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Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care

  • Obesity Treatment (CM Apovian, Section Editor)
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Abstract

Purpose of Review

This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient’s obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.

Recent Findings

Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment.

Summary

Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. • Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128(15):1689–712. This review summarizes the defintions, epidemiology and short- and long-term risks of severe pediatric obesity.

    Article  PubMed  Google Scholar 

  3. • Grossman D, Bibbins-Domingo K, Curry SJ, et al. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(23):2417–26. USPSTF reviewed studies that measured outcomes of interventions for pediatric obesity and found that comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older with obesity can result in improvements in weight status for up to 12 months.

    Article  PubMed  Google Scholar 

  4. Sharma AM, Padwal R. Obesity is a sign - over-eating is a symptom: an aetiological framework for the assessment and management of obesity. Obes Rev. 2010;11(5):362–70.

    Article  CAS  PubMed  Google Scholar 

  5. Min J, Chiu DT, Wang Y. Variation in the heritability of body mass index based on diverse twin studies: a systematic review. Obes Rev. 2013;14(11):871–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fairbrother U, Kidd E, Malagamuwa T, Walley A. Genetics of severe obesity. Curr Diab Rep. 2018;18(10):85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Farooqi IS, O'Rahilly S. Mutations in ligands and receptors of the leptin-melanocortin pathway that lead to obesity. Nat Clin Pract Endocrinol Metab. 2008;4(10):569–77.

    Article  CAS  PubMed  Google Scholar 

  8. Chen KY, Muniyappa R, Abel BS, Mullins KP, Staker P, Brychta RJ, et al. RM-493, a melanocortin-4 receptor (MC4R) agonist, increases resting energy expenditure in obese individuals. J Clin Endocrinol Metab. 2015;100(4):1639–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gross AC, Fox CK, Rudser KD, Foy AM, Kelly AS. Eating behaviours are different in youth with obesity and severe obesity. Clin Obes. 2016;6(1):68–72.

    Article  CAS  PubMed  Google Scholar 

  10. St-Onge MP. Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes Rev. 2017;18(Suppl 1):34–9.

    Article  PubMed  Google Scholar 

  11. Geiker NRW, Astrup A, Hjorth MF, Sjodin A, Pijls L, Markus CR. Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obes Rev. 2018;19(1):81–97.

    Article  CAS  PubMed  Google Scholar 

  12. Puder JJ, Munsch S. Psychological correlates of childhood obesity. Int J Obes. 2010;34(Suppl 2):S37–43.

    Article  Google Scholar 

  13. Fox CK, Gross AC, Rudser KD, Foy AM, Kelly AS. Depression, anxiety, and severity of obesity in adolescents: is emotional eating the link? Clin Pediatr (Phila). 2016;55(12):1120–5.

    Article  Google Scholar 

  14. Bauer KW, Marcus MD, Larson N, Neumark-Sztainer D. Socioenvironmental, personal, and behavioral correlates of severe obesity among an ethnically/racially diverse sample of US adolescents. Child Obes. 2017;13(6):470–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Small L, Aplasca A. Child obesity and mental health: a complex interaction. Child Adolesc Psychiatr Clin N Am. 2016;25(2):269–82.

    Article  PubMed  Google Scholar 

  16. Davis L, Barnes AJ, Gross AC, Ryder JR, Shlafer RJ. Adverse childhood experiences and weight status among adolescents. J Pediatr. 2019;204:71–6 e71.

    Article  PubMed  Google Scholar 

  17. Kaur J, Lamb MM, Ogden CL. The association between food insecurity and obesity in children-the National Health and nutrition examination survey. J Acad Nutr Diet. 2015;115(5):751–8.

    Article  PubMed  Google Scholar 

  18. Gundersen C, Lohman BJ, Garasky S, Stewart S, Eisenmann J. Food security, maternal stressors, and overweight among low-income US children: results from the National Health and nutrition examination survey (1999-2002). Pediatrics. 2008;122(3):e529–40.

    Article  PubMed  Google Scholar 

  19. Larson N, Story M. Food insecurity and weight status among US children and families: a review of the literature. Am J Prev Med. 2011;40(2):166–73.

