Childhood Obesity Nursing CE Course

atory disorders (Hinkle et al., 2021; Khanna, Welch et al., 2022; Skelton & Klish, 2025a).

Risk Factors and Psychosocial Triggers

Identifying the risk factors associated with childhood obesity can help decrease incidence. The risk factors for childhood obesity are multifactorial, including genetic (refer to the pathophysiology section), physical, cultural, and environmental. Physical risk factors for obesity are related to a sedentary lifestyle. During the last decade, physical activity has declined due to increased screen time (i.e., smartphones, computers, televisions). Watching television or playing video games often replaces physical exercise. These behaviors can occur when children are social but can also occur when the child is withdrawn or depressed and does not interact with peers. Researchers have found a connection between screen time and the overeating of non-nutritious foods. Advertised foods are often consumed more than unadvertised foods, leading to poor food choices. Most advertised foods are not healthy meal options. Researchers have found that children develop their eating patterns at a young age, often determined by behaviors modeled by their parents or caregivers. Parental education about healthy food choices can positively influence healthy food choices in children. Poor food choices and excessive screen time contribute significantly to the rise of obesity in children. During the COVID-19 pandemic, researchers found an increased risk of obesity due to the exponential increase in sedentary activities and screen time. Researchers have also found a connection between shortened sleep duration or irregular sleep patterns and the risk of obesity (Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Mohamed et al., 2022; Skelton & Klish, 2025a).

Many environmental risk factors are known to impact childhood obesity. Researchers have found that obesity rates were higher in children living in low socioeconomic areas. Furthermore, lower socioeconomic status (SES) can negatively impact mental health, leading to depression, anxiety, and feelings of low self-worth, which are also linked to obesity in children. Emotional eating can lead to overeating and poor food choices. The most significant contributor to obesity in children with low SES is the lack of access to healthy foods and adequate exercise. This disparity is partly due to the lack of grocery stores with sufficient fresh vegetables and fruits and the lack of safe playgrounds (Balasundaram & Krishna, 2023; CDC, 2024f; Hemmingsson, 2018).

The presence of unhealthy family dynamics is another potential risk factor. In families where there is discord and dysfunction, children are found to be more at risk for obesity. This family dysfunction includes situations where there is neglect or emotional abuse. These situations can increase the risk of emotional eating, as previously mentioned. When a child is neglected, they are unlikely to be able to participate in activities that promote cardiovascular health. Children are also not primarily responsible for obtaining and preparing food. The parent or guardian controls this part of daily life, which can negatively impact dysfunctional families (Balasundaram & Krishna, 2023; CDC, 2024f; Hemmingsson, 2018).

Stress can also impact a child’s eating habits and psychosocial development. Some children overuse junk food to ease the psychological burden of living in a dysfunctional home. Junk food, otherwise known as food with little nutritional value, is easily obtainable and often used to self-soothe during times of emotional distress. Once this habit is established, it becomes difficult to change. Therefore, living in a dysfunctional household increases the risk of junk food overconsumption. In addition to dysfunctional households, school-related stress can also affect the child’s tendency to overeat or eat non-nutritious food. Educational stress (deadlines, academic performance, and outside emotional situations) impacts students’ healthy lifestyles from early childhood through adolescence. During a stressful episode, the body will excrete cortisol. Increased cortisol levels cause an increase in appetite and cravings for foods higher in sugar and fat, which then results in food choices that are less nutritious, leading to more weight gain. This overeating affects children assigned female at birth much more frequently than those assigned male at birth (Balasundaram & Krishna, 2023; CDC, 2024f; Hemmingsson, 2018; Nga et al., 2019).

A decrease in executive function has also been identified in children who are obese. Executive functioning incorporates “inhibitory control, working memory, and cognitive flexibility” (Hayes et al., 2018, p. 11). When considering control, the child with a high level of functioning can decline appealing food choices that are sugary or otherwise unhealthy. Working memory allows children to synthesize the knowledge they have gained in education, make the best choice, and understand how to develop a dietary or exercise plan that promotes health. Cognitive flexibility allows individuals to switch between unhealthy temptations and creatively substitute healthier options. Executive functioning has been well researched and leads to the ability to make healthy choices when confronted with unhealthy options. Weight loss and physical exercise can also improve one’s executive functioning (Hayes et al., 2018; Sanchez-Castaneda et al., 2021).

