Childhood & Teen Obesity
Videos
Overview
Childhood and adolescent obesity is a chronic disease that affects about one in five American children and teenagers. It is not simply a matter of habits: genetics, biology, environment and social factors all contribute. Teens with obesity increasingly develop conditions once seen only in adults, including type 2 diabetes, high blood pressure, fatty liver disease and sleep apnea, and most continue to have obesity into adulthood without effective treatment (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023).
In 2023, the American Academy of Pediatrics issued its first comprehensive guideline on obesity treatment, recommending prompt, intensive treatment rather than "watchful waiting," including intensive health behavior and lifestyle treatment, consideration of anti-obesity medications for adolescents 12 and older, and evaluation for metabolic and bariatric surgery for adolescents 13 and older with severe obesity (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023).
Evidence for these treatments has grown substantially. In the STEP TEENS trial, semaglutide reduced BMI by about 16% in adolescents (Weghuber et al., STEP TEENS, New England Journal of Medicine, 2022), and the Teen-LABS study showed large, durable weight loss and high rates of diabetes and hypertension remission after bariatric surgery in teens (Inge et al., Teen-LABS, New England Journal of Medicine, 2016; Inge et al., Teen-LABS, New England Journal of Medicine, 2019).
Causes
- Genetics and family history
- Food environment: easy access to ultra-processed foods and sugary drinks
- Reduced physical activity and more screen time
- Short sleep
- Social and economic factors
- Medications and, rarely, hormonal or genetic syndromes
Risk Factors
- Parental obesity
- Hispanic and Black backgrounds, with higher rates in the United States
- Low income and food insecurity
- Insufficient sleep
- Sugary drink consumption
Who It Affects
Obesity affects children and adolescents of all backgrounds. Severe obesity in adolescents is increasing, and these teens face the highest risk of early complications.
Complications
- Type 2 diabetes, which progresses faster in teens than adults (Inge et al., Teen-LABS, New England Journal of Medicine, 2019)
- High blood pressure and abnormal cholesterol
- Fatty liver disease
- Sleep apnea
- Joint and bone problems
- PCOS in girls
- Depression, anxiety and bullying
Symptoms
- BMI at or above the 95th percentile for age and sex
- Snoring and daytime sleepiness
- Joint pain
- Dark skin patches (acanthosis nigricans)
- Low self-esteem and social withdrawal
Diagnosis
- BMI percentile: obesity at or above the 95th percentile; severe obesity at or above 120% of the 95th percentile (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023)
- Screening labs: glucose or HbA1c, lipids and liver tests starting at age 10
- Blood pressure
- Screening for sleep apnea, depression and other conditions
Differential Diagnosis
- Hypothyroidism
- Cushing syndrome
- Genetic syndromes
- Medication-related weight gain
Lifestyle Modifications
- Family-based health behavior treatment, ideally 26 or more hours of contact over three to twelve months (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023)
- Eliminate sugary drinks.
- At least 60 minutes of activity daily.
- Limit recreational screen time.
- Protect sleep.
Treatment Options
- Intensive health behavior and lifestyle treatment for all ages (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023)
- Anti-obesity medications for adolescents 12 and older, including GLP-1 receptor agonists (Weghuber et al., STEP TEENS, New England Journal of Medicine, 2022); see medical weight loss
- Metabolic and bariatric surgery for adolescents with severe obesity, recommended by the ASMBS and AAP for appropriately selected teens (Pratt et al., ASMBS Pediatric Guidelines, Surgery for Obesity and Related Diseases, 2018; Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023). In Teen-LABS, adolescents lost about a quarter of their weight and most achieved remission of type 2 diabetes (Inge et al., Teen-LABS, New England Journal of Medicine, 2016; Inge et al., Teen-LABS, New England Journal of Medicine, 2019). See sleeve gastrectomy.
When to See a Doctor
Talk with your child's doctor if their BMI is at or above the 95th percentile, they snore, or they have signs of high blood sugar or blood pressure.
When to Seek Treatment
Seek treatment promptly for teens with severe obesity or complications such as type 2 diabetes or sleep apnea; guidelines recommend against delaying treatment (Hampl et al., AAP Clinical Practice Guideline, Pediatrics, 2023).
Long-Term Outlook
Ongoing family support, medical follow-up and, for adolescents who undergo surgery, lifelong nutritional monitoring support lasting health.
Related Reading and Videos
Read more in our articles Why Obesity Is a Metabolic Disease — Not a Willpower Problem and Why Diets Fail: The Biology Behind Weight Loss, Regain, and Metabolic Adaptation. Watch Am I a Candidate for Weight-Loss Surgery? What Qualifies You and Every Obesity Treatment Explained — And How to Know Which One You Need on our video library. Related conditions include Metabolic Adaptation, Insulin Resistance, Chronic Kidney Disease (CKD) and High Cholesterol (Dyslipidemia). Treatments that may be involved include Endoscopic Sleeve Gastroplasty (ESG), Gastric Bypass (RYGB) and Magnetic Duodeno-Ileal Bypass with Sleeve (MagDI + Sleeve).
Prognosis
With early, comprehensive treatment, many children and teens achieve meaningful improvements in weight and health that can last into adulthood (Inge et al., Teen-LABS, New England Journal of Medicine, 2019).
Long-Term Results From Our Own Research
Dr. de la Cruz-Muñoz led a study published in the Journal of the American College of Surgeons that followed patients who had bariatric surgery, mostly gastric bypass, before age 22, at an average of 14.2 years after surgery. Patients maintained an average total body weight loss of about 31%, more than three-quarters kept their weight off, and obesity-related conditions such as diabetes, high cholesterol, high blood pressure and sleep apnea were greatly reduced (de la Cruz-Muñoz et al., Journal of the American College of Surgeons, 2022). These findings add to the evidence from Teen-LABS that surgery in adolescence produces durable benefits that last well into adulthood.