    Article  PubMed  Google Scholar 

  20. Larson N, Story M, Nelson M. Neighborhood environments: disparities in access to healthy foods in the US. Am J Prev Med. 2009;36(1):74–81.

    Article  PubMed  Google Scholar 

  21. Stephens L, McNaughton S, Crawford D, Ball K. Predictors of high-energy foods and beverages: a longitudinal study among socio-economically disadvantaged adolescents. Public Health Nutr. 2014;17(2):324–37.

    Article  PubMed  Google Scholar 

  22. Kral T, Chittams J, Moore R. Relationship betwen food insecurity, child weight status, and parent-reported child eating and snacking behaviors. J Spec Pediatr Nurs. 2017;22(2):1–11.

  23. Tomayko E, Mosso K, Cronin K, et al. Household food insecurity and dietary patterns in rural and urban American Indian families with young children. BMC Public Health. 2017;17(1):611–21.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Eicher-Miller H, Zhao Y. Evidence for the age-specific relationship of food insecurity and key dietary outcomes among US children and adolescents. Nutr Res Rev. 2018;31:98–113.

    Article  PubMed  Google Scholar 

  25. Wilde P, Ranney C. The monthly food stamp cycle: shopping frequency and food intake decisions in an endogenous switching regression framework. Am J Agric Econ. 2000;82(1):200–13.

    Article  Google Scholar 

  26. Dinour L, Bergen D, Yeh M. The food insecurity-obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007;107(11):1952–61.

    Article  PubMed  Google Scholar 

  27. • Inge TH, Jenkins TM, Zeller M, Dolan L, Daniels SR, Garcia VF, et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr. 2010;156(1):103–108.e101. A longitudinal assessment of 61 adolescents who underwent laparoscopic Roux-en-Y gastric bypass at a single pediatric center showed a decrease in BMI of approximately 37% in all patients, regardless of starting BMI, 1 year after surgery.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84; discussion 484-465.

    PubMed  PubMed Central  Google Scholar 

  29. • Gross A, Kaizer A, Kelly AS, et al. Long and Short of It: Early Response Predicts Longer-term Outcomes in Pediatric Weight Management. Obesity. 2019;27(2):272–9 Among 687 children treated in multicomponent pediatric weight management clinics across the U.S., those who achieved 3% BMI reduction at 1-month compared to those who did not achieve this early success were 5 times more likely to also have BMI reduction at 12 months.

    Article  PubMed  Google Scholar 

  30. Danielsson P, Kowalski J, Ekblom O, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med. 2012;166(12):1103–8.

  31. Kalarchian MA, Levine MD, Arslanian SA, Ewing LJ, Houck PR, Cheng Y, et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics. 2009;124(4):1060–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Johnston CA, Tyler C, Palcic JL, Stansberry SA, Gallagher MR, Foreyt JP. Smaller weight changes in standardized body mass index in response to treatment as weight classification increases. J Pediatr. 2011;158(4):624–7.

    Article  PubMed  Google Scholar 

  33. Kelly KP, Kirschenbaum DS. Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention. Obes Rev. 2011;12(1):37–49.

    Article  CAS  PubMed  Google Scholar 

  34. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  PubMed  Google Scholar 

  35. Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. JAMA. 2018;319(7):667–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Bailes JR, Strow MT, Werthammer J, McGinnis RA, Elitsur Y. Effect of low-carbohydrate, unlimited calorie diet on the treatment of childhood obesity: a prospective controlled study. Metab Syndr Relat Disord. 2003;1(3):221–5.

    Article  CAS  PubMed  Google Scholar 

  37. Berkowitz RI, Wadden TA, Gehrman CA, Bishop-Gilyard CT, Moore RH, Womble LG, et al. Meal replacements in the treatment of adolescent obesity: a randomized controlled trial. Obesity. 2011;19(6):1193–9.

    Article  PubMed  Google Scholar 

  38. Sothern, Udall JN, Jr., Suskind RM, Vargas A, Blecker U. Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification Acta Paediatr (Oslo, Norway : 1992) 2000;89(9):1036–1043.