Additional biological factors can also increase the risk of childhood obesity. For example, researchers have found a connection between perinatal factors and the risk of obesity. These factors include high parental body mass index (BMI) in pregnancy, birth weight, child nutrition in the first 1,000 days of life, breastfeeding (protective) versus formula feeding, and weight gain in the first year. Certain medications can also cause weight gain in children, including antidepressants, antipsychotics, antiseizure medications, glucocorticoids, progestins, antihistamines, alpha- and beta-blockers, and antidiabetic medications (e.g., sulfonylureas, insulin, thiazolidinediones; Balasundaram & Krishna, 2023; Hemmingsson, 2018). Corica and colleagues (2018) found that a familial correlation in childhood obesity does exist. This knowledge allows the HCP to plan interventions more quickly when there is a strong suggestion of family history. Familial history is one aspect that is key to the onset of severe obesity, in addition to endocrine disorders. Earlier onset of obesity increases the risk of significant lifelong weight issues (Corica et al., 2018; Tirhani et al., 2023).

Screening for and Diagnosing Obesity

Obesity refers to excess fat; however, the methods used to measure body fat directly are not routinely available in clinical practice. Instead, HCPs assess obesity by evaluating the relationship between weight and height (i.e., anthropometrics). At well-child appointments, children are weighed and measured. Those measurements are then plotted on standardized growth charts individualized for children assigned male and female at birth. The BMI is widely accepted as the standard measurement for determining overweight and obesity in children 2 years and older. BMI is calculated by dividing the patient’s weight in kilograms by the square of their height in meters. Although BMI does not measure body fat directly, it correlates with direct measures of body fat, such as skinfold thickness measurements, dual-energy x-ray absorptiometry, bioelectrical impedance, and densitometry (i.e., underwater weighing). As children grow, the average BMI will vary with age and sex (CDC, 2024b; Skelton & Klish, 2024). In 2000, the National Center for Health Statistics and the CDC published the current reference BMI standards using the CDC growth charts for children ages 2 to 20:

• underweight: BMI <5th percentile for age and gender
• normal/healthy weight: BMI between the 5th and <85th percentile for age and sex
• overweight: BMI between the >85th and 95th percentile for age and sex
• obese: BMI ≥95th percentile for age and sex
• severe obesity: BMI ≥120% of the 95th percentile value or a BMI ≥35 kg/m² (whichever is lower; CDC, 2024b; Skelton & Klish, 2024)

The American Academy of Pediatrics (AAP) uses an expanded definition of severe obesity to include:

• class II obesity: 120% to less than 140% of the 95th percentile, or BMI 35 kg/m² to less than 40 kg/m²
• class III obesity: 140% of the 95th percentile or greater or BMI 40 kg/m² or greater (Hampl et al., 2023; Skelton & Klish, 2024)

Obesity in children and adolescents is associated with cardiovascular changes and an increased risk of cardiovascular disease in adulthood. This risk of hypertension and dyslipidemia in children and adolescents increases significantly as the severity of obesity increases. An expert panel that includes the American Medical Association (AMA), the CDC, and the Maternal and Child Health Bureau (MCHB) recommends that children with a BMI above the 94th percentile undergo an assessment for cardiovascular risk factors (National Heart, Lung, and Blood Institute [NHLBI], 2012). As children approach adulthood, the BMI thresholds for defining overweight and obesity will be the same as in the case of adults. The World Health Organization (WHO) has growth charts that are recommended for children younger than 2. The growth charts from the WHO are based on research regarding optimal growth in breastfed infants as opposed to historical data (Mukhopadhyay et al., 2019; WHO, n.d.).

The validity and reliability of the BMI as a measurement of obesity have been called into question within the medical and fitness communities in recent years. Khanna, Peltzer, and colleagues (2022) examined BMI to predict disease and health outcomes. They also reviewed how BMI correlates with other commonly used measures of obesity, such as waist circumference and waist-to-hip ratio. Among children, they found a positive association between elevated BMI during childhood and cardiovascular death in adulthood based on a study of adolescents in Israel. Similar studies found a correlation between high childhood BMI and the incidence of T2DM and endometrial cancer in adulthood. They also point out significant limitations to using BMI to diagnose obesity: it cannot assess body fat percentage and may underestimate the variability in sex, age, and race. Those with higher muscle mass may be categorized as overweight or obese due to an increased level of fat-free mass despite a lack of increased health risks. The use of waist circumference along with BMI may increase its validity and accuracy (Freedman et al., 2024; Khanna, Peltzer et al., 2022). Weight-for-height measurements are another way to assess adiposity and are preferred for the clinical assessment of failure to thrive and obesity in children younger than 2 years old (Phillips & Shulman, 2023).

