Obesity in Children and Adolescents: Modern Challenges
Obesity among children and adolescents represents one of the most urgent and serious public health problems worldwide [7]. This is a multifactorial and multisystem disease associated with the development of severe comorbidities [5]. These comorbidities can significantly impair the quality of life and long-term health of young patients. Standardized approaches to identifying and managing obesity and its comorbidities in primary care settings are often lacking, especially in resource-limited regions [4].
Effective obesity management requires a comprehensive approach that begins with early diagnosis and includes various strategies aimed at lifestyle modification, as well as medical and surgical treatment when necessary. It is important to consider that obesity affects various aspects of health, and its management requires a systematic approach [4, 5].
A Comprehensive Approach to Weight and Health Management
Successful obesity management in children and adolescents is based on a multifaceted approach that includes both lifestyle changes and support from healthcare providers and families. A key aspect is the optimization of daily time distribution between physical activity, sedentary behavior, and sleep. Studies show that even minor time redistributions (e.g., just 10 minutes) between these activities can have a positive impact on obesity indicators, such as body mass index (BMI) and waist circumference, across all age groups, including children and adolescents [6].
To standardize the identification and management of obesity comorbidities in primary care, technological and visual tools such as electronic health records (EHRs) with templates and graphic reminders can be utilized. This helps physicians more effectively document, assess, and manage comorbidities, as well as support healthy lifestyles in young patients [4]. It is also crucial to consider the values and preferences of patients and their families when choosing treatment methods to ensure maximum adherence and therapeutic efficacy [8].
Pharmacotherapy as Part of the Treatment Strategy
Amid the growing prevalence of childhood and adolescent obesity, pharmacological interventions are becoming an important adjunct to lifestyle modification. Systematic reviews and network meta-analyses of randomized controlled trials confirm the efficacy and safety of certain medications in this age group. For example, semaglutide showed the greatest reduction in the 95th BMI percentile compared to lifestyle modification alone [7].
The choice of a specific drug and its dosage should be determined by a physician, taking into account the patient's individual characteristics, severity of obesity, presence of comorbidities, and potential side effects. Pharmacotherapy is generally used when lifestyle modifications are insufficient to achieve target weight goals and health improvements [7].
Bariatric Surgery: Indications and Efficacy
For children and adolescents with severe forms of obesity accompanied by serious comorbidities, surgical interventions can be a reliable way to achieve sustained weight loss and resolution of comorbidities [5]. Systematic reviews evaluating the efficacy and safety of various bariatric procedures show significant weight loss, improvement or complete resolution of comorbidities, and an acceptable postoperative complication profile in this patient group [5].
The decision to perform bariatric surgery is complex and must be made by an interdisciplinary team considering multiple factors, including the degree of obesity, presence and severity of comorbidities, patient age, psychological state, and readiness for long-term lifestyle changes after surgery. Ethical aspects and family preferences also play an important role in the decision-making process [5, 8].
Enhanced Recovery After Surgery (ERAS) in Children
Enhanced Recovery After Surgery (ERAS) protocols have become standard in various fields of adult surgery, demonstrating improved outcomes. Although the application of ERAS principles in pediatric surgery is not yet as widespread as in adults, studies demonstrate their potential applicability [3].
ERAS elements in pediatrics include early postoperative feeding, mobilization protocols, opioid-sparing analgesia, and a reduction in the use of nasogastric tubes and urinary catheters. Applying these principles can facilitate faster recovery in children after surgery, reduce complication rates, and shorten hospital stays, which is particularly relevant for complex procedures such as bariatric surgery [3].
References
- 1. Correction of spinal deformities in adult patients with Parkinson's disease: evaluation of surgical complications, reoperations, and costs. (World neurosurgery, 2023) https://pubmed.ncbi.nlm.nih.gov/37480985/
- 2. Camptocormia in Parkinson's disease: a systematic review of treatment methods using spine surgery. (World neurosurgery, 2024) https://pubmed.ncbi.nlm.nih.gov/39098502/
- 3. What is the role of enhanced recovery after surgery in children? A review. (Pediatric surgery international, 2017) https://pubmed.ncbi.nlm.nih.gov/27679510/
- 4. Standardizing comorbidity management in overweight or obese youth in primary care using technological and visual tools to facilitate assessment and healthy lifestyle change support. (Childhood obesity (Print), 2026) https://pubmed.ncbi.nlm.nih.gov/42159159/
- 5. Efficacy of bariatric methods in the treatment of obesity in children and adolescents: a systematic review. (Hormones (Athens, Greece), 2026) https://pubmed.ncbi.nlm.nih.gov/42443699/
- 6. Time reallocation across 24-h movement behaviors for lifelong obesity management: a pooled data meta-analysis of over 9800 participants from seven countries. (Sports medicine (Auckland, N.Z.), 2025) https://pubmed.ncbi.nlm.nih.gov/39708280/
- 7. Pharmacotherapy for children and adolescents with overweight or obesity: a systematic review and network meta-analysis of randomized controlled trials. (Diabetes, obesity & metabolism, 2026) https://pubmed.ncbi.nlm.nih.gov/42310900/
- 8. Incorporating patient and family values and preferences regarding health-related outcomes in pediatric obesity treatment: a systematic review. (Pediatric obesity, 2023) https://pubmed.ncbi.nlm.nih.gov/36810978/
The information provided in this article is for informational purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.