  39. Bakhach M, Shah V, Harwood T, et al. The protein-sparing modified fast diet: an effective and safe approach to induce rapid weight loss in severely obese adolescents. Global pediatric health. 2016;3:2333794x15623245.

    Article  PubMed  PubMed Central  Google Scholar 

  40. AAP. Promoting Physical Activity. Bright Futures Web site. https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_PhysicalActivity.pdf. Published 2018. Accessed.

  41. Wu L, Sun S, He Y, Jiang B. The effect of interventions targeting screen time reduction: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(27):e4029.

    Article  Google Scholar 

  42. Wickham EP, 3rd, DeBoer MD. Evaluation and treatment of severe obesity in childhood. Clin Pediatr 2015;54(10):929–940.

  43. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43–53.

    Article  CAS  PubMed  Google Scholar 

  44. Wing RR, Venditti E, Jakicic JM, Polley BA, Lang W. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care. 1998;21(3):350–9.

    Article  CAS  PubMed  Google Scholar 

  45. Foright RM, Presby DM, Sherk VD, Kahn D, Checkley LA, Giles ED, et al. Is regular exercise an effective strategy for weight loss maintenance? Physiol Behav. 2018;188:86–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Jull A, Chen R. Parent-only vs. parent-child (family-focused) approaches for weight loss in obese and overweight children: a systematic review and meta-analysis. Obes Rev. 2013;14(9):761–8.

    Article  CAS  PubMed  Google Scholar 

  47. Buttitta M, Iliescu C, Rousseau A, Guerrien A. Quality of life in overweight and obese children and adolescents: a literature review. Qual Life Res. 2014;23(4):1117–39.

    Article  PubMed  Google Scholar 

  48. •• Srivastava G, Fox CK, Kelly AS, et al. Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity. Obesity (Silver Spring). 2019;27(2):190–204. This expert consensus statement describes the indications for the use of pharmacotherapy for pediatric obesity.

    Article  Google Scholar 

  49. Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA. 2005;293(23):2873–83.

    Article  CAS  PubMed  Google Scholar 

  50. Ryder JR, Kaizer A, Rudser KD, Gross A, Kelly AS, Fox CK. Effect of phentermine on weight reduction in a pediatric weight management clinic. Int J Obes. 2017;41(1):90–3.

    Article  CAS  Google Scholar 

  51. Sherafat-Kazemzadeh R, Yanovski SZ, Yanovski JA. Pharmacotherapy for childhood obesity: present and future prospects. Int J Obes (2005). 2013;37(1):1–15.

  52. Kelly AS, Fox CK, Rudser KD, Gross AC, Ryder JR. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. Int J Obes. 2016;40(7):1043–50.

    Article  CAS  Google Scholar 

  53. •• Ryder JR, Fox CK, Kelly AS. Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities. Obesity (Silver Spring). 2018;26(6):951–60. This review describes the current state and future directions of obesity pharmacotherapy and metabolic and bariatric surgery for the pediatric population.

    Article  Google Scholar 

  54. Fox CK, Kelly AS. The potential role of combination pharmacotherapy to improve outcomes of pediatric obesity: a case report and discussion. Front Pediatr. 2018;6:361.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of Pharmacological Treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. O'Neil PM, Birkenfeld AL, McGowan B, Mosenzon O, Pedersen SD, Wharton S, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet. 2018;392(10148):637–49.

    Article  CAS  PubMed  Google Scholar 

  57. •• Pratt JSA, Browne A, Browne NT, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. SOARD. 2018;14(7):882–901 This review describes recommendations for metabolic and bariatric surgery for the pediatric population based on updated outomes of longitudinal studies.

  58. Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.

    Article  CAS  PubMed  Google Scholar 

  59. • Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endo. 2017;5(3):165–73. A prospective follow-up analysis of 58 adolescents undergoing roux-en-Y gastric bypass found a mean BMI reduction of 29% at 8 years with accompanying improvements in hypertenstion, dyslipidemia, and type 2 diabetes.

  60. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endo. 2017;5(3):174–83.

  61. Ryder JR, Gross AC, Fox CK, et al. Factors associated with long-term weight loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obes. 2018;42(1):102–107.