History and Physical Examination

HCPs play a vital role in screening for obesity in children. The USPSTF et al. (2017) found no evidence regarding the appropriate screening intervals for obesity in children. The AAP recommends that HCPs assess BMI at least annually for children and adolescents over the age of 2. When an HCP determines that a child meets the criteria for overweight or obese, a thorough history and physical are needed to determine etiology. HCPs should use a nonjudgmental approach when talking with the child and family (Balasundaram & Krishna, 2023; CDC, 2024g; Daley & Balasundaram, 2025; Hampl et al., 2023; Skelton & Klish, 2024). The evaluation of potential etiology and comorbidities should include:

• weight history (i.e., gradual vs. rapid onset, severe early onset)
• behavior changes, such as extreme appetite or food-seeking behaviors
• family history of obesity
• family dynamics, including feeding patterns, meal composition, snacking, and screen time
• a 24-hour diet recall, including the servings of vegetables, fruits, and high-carbohydrate foods
• duration and type of physical activity
• history of T2DM and hypertension; cardiovascular disease in the child and family
• birth history, including intrauterine growth restriction (IUGR) and increased catch-up growth
• head trauma (could suggest a hypothalamic cause)
• easy bruising, fatigue, central obesity, and muscle weakness (could indicate Cushing syndrome)
• cold intolerance, swelling of the neck, and dryness of the skin (could indicate hypothyroidism)
• review current medications to check for drug-induced obesity (i.e., beta-blockers, antidepressants, antiseizure medications, corticosteroids, antipsychotics)
• polyuria, polydipsia (could indicate DM)
• anxiety and depression
• worsening school performance or behavioral problems such as bullying
• sleep disorders
• smoking or vaping
• irregular menses, hirsutism, and acne (indicating polycystic ovarian syndrome [PCOS]; Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Skelton & Klish, 2024)

Physical examination should include an assessment of height and weight to calculate BMI. The HCP should complete a thorough head-to-toe physical examination, checking for findings that could indicate etiology of obesity or complications related to obesity (Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Skelton & Klish, 2024). In addition, laboratory tests may be indicated to evaluate for comorbidities associated with obesity, including:

• dyslipidemia: low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol
• metabolic syndrome, DM: fasting blood glucose and hemoglobin A1C (HbA1C)
• metabolic dysfunction–associated steatotic liver disease (MASLD, previously nonalcoholic fatty liver disease or NAFLD): alanine aminotransferase (ALT) and aspartate transaminase (AST)
• PCOS: luteinizing hormone (LH), stimulating follicle hormone (FSH), and free testosterone
• hypothyroidism: stimulating thyroid hormone (TSH), free-T3, and free-T4
• Cushing syndrome: serum cortisol (Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Skelton & Klish, 2024)

The AAP (Hampl et al., 2023) recommends screening children with a BMI above the 85th percentile for comorbidities annually, including lipid abnormalities. Glucose metabolism and liver functioning testing are also recommended in those with a BMI above the 95th percentile or those with a BMI above the 85th percentile and other risk factors for T2DM or MASLD. Blood pressure should be assessed at each visit in children 3 and over with a BMI above the 85th percentile (Hampl et al., 2023).

Physical and Emotional Effects of Obesity

Childhood obesity significantly impacts psychological and physical health. Certain diseases, such as T2DM and steatohepatitis, were historically considered adult diseases and now regularly affect children and adolescents with obesity. As obesity rates rise, the resulting comorbidities have physical, psychological, and economic implications across the United States and worldwide. Obesity can impact every organ in the body, creating significant long-term effects (Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Skelton & Klish, 2025b). Refer to Table 1 for common health conditions associated with obesity by body system.

