG (2004) A comparison of cognitive and behavioral treatments for pediatric obesity. Child Health Care 33(2):151–167CrossRefGoogle Scholar
  42. 42.
    Ikeda JP, Fujii M, Fong KA, Hanson M (1982) Two approaches to adolescent weight reduction. J Nutr Educ 14:90–92Google Scholar
  43. 43.
    Israel AC, Guile CA, Baker JE, Silverman WK (1994) An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 19:737–749PubMedCrossRefGoogle Scholar
  44. 44.
    James WPT, Astrup A, Finer N, Hilsted J, Kopelman P, Rossner S, Saris WH, Van Gaal LF; STORM Study Group, Sibutramine Trial of Obesity Reduction and Maintenance (2000) Effect of sibutramine on weight maintenance after weight loss: a randomised trial. Lancet 356(9248):2119–2125PubMedCrossRefGoogle Scholar
  45. 45.
    Jelalian E, Mehlenbeck R, Lloyd-Richardson EE, Birmaher V, Wing RR (2006) ‘Adventure therapy’ combined with cognitive-behavioral treatment for overweight adolescents. Int J Obes (Lond) 30(1):31–39CrossRefGoogle Scholar
  46. 46.
    Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U (2005) A two year family based behaviour treatment for obese children. Arch Dis Child 90(12):1235–1238PubMedCrossRefGoogle Scholar
  47. 47.
    Johnson WG, Hinkle LK, Carr RE, Anderson DA, Lemmon CR, Engler LB, Bergeron KC (1997) Dietary and exercise interventions for juvenile obesity: long-term effect of behavioral and public health models. Obes Res 5:257–261PubMedGoogle Scholar
  48. 48.
    Kang H, Gutin B, Barbeau P, Owens S, Lemmon CR, Allison J, Litaker MS, Le N (2002) Physical training improves insulin resistance syndrome markers in obese adolescents. Med Sci Sports Exerc 34(12):1920–1927PubMedCrossRefGoogle Scholar
  49. 49.
    Kelly SD, Howe CJ, Hendler JP, Lipman TH (2005) Disordered eating behaviors in youth with type 1 diabetes. Diabetes Educ 31(4):572–583PubMedCrossRefGoogle Scholar
  50. 50.
    Latner JD, Wilson GT (2000) Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating. Eat Behav 1:3–21PubMedCrossRefGoogle Scholar
  51. 51.
    LeMura LM, Maziekas MT (2002) Factors that alter body fat, body mass, and fat-free mass in pediatric obesity. Med Sci Sports Exerc 34(3):487–496PubMedCrossRefGoogle Scholar
  52. 52.
    Lobstein T, Baur L, Uauy R; IASO International Obesity Task Force (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5(1):4–104PubMedCrossRefGoogle Scholar
  53. 53.
    Lustman PJ, Griffith LS, Freedland KE, Kissel SS, Clouse RE (1998) Cognitive behavior therapy for depression in type 2 diabetes mellitus. Ann Intern Med 129(8):613–621PubMedGoogle Scholar
  54. 54.
    Maahs D, de Serna DG, Kolotkin RL, Ralston S, Sandate J, Qualls C, Schade DS (2006) Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocr Pract 12(1):18–28PubMedGoogle Scholar
  55. 55.
    McLean N, Griffin S, Toney K, Hardeman W (2003) Family involvement in weight control, weight maintenance and weight-loss interventions: a systematic review of randomised trials. Int J Obes Relat Metab Disord 27(9):987–1005PubMedCrossRefGoogle Scholar
  56. 56.
    Mellin LM, Slinkard LA, Irwin CE Jr (1987) Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 87:333–338PubMedGoogle Scholar
  57. 57.
    Molnar D, Torok K, Erhardt E, Jeges S (2000) Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents. Int J Obes Relat Metab Disord 24(12):1573–1578PubMedCrossRefGoogle Scholar
  58. 58.
    Montani JP, Viecelli AK, Prévot A, Dulloo AG (2006) Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the ‘repeated overshoot’ theory. Int J Obes (Lond) 30(Suppl 4):S58–S66CrossRefGoogle Scholar
  59. 59.
    National Health and Medical Research Council (NHMRC) (2003) Clinical practice guidelines for the management of overweight and obesity in children and adolescents. Available online at
  60. 60.
    Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A (2005) Short- and long-term beneficial effects of a combined dietary–behavioral–physical activity intervention for the treatment of childhood obesity. Pediatrics 115(4):e443–e449PubMedCrossRefGoogle Scholar
  61. 61.
    Norton K, Dollman J, Martin M, Harten N (2006) Descriptive epidemiology of childhood overweight and obesity in Australia: 1901–2003. Int J Pediatr Obes 1:232–238PubMedCrossRefGoogle Scholar
  62. 62.