  62. Beamish AJ, Olbers T, Kelly AS, Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol. 2016;13(12):730–43.

    Article  CAS  PubMed  Google Scholar 

  63. Ryder JR, Edwards NM, Gupta R, Khoury J, Jenkins TM, Bout-Tabaku S, et al. Changes in functional mobility and musculoskeletal pain after bariatric surgery in teens with severe obesity: teen-longitudinal assessment of bariatric surgery (LABS) study. JAMA Pediatr. 2016;170(9):871–7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kelly AS, Ryder JR, Marlatt KL, Rudser KD, Jenkins T, Inge TH. Changes in inflammation, oxidative stress, and adipokines following bariatric surgery among adolescents with severe obesity. Int J Obes. 2016;40(2):275-80.

  65. Inge TH, Prigeon RL, Elder DA, Jenkins TM, Cohen RM, Xanthakos SA, et al. Insulin sensitivity and beta-cell function improve after gastric bypass in severely obese adolescents. J Pediatr. 2015;167(5):1042–1048.e1041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Nehus EJ, Khoury JC, Inge TH, Xiao N, Jenkins TM, Moxey-Mims MM, et al. Kidney outcomes three years after bariatric surgery in severely obese adolescents. Kidney Int. 2017;91(2):451–8.

    Article  PubMed  Google Scholar 

  67. Manco M, Mosca A, De Peppo F, et al. The benefit of sleeve gastrectomy in obese adolescents on nonalcoholic steatohepatitis and hepatic fibrosis. J Pediatr. 2017;180:31–7 e32.

    Article  PubMed  Google Scholar 

  68. Nobili V, Carpino G, De Peppo F, et al. Laparoscopic sleeve gastrectomy improves nonalcoholic fatty liver disease-related liver damage in adolescents by reshaping cellular interactions and hepatic Adipocytokine production. J Pediatr. 2017.

  69. Sarwer DB, Dilks RJ, Spitzer JC, et al. Changes in dietary intake and eating behavior in adolescents after bariatric surgery: an ancillary study to the teen-LABS consortium. Obes Surg. 2017;27(12):3082–91.

    PubMed  PubMed Central  Google Scholar 

  70. Zeller MH, Pendery EC, Reiter-Purtill J, et al. From adolescence to young adulthood: trajectories of psychosocial health following Roux-en-Y gastric bypass. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.. 2017;13(7):1196–203.

  71. Zeller MH, Pendery EC, Reiter-Purtill J, Hunsaker SL, Jenkins TM, Helmrath MA, et al. From adolescence to young adulthood: trajectories of psychosocial health following Roux-en-Y gastric bypass. SOARD : official journal of the American Society for Bariatric Surgery. 2017;13(7):1196–203.

  72. Purnell JQ, Selzer F, Wahed AS, Pender J, Pories W, Pomp A, et al. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the longitudinal assessment of bariatric surgery study. Diabetes Care. 2016;39(7):1101–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Kadera BE, Lum K, Grant J, Pryor AD, Portenier DD, DeMaria EJ. Remission of type 2 diabetes after Roux-en-Y gastric bypass is associated with greater weight loss. SOARD : official journal of the American Society for Bariatric Surgery. 2009;5(3):305–9.

  74. Wang G-F, Yan Y-X, Xu N, Yin D, Hui Y, Zhang JP, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25(2):199–208.

    Article  PubMed  Google Scholar 

  75. Zeitler P, Hirst K, Pyle L, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56.

    Article  CAS  PubMed  Google Scholar 

  76. Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (labs) study. JAMA Surgery. 2018;153(5):427–34.

  77. Hatoum IJ, Blackstone R, Hunter TD, Francis DM, Steinbuch M, Harris JL, et al. Clinical factors associated with remission of obesity-related comorbidities after bariatric surgery. JAMA Surgery. 2016;151(2):130–7.

    Article  PubMed  Google Scholar 

  78. Benaiges D, Sague M, Flores-Le Roux JA, et al. Predictors of hypertension remission and recurrence after bariatric surgery. Am J Hypertens. 2016;29(5):653–9.

