Table.

Treatment Approach for Managing Adolescent Obesity

Recommendation	How	When
Classify and document weight status using BMI	Overweight: BMI in the 185th to 95th percentile for sex and age	Throughout care and follow-up
	Obesity: BMI ≥95th percentile for age and sex
	Severe obesity: BMI ≥120% of the 95th percentile for age and sex or BMI >35
Conduct a thorough history, physical examination, and laboratory assessment	Conduct a comprehensive weight history; medical, surgical, social, and family history; medication review; physical examination; and laboratory tests3,4	At the initial diagnosis of overweight or obesity; monitoring and reassessment as needed thereafter
Discuss diagnosis with patient and caregivers	Ask patient if she or he is open to discussing weight	Throughout care and follow-up
	Communicate in a respectful, empathetic, and compassionate manner using patient-first language and appropriate terms5
Recommend behavioral interventions	Present throughout treatment continuum	At the initial diagnosis of overweight or obesity; monitoring and discussion as needed thereafter
	Suggest dietary modifications and, when possible, refer patient to a registered dietitian
	Recommend 60 min of physical activity and less than 2 h of nonacademic sedentary activities
	Encourage behavioral change strategies, such as self-monitoring and goal setting
	Refer patient to a psychologist if psychological problems or adverse family dynamics are noted
Prescribe an FDA-approved pharmacological intervention	Orlistat, a pancreatic lipase inhibitor, is FDA-approved for long-term use in individuals aged ≥12 years	Combined with lifestyle interventions, medications are appropriate for individuals with BMI ≥120% of 95th percentile for age and sex or BMI ≥95th percentile with at least 1 significant obesity-related comorbidity
	Phentermine, a norepinephrine reuptake inhibitor, is FDA-approved for short-term use in individuals aged ≥17 years
Recommend a surgical intervention	Refer medically eligible and interested patients to a surgeon with experience performing bariatric surgical procedures on adolescents with a dedicated and experienced multidisciplinary team that provides support before and after the surgical procedure with consistent, long-term follow-up	Individuals with BMI ≥140% of 95th percentile for age and sex or BMI ≥120% of 95th percentile with at least 1 significant obesity-related comorbidity

Abbreviations: BMI, body mass index; FDA, US Food and Drug Administration.