Adolescence: clinical and psychosocial challenges

Abstract

Obesity during adolescence represents one of the major public health challenges due to its increasing prevalence, complex pathophysiology, and profound impact on physical, mental, and social health. It is currently recognized as a chronic, multifactorial, and relapsing disease resulting from the interaction of biological, genetic, environmental, psychological, and sociocultural factors. During this developmental stage, characterized by profound physical, emotional, and cognitive changes, excess adiposity has implications that extend far beyond cardiometabolic risk.

Adolescents with obesity exhibit a high burden of clinical comorbidities, including insulin resistance, prediabetes and type 2 diabetes, dyslipidemia, hypertension, metabolic dysfunction-associated steatotic liver disease (MASLD), obstructive sleep apnea, and orthopedic complications. However, the psychosocial consequences are often equally significant. Weight-related stigma, bullying, discrimination, and internalized weight bias adversely affect self-esteem, promote social isolation, and increase the risk of anxiety, depression, eating disorders, and impaired quality of life. These experiences may compromise treatment adherence and perpetuate the cycle of disease.

Clinical management requires a comprehensive assessment that addresses not only metabolic complications but also mental health, family dynamics, social determinants of health, and lifestyle behaviors. Interventions focused exclusively on weight reduction have proven insufficient; instead, interdisciplinary models integrating pediatrics, endocrinology, nutrition, psychology, physical activity, and family involvement achieve superior outcomes. Furthermore, the use of respectful, person-centered, and non-stigmatizing language is an essential therapeutic tool for strengthening the therapeutic alliance with adolescents andpromoting sustainable behavioral change.

In recent years, recognizing obesity as a chronic disease has led to a paradigm shift in itsmanagement. In addition to intensive lifestyle interventions and psychosocial support,effective and safe pharmacological therapies are now available for selected adolescents,and metabolic bariatric surgery has become an evidence-based option for carefullyselected cases. These therapeutic strategies are not intended to replace interdisciplinarycare but rather to complement it, enabling a personalized treatment approach based ondisease severity, the presence of comorbidities, and the individual needs of eachadolescent, with the ultimate goal of improving both metabolic outcomes and quality of life.