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Adolescent obesity

ACOG stresses the need for ob-gyns to be aware of adolescent obesity

The risks of all contraceptive methods are lower than the risks of pregnancy and the postpartum period for overweight and obese adolescents

New guidance from the American College of Obstetricians and Gynecologists (ACOG) has emphasised the need for obstetrician–gynaecologist to be aware of and sensitive to obesity in adolescent patients. According to the Committee Opinion, “Obesity in Adolescents,” adolescents affected by obesity face serious short-term and long-term physical and mental health complications that are often otherwise uncommon in their age group, including cardiovascular disease, diabetes, non-fatty alcoholic fatty liver disease and breathing complications.

Obesity can also lead to specific gynaecologic risks, from abnormal or heavy uterine bleeding to polycystic ovary syndrome; and for obese adolescents who become pregnant, greater risk of caesarean delivery, preeclampsia and gestational diabetes. As the leading health care providers for women, ob-gyns are in a unique position to educate their adolescent patients about the risks of obesity. Ob-gyns also play an integral role in providing the appropriate counselling regarding behaviour changes to improve an obese patient’s health.

“Ob-gyns should be a trusted resource for obese teens and their parents,” said Dr Bliss Kaneshiro, Committee Opinion author. “We have a responsibility to provide critical information about active lifestyles and healthy caloric intake, but we must also listen carefully to patients’ and their parents to ensure we’re addressing the health concerns thoughtfully and collaboratively.”

The new Committee Opinion, underscores that sensitivity is paramount to counselling and treating obesity in adolescents. Teenage girls face significant social stigma around their weight from peers, family and the media that can lead to depression, anxiety, low self-esteem and in some instances, self-harm.

The paper also highlights the role of bariatric surgery and states that a multidisciplinary team, including an experienced bariatric surgeon, dietitian, and psychologist or psychiatrist, should be used to select appropriate candidates for surgical intervention and provide postoperative support.

“Good candidates are those with mature decision-making abilities, appropriate understanding of the risks and benefits of surgery, and support but not coercion from family members. Patients and their families need to have the ability and motivation to adhere to postoperative treatments, including consistent use of micronutrient supplements,” the paper states.

Surgically induced weight loss will lead to resumption of ovulation in some anovulatory women and although women with a history of gastric bypass can have healthy pregnancies, pregnancy should be avoided for at least 12–18 months after gastric bypass because of rapid weight loss and micronutrient deficiencies.

In addition to counselling obese patients on healthy behaviour changes, the Committee Opinion includes several key recommendations:

  • The obstetrician–gynaecologist should be able to identify obese adolescents, particularly those at risk of comorbid conditions. They may have the opportunity to initiate behavioural counselling, participate in multidisciplinary teams that care for overweight and obese adolescents, and advocate for community programs to prevent obesity.
  • Oral emergency contraception should not be withheld from adolescents or women who are overweight or obese because no research to date has been powered adequately to evaluate a threshold weight at which it would be ineffective.
  • The risks of all contraceptive methods are lower than the risks of pregnancy and the postpartum period for overweight and obese adolescents.
  • The obstetrician–gynaecologist should screen overweight and obese adolescents for depression, bullying, and peer victimization and appropriately refer to school-based and community-based resources as well as psychiatric services.
  • There are currently no evidence-based guidelines for the use of pharmaceutical agents in the management of obesity in adolescents.
  • The obstetrician–gynaecologist should caution against the use of weight loss supplements.

Ob-gyns should screen for these factors, and be prepared to refer patients to school and community based resources, as well as psychiatric services. Without proper support, struggling with their mental health may limit obese adolescents social, educational and professional engagement, leading to fewer opportunities as they continue to grow-up.

Early intervention in obesity can have lasting positive effect. When adolescents received adequate support and treatment resulting in healthy weight loss, many of the health risks attendant to obesity and their long-term consequences are entirely mitigated.

The ACOG Committee Opinion, “Obesity in Adolescents,” is available in journal, Obstetrics & Gynecology. The paper can be accessed here

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