Table 1 

Obesity-Related Health Conditions by Body System

Body System	Health Condition
Cardiovascular	Hypertension Dyslipidemia Stroke
Respiratory	Asthma Obstructive sleep apnea
Neurological	Pseudotumor cerebri Idiopathic intracranial hypertension
Abdominal	Gallstones and gallbladder disease Nonalcoholic fatty liver disease (NAFLD) Gastroesophageal reflux disease (GERD)
Musculoskeletal	Joint problems Osteoarthritis Fractures Slipped capital femoral epiphysis Genu varus (Blount disease; progressive bowed legs and tibial torsion) Genu valgus (knock-knees; deformity of the tibiofemoral angle toward the midline)
Endocrine	Type 2 diabetes mellitus (T2DM) Metabolic syndrome
Reproductive	Hyperandrogenism and polycystic ovary syndrome (PCOS) Infertility Early onset puberty
Renal	Impaired glomerular filtration rate
Dermatologic	Acanthosis nigricans (i.e., hyperpigmentation and increased thickness of the skin associated with insulin resistance)
Psychosocial	Anxiety Depression Eating disorders Body image disorder

(Balasundaram & Krishna, 2023; Daley & Balasundaram, 2025; Skelton & Klish, 2025b)

Prevention and Management Strategies for Obesity

There is no single, simple solution to the obesity epidemic in the United States. Instead, this complex problem requires a multifaceted approach that includes state and local organizations, policymakers, health care organizations, schools, and community leaders working together to create an environment that supports healthy living. The CDC recommends that obesity prevention should be a community effort because children and adolescents are exposed to numerous care settings where healthy behaviors can be taught. Some community-based prevention strategies include (CDC, 2023, 2024d):

• Improving early care and education (ECE) environments can directly impact healthy living. These environments can create a foundation of healthy habits by monitoring what children consume and how active they are.
• Salad bar schools are private–public partnerships that engage stakeholders at various levels to sponsor and promote salad bars in schools.
• Healthy food environments utilize policies and programs to create healthy environments in communities. Some of these programs include incentives to establish a healthy business in an underserved area, placing nutritional factors on restaurant menus, and implementing nutritional standards for childcare centers, schools, and worksites.
• Healthy hospitals include obesity prevention efforts in these settings since they can impact large communities.
• Physical activity community strategies include efforts to increase the number of places where people can be active, such as walking trails, gyms, and parks. Additional approaches include community-wide education and enhanced school-based physical education programs.
• Digital health interventions can increase healthy eating and physical activity.

 

School systems and school nurses play an essential role in preventing childhood obesity. Children and adolescents spend significant time attending school; therefore, a comprehensive, school-based approach to addressing and preventing childhood obesity can impact healthy living. The CDC recommends that school systems adopt policies and practices to help children with healthy eating and increased physical activity. Research has shown that school-based obesity prevention programs are cost-effective and have successfully addressed childhood obesity, especially in elementary and middle school students. Schools can serve more fruits and vegetables, monitor portions, and limit foods and beverages high in added sugars or solid fats. These school-based programs can also have a meaningful impact on addressing weight-based stereotypes and creating a safe environment for students. The school nurse can address the complex physical, social, and health education needs of children who are overweight or obese. These nurses can create a health and wellness culture while partnering with families and HCPs (CDC, 2024d, 2024e).

General Approach to Weight Management

The AAP previously recommended a staged approach to weight management. In the most recent 2023 guideline, the AAP recommends early treatment using the highest level of intensity that is appropriate for and available to the child. The intensity of the treatment should be based on the level of concern (overweight, obese, or concerning BMI trends), priorities of the family, and availability of local resources. Intensive treatment is critical for children 6 years of age and older with severe obesity or concerning BMI trends. A referral to a specialized medical weight management program is recommended. However, if those programs are not feasible or available, the HCP can collaborate with a registered dietician and/or a behavioral specialist. The most successful prevention and management strategies for obesity in children focus on modifying behaviors that lead to excessive energy intake and insufficient energy expenditure. These behavioral strategies should focus on long-term behavioral change rather than short-term weight loss. Successful behavior change strategies for children and adolescents include (Daley & Balasundaram, 2025; Skelton, 2025):

• Self-monitoring of target behaviors allows the child and family to identify behaviors contributing to weight gain using food and physical activity logs. HCP feedback throughout this process is essential.
• Stimulus control includes reducing access to unhealthy behaviors, which helps to reduce environmental cues.
• Goal-setting is a widely used strategy for behavior change. This approach involves setting measurable and realistic goals for healthy behaviors (e.g., servings of fruits or vegetables or number of active minutes per day).
• Contracting is an agreement to give a reward for achieving a specific goal (e.g., nutrition or activity). This approach provides structure to the goal-setting process.
• Positive reinforcement involves giving a reward or praise for achieving a specific goal. The reward should be a small privilege or activity the child can frequently do instead of monetary incentives or toys.