    Reilly JJ, McDowell ZC (2003) Physical activity interventions in the prevention and treatment of paediatric obesity: Systematic review and critical appraisal. Proc Nutr Soc 62(3):611–619PubMedCrossRefGoogle Scholar
  63. 63.
    Robinson TN (2001) Television viewing and childhood obesity. Pediatr Clin North Am 48(4):1017–1025PubMedCrossRefGoogle Scholar
  64. 64.
    Saelens BE, Sallis JF, Wilfey DE, Patrick K, Cella JA, Buchta R (2002) Behavioral weight control for overweight adolescents initiated in primary care. Obes Res 10(1):22–32PubMedCrossRefGoogle Scholar
  65. 65.
    Savoye M, Berry D, Dziura J, Shaw M, Serrecchia JB, Barbetta G, Rose P, Lavietes S, Caprio S (2005) Anthropometric and psychosocial changes in obese adolescents enrolled in a weight management program. J Am Diet Assoc 105(3):364–370PubMedCrossRefGoogle Scholar
  66. 66.
    Schwingshandl J, Borkenstein M (1995) Changes in lean body mass in obese children during a weight reduction program: effect on short term and long term outcome. Int J Obes Relat Metab Disord 19:752–755PubMedGoogle Scholar
  67. 67.
    Smith A, Kellet E, Schmerlaib Y (1998) The Australian guide to healthy eating. Commonwealth of AustraliaGoogle Scholar
  68. 68.
    Snethen JA, Broome ME, Cashin SE (2006) Effective weight loss for overweight children: a meta-analysis of intervention studies. J Pediatr Nurs 21(1):45–56PubMedCrossRefGoogle Scholar
  69. 69.
    Sondike SB, Copperman N, Jacobson MS (2003) Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factors in overweight adolescents. J Pediatr 142(3):253–258PubMedCrossRefGoogle Scholar
  70. 70.
    Soper RT, Mason EE, Printen KJ, Zellweger H (1975) Gastric bypass for morbid obesity in children and adolescents. J Pediatr Surg 10(1):51–58PubMedCrossRefGoogle Scholar
  71. 71.
    Stallard P, Simpson N, Anderson SE, Carter T, Osborn C, Bush S (2005) An evaluation of the FRIENDS programme: a cognitive behaviour therapy intervention to promote emotional resilience. Arch Dis Child 90:1016–1019PubMedGoogle Scholar
  72. 72.
    Strauss RS, Bradley LJ, Brolin RE (2001) Gastric bypass surgery in adolescents with morbid obesity. J Pediatr 138(4):499–504PubMedCrossRefGoogle Scholar
  73. 73.
    Stuart WP, Broome ME, Smith BA, Weaver M (2005) An integrative review of interventions for adolescent weight loss. J Sch Nurs 21(2):77–85PubMedCrossRefGoogle Scholar
  74. 74.
    Summerbell CD, Ashton V, Campbell KJ, Edmund L, Kelly S, Waters E (2003) Interventions for treating obesity in children. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD001872. DOI  10.1002/14651858.CD001872
  75. 75.
    Wadden TA, Stunkard AJ, Rich L, Rubin CJ, Sweidwl G, McKinney S (1990) Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics 85:345–352PubMedGoogle Scholar
  76. 76.
    Warschburger P, Fromme C, Petermann F, Wojtalla N, Oepen J (2001) Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity. Int J Obes Relat Metab Disord 25(Suppl 1):S93–S95PubMedCrossRefGoogle Scholar
  77. 77.
    Watts K, Beye P, Siafarikas A, Davis EA, Jones TW, O’Driscoll G, Green DJ (2004) Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. J Am Coll Cardiol 43(10):1823–1827PubMedCrossRefGoogle Scholar
  78. 78.
    Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA (2005) Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 116(1):e125–e144PubMedCrossRefGoogle Scholar
  79. 79.
    WHO (2000) Obesity: preventing and managing the global epidemic. Report of a World Health Organisation consultation. World Health Organisation Technical Report Series. Available online at
  80. 80.
    Wisotsky W, Swencionis C (2003) Cognitive-behavioral approaches in the management of obesity. Adolesc Med 14(1):37–48PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Margarita D. Tsiros
    • 1
  • Natalie Sinn
    • 1
  • Alison M. Coates
    • 1
  • Peter R. C. Howe
    • 1
  • Jonathan D. Buckley
    • 1
  1. 1.Nutritional Physiology Research Centre and ATN Centre for Metabolic Fitness, School of Health SciencesUniversity of South AustraliaAdelaideAustralia

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