Why Choose Dr. de la Cruz-Muñoz
Dr. de la Cruz-Muñoz has performed metabolic and bariatric surgery in adolescents for more than two decades and is one of the leading researchers in the field. He led one of the longest follow-up studies of adolescent bariatric surgery ever published, tracking patients an average of 14 years after surgery, and has authored numerous additional papers on adolescent bariatric care (de la Cruz-Muñoz et al., Journal of the American College of Surgeons, 2022). His program provides family-centered evaluation, coordination with pediatricians and pediatric specialists, nutrition and behavioral support, and the full range of medical and surgical options recommended by the AAP and ASMBS, with lifelong follow-up into adulthood.
Dr. de la Cruz-Muñoz's Research on Adolescent Bariatric Surgery
- de la Cruz-Muñoz N, et al. Long-Term Outcomes after Adolescent Bariatric Surgery. Journal of the American College of Surgeons. 2022;235(4):592-602.
- Messiah SE, et al., de la Cruz-Muñoz N. Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018. Annals of Surgery. 2022;276(2):324-333.
- Messiah SE, Xie L, de la Cruz-Muñoz N, Lipshultz S. Use of Metabolic and Bariatric Surgery among US Youth. JAMA Pediatrics. 2023;177(8):856-857.
- Messiah SE, et al., de la Cruz-Muñoz N. Metabolic and Bariatric Surgery Utilization in the Era of GLP-1 Receptor Agonists among Adolescents versus Adults. Journal of Pediatrics. 2025;282.
- Sarno LA, et al., de la Cruz-Muñoz N. Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review. Pediatric Research. 2020;87(2):202-209.
- de la Cruz-Muñoz N, et al. Effectiveness of Bariatric Surgery in Reducing Weight and Body Mass Index Among Hispanic Adolescents. Obesity Surgery. 2013;23(2):150-156.
- Messiah SE, et al., de la Cruz-Muñoz N. Changes in Weight and Comorbidities among Adolescents Undergoing Bariatric Surgery: 1-Year Results from the Bariatric Outcomes Longitudinal Database. Surgery for Obesity and Related Diseases. 2013;9(4):503-513.
- Messiah SE, et al., de la Cruz-Muñoz N. Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery. World Journal of Diabetes. 2013;4(5):202-209.
- de la Cruz-Muñoz N, et al. Four-Year Weight Outcomes of Laparoscopic Gastric Bypass Surgery and Adjustable Gastric Banding Among Multiethnic Adolescents. Surgery for Obesity and Related Diseases. 2010;6(5):542-547.
- de la Cruz-Muñoz N, Messiah S, Monzon Canales EJ. Adolescents and Bariatric Surgery: Techniques and Outcomes. In: The SAGES Manual of Metabolic and Bariatric Surgery. Springer; 2024.
Dr. de la Cruz-Muñoz’s research on adolescent bariatric surgery has been covered by the Bulletin of the American College of Surgeons, HealthDay and Physician’s Weekly and Bariatric News.
Dr. de la Cruz-Muñoz has been performing bariatric surgery for over 25 years and has completed more than 9,000 bariatric operations — a volume few surgeons reach.
Featured Procedures
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FAQ
Partly. Calorie reduction, exercise, and bariatric surgery measurably shift methylation toward healthier patterns. However, fat tissue retains an epigenetic memory of prior obesity that can persist for years and contributes to weight regain, so reversal is incomplete rather than total.
Patients should consider medical or surgical treatment when obesity is causing health problems (diabetes, hypertension, sleep apnea, fatty liver disease), when weight is affecting quality of life, or when repeated dieting has failed. Metabolic surgery is the most effective option for patients with severe obesity or obesity‑related diseases, offering durable weight loss and powerful metabolic improvements.
Obesity is driven by genetics, hormones, metabolism, gut microbiota, sleep disruption, medications, stress, and environmental factors. More than 100 genes influence appetite, cravings, and fat storage. This is why two people can eat the same diet and gain or lose weight differently. Obesity is a biological disease, not a behavioral failure.
Yes—obesity is treatable and its complications are often reversible. With evidence‑based therapy (nutrition, medications, or metabolic surgery), patients can improve insulin resistance, normalize blood pressure, resolve sleep apnea, reverse fatty liver disease, and dramatically reduce long‑term cardiovascular and cancer risk. The key is early, sustained treatment, not short‑term dieting.
Obesity is diagnosed using body composition, not just weight. While BMI is a screening tool, the true diagnosis comes from evaluating body fat percentage, visceral fat, metabolic markers, waist circumference, and obesity‑related conditions such as diabetes, fatty liver disease, or sleep apnea. Many patients with a “normal BMI” still have obesity based on excess body fat and metabolic dysfunction.
Obesity treatment falls into three evidence‑based categories:
- Lifestyle therapy: Nutrition, physical activity, sleep, and behavioral support. Helpful, but rarely enough alone.
- Medical therapy: FDA‑approved anti‑obesity medications (including GLP‑1s) that target hunger, cravings, insulin resistance, and metabolic adaptation.
- Metabolic & bariatric surgery: Sleeve gastrectomy, gastric bypass, SADI‑S, and duodenal switch create the most powerful and durable metabolic change, improving or resolving diabetes, hypertension, sleep apnea, fatty liver disease, and long‑term cardiovascular risk.
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