Additional strategies for weight management include patient- and family-centered approaches; care should be based on the principle of the patient-centered medical home (PCMH). This model emphasizes long-term relationships and care that is coordinated, patient-centered, and comprehensive. The HCP should use a collaborative rather than a prescriptive approach to behavior change and goal-setting. When the HCP allows the child and family to help choose the goals, they are more likely to be successful. Goals should not be limited to reductions in BMI but should also address self-image, quality of life, and improvement in comorbidities, if present. The child should be directly involved in the decision-making process, as appropriate, based on their age. Sometimes, this might include giving two healthy choices and allowing them to pick the one they prefer. Motivational interviewing is an effective counseling technique for obesity management. Motivational interviewing utilizes a nonjudgmental, empathic, and encouraging approach to help patients identify their reasons for a behavior change. HCPs should encourage family involvement and avoid pressure or criticism whenever possible. In addition, the HCP should address potential economic and cultural factors that could limit the family’s ability or willingness to change nutrition or physical activity. Discussions about childhood obesity can be difficult, and the HCP should use nonstigmatizing language and avoid language that implies blame. Instead, consider initiating these discussions by acknowledging that some individuals gain weight more easily than others. This technique allows the HCP to recognize the role of nonmodifiable factors such as genetics. Finally, HCPs should use terms like “weight” or “BMI” when discussing with patients and families instead of “obese” or “fat” (Daley & Balasundaram, 2025; Hampl et al., 2023; Skelton, 2025).

The USPSTF (2024) and the AAP Clinical Practice Guideline Panel (Hampl et al., 2023) recommend obesity screening for children and adolescents 6 years and older and offering prevention and treatment services. They recommend offering comprehensive, family-centered, intensive behavioral interventions to improve weight status or intensive health behavior and lifestyle treatment (IHBLT) in patients 6 years and older with a BMI in the 85th percentile or greater. The guidelines recommend at least 26 hours over 3 to 12 months to achieve weight loss in children and adolescents. Behavioral interventions totaling over 52 contact hours had more significant weight loss and improved metabolic and cardiac risk factors. The USPSTF defined intensive and comprehensive behavioral interventions as multi-component, including sessions with the parent and child alone and together, and information about safe exercising, healthy eating, reading labels, stimulus control, goal-setting, and self-monitoring. They also found that supervised physical activity sessions are beneficial. Patients should be monitored for weight-related comorbidities. Social drivers of health should be considered and addressed (Hampl et al., 2023; USPSTF, 2024).

Strategies for Weight Management

The AAP no longer recommends a watchful waiting approach to weight management. Instead, general obesity prevention should be performed on all children at each well-child visit and should include routine monitoring and brief counseling. Routine monitoring should consist of BMI measurements tracked over time (CDC, 2024f; Daley & Balasundaram, 2025; Hampl et al., 2023; Skelton, 2025). Routine obesity-related counseling for all children at well-child visits should include:

• Establishing healthy feeding environments: HCPs should provide clear recommendations on healthy food choices and portion sizes. Simple education like “eat less and exercise more” is not effective. Families should be encouraged to use a diverse diet and meal-based eating plan, including limiting snacking, picky eating, and poor modeling by family members. Research does not suggest that any one specific diet is most effective for weight loss. Families should be encouraged to choose a plan that works for them. The traffic light diet can help families make healthy changes that align with cultural beliefs. Another option is the “5-2-1-0” guideline, which suggests 5 daily servings of fruits and vegetables, no more than 2 hours of screen time, and at least 1 hour of physical activity a day, along with no sugar-sweetened beverages.
• Encourage structured and unstructured physical activity: Physical activity guidelines recommend that children aged 6 to 17 engage in at least 60 minutes of moderate-to-rigorous exercise daily. Children aged 3 to 5 should be physically active throughout the day. Recommendations for activities can include walking, participating in sports, exercising with family, and unstructured outdoor play. Both aerobic and resistance exercises have been shown to improve the metabolic profile and reduce the risk of cardiovascular disease.
• Limit screen time: Increased screen time has been linked to lower physical activity levels. Screen time should be limited to less than 1 hour a day for children aged 2 to 5. For children over the age of 5, screen time should be limited to 2 hours per day.
• Target recommended sleep time for each age group: Children who do not get adequate sleep are at an increased risk of unhealthy weight gain, T2DM, and problems with attention and behavior. Researchers are still investigating the link between sleep and weight gain, but it is hypothesized that inadequate sleep leads to a more sedentary lifestyle. It is recommended that children aged 2 to 5 get 10 to 13 hours of sleep a day (including naps), children aged 6 to 12 should get 9 to 12 hours of uninterrupted sleep a night, and adolescents aged 13 to 17 should get 8 to 10 hours of uninterrupted sleep a night.