    Article  CAS  PubMed  Google Scholar 

  79. Staalesen T, Olbers T, Dahlgren J, Fagevik Olsén M, Flodmark CE, Marcus C, et al. Development of excess skin and request for body-contouring surgery in postbariatric adolescents. Plast Reconstr Surg. 2014;134(4):627–36.

    Article  CAS  PubMed  Google Scholar 

  80. Zeller MH, Inge TH, Modi AC, Jenkins TM, Michalsky MP, Helmrath M, et al. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr. 2015;166(3):651–9 e654.

    Article  PubMed  Google Scholar 

  81. Zeller MH, Washington GA, Mitchell JE, Sarwer DB, Reiter-Purtill J, Jenkins TM, et al. Alcohol use risk in adolescents 2 years after bariatric surgery. SOARD : official journal of the American Society for Bariatric Surgery. 2017;13(1):85–94.

  82. Goldschmidt AB, Khoury J, Jenkins TM, Bond DS, Thomas JG, Utzinger LM, et al. Adolescent loss-of-control eating and weight loss maintenance after bariatric surgery. Pediatrics. 2018;141(1):e20171659.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Phillips CM. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann N Y Acad Sci. 2017;1391(1):85–100.

    Article  PubMed  Google Scholar 

  84. • Ryder JR, Kaizer AM, Jenkins TM, Kelly AS, Inge TH, Shaibi GQ. Heterogeneity in Response to Treatment of Adolescents with Severe Obesity: The Need for Precision Obesity Medicine. Obesity (Silver Spring). 2019;27(2):288–94. Outcomes data from three centers across the United States conducting either lifestyle, pharmacotherapy, or metabolic and bariatric surgery interventions for pediatric severe obesity were pooled. Change in BMI following interventions ranged from -50.2% to +12.9%, with each intervention (lifestyle [range: -25.4% to 5.0%], pharmacotherapy [range: -10.8% to 12.9%], and metabolic and bariatric surgery [range: -50.2% to -13.3%]) exhibiting wide individual variation in response.

    Article  Google Scholar 

  85. Braet C. Patient characteristics as predictors of weight loss after an obesity treatment for children. Obesity (Silver Spring). 2006;14(1):148–55.

    Article  Google Scholar 

  86. Di Stefano G, Bini V, Papi F, et al. Leptin serum concentrations predict the responsiveness of obese children and adolescents to weight excess reduction program. Int J Obes Relat Metab Disord. 2000;24(12):1586–91.

    Article  CAS  PubMed  Google Scholar 

  87. Nathan BM, Rudser KD, Abuzzahab MJ, Fox CK, Coombes BJ, Bomberg EM, et al. Predictors of weight-loss response with glucagon-like peptide-1 receptor agonist treatment among adolescents with severe obesity. Clin Obes. 2016;6(1):73–8.

    Article  CAS  PubMed  Google Scholar 

  88. Love-Osborne K, Sheeder J, Zeitler P. Addition of metformin to a lifestyle modification program in adolescents with insulin resistance. J Pediatr. 2008;152(6):817–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Ryder JR, Gross AC, Fox CK, Kaizer AM, Rudser KD, Jenkins TM, et al. Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obes. 2018;42(1):102–7.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA

    Claudia K. Fox, Amy C. Gross, Eric M. Bomberg, Justin R. Ryder, Megan M. Oberle, Carolyn T. Bramante & Aaron S. Kelly

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  1. Claudia K. Fox
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Correspondence to Claudia K. Fox.

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Conflict of Interest

Claudia K. Fox has received research support from Novo Nordisk.

Amy C. Gross declares that she has no conflict of interest.

Eric M. Bomberg declares that he has no conflict of interest.

Justin R. Ryder has received drug and placebo support for a clinical trial from Boehringer Ingelheim.

Megan M. Oberle declares that she has no conflict of interest.

Carolyn T. Bramante declares that she has no conflict of interest.

Aaron S. Kelly declares that he has no conflict of interest.

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Fox, C.K., Gross, A.C., Bomberg, E.M. et al. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 8, 201–209 (2019). https://doi.org/10.1007/s13679-019-00347-z

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