 

Pharmacologic Treatment

Although research does not support weight loss medications as a stand-alone treatment in pediatric patients, they can be effective when IHBLT has not been successful. Many weight loss medications have not been approved by the US Food and Drug Administration (FDA) for children, and more studies are needed to assess their efficacy. Patients aged 12 and older with a BMI in the 95th percentile or greater may be appropriate for pharmacological therapy (Hampl et al., 2023; Skelton, 2025).

• Glucagon-like peptide-1 (GLP-1) receptor agonists reduce hunger by slowing gastric emptying. Semaglutide (Wegovy) and liraglutide (Saxenda) are FDA-approved for adolescents aged 12 and older over 60 kg (132 lbs) with obesity. Side effects typically include nausea and vomiting. Mean weight loss in studies is 16.7% (or about 17.7 kg) or a decrease in BMI of 6.0 kg/m² for semaglutide (Wegovy). Mean weight loss in studies is 4.6% (or about 4.5 kg) or a decrease in BMI of 1.6 kg/m² for liraglutide (Saxenda).
• Orlistat (Xenical), a pancreatic lipase inhibitor, promotes mild-to-moderate weight loss by blocking fat absorption. It is FDA-approved for adolescents aged 12 and older with obesity. The average decrease in BMI in meta-analysis in children was 0.79 kg/m² after 6 to 12 months. Common adverse effects include steatorrhea, fecal urgency, flatulence, and a decrease in fat-soluble vitamin absorption.
• Metformin (Glucophage) is FDA-approved for treating T2DM in children aged 10 and older. Metformin (Glucophage) works by decreasing hepatic glucose production, reducing glucose absorption, and increasing insulin sensitivity. This drug is NOT approved for weight loss, but studies have shown that mild-to-moderate weight reduction can occur in children with T2DM. Average decrease in BMI in meta-analysis in children with T2DM was 0.86 kg/m² after 6 to 12 months. Common adverse effects include bloating, nausea, flatulence, and diarrhea; lactic acidosis may occur but is rare.
• Phentermine/topiramate (Qsymia) is an oral medication FDA-approved for weight management in patients 12 and older. It is a centrally acting appetite suppressant that may cause sympathomimetic (insomnia, xerostomia, constipation) or neuropsychiatric adverse effects and must be tapered off to reduce the risk of seizures. Average weight loss varies from 12 to 15.8 kg (8%–10%) or 5.3 kg/m². Topiramate is contraindicated in pregnancy, so caution should be exercised in adolescent patients assigned female at birth. Phentermine (Adipex-P) is also approved for use in adolescents 16 and older for short-term (12 weeks) use. Average weight loss with monotherapy in children is 3.2 kg (BMI decrease of 4%) at 6 months.
• Setmelanotide (Imcivree) is an injectable medication that targets the MC4R pathway and leptin signaling. It is approved for patients 2 years and older with certain syndromic etiologies of obesity, such as Bardet–Biedl syndrome, proopiomelanocortin (POMC) deficiency, and other rare genetic disorders associated with significant weight gain.

 

Bariatric Surgery

The AAP guidelines suggest consideration of referral to a bariatric surgery specialist in adolescents with severe obesity (a BMI of at least 120% of the 95th percentile for age and sex) who are at least 13 years old. This referral should be offered along with a discussion regarding the risks and benefits of a surgical component to the overall treatment plan. This typically results in a total weight loss of 50% to 70% of excess body weight. Pediatricians and other primary care providers should ensure which programs in their area specialize in the treatment of adolescent patients (Hampl et al., 2023; Skelton, 2025).

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