Obesity Guidelines Differ for Adult, Pediatric Patients

Obesity is a major public health issue for adults, but for an increasing number of patients, its onset begins in childhood. One study found that more than half of children with obesity will remain obese in adolescence, and 80% of adolescents with obesity go on to have obesity in adulthood.¹ 

Yet, despite the significant risk that obesity will bridge different phases of life, current guidelines tend to be broken up into discrete age categories. In a new review published in Obesity Reviews, researchers examined existing guidelines for patients with obesity to see where similarities and discrepancies could be found between recommendations for adults and those for pediatric patients.²

The investigators completed a systematic review, finding 39 sets of guidelines published between 2017 and 2023. Within those guidelines were 1248 specific recommendations.¹

One area of significant difference between adult and pediatric guidelines is in recommendations related to body mass index. | Image credit: Feng Yu - stock.adobe.com

The investigators found numerous discrepancies between the recommendations for adults and those for pediatric patients. In particular, though, they found that guidelines for patients transitioning between those 2 periods of life—adolescents—were relatively few and lacked strong evidence.

One area of significant difference between adult and pediatric guidelines is in recommendations related to body mass index (BMI). For children, BMI is assessed using a dynamic percentile curve; for adults, the BMI categories are “rigid,” the authors noted. Adults with obesity are encouraged to perform aerobic and resistance training; while adolescents are only encouraged to do aerobic training. Similarly, guidelines suggest adults consider low-calorie diets, low-carbohydrate diets, and partial meal replacements, whereas no such guidelines exist for adolescents, and some guidelines even recommend against low-calorie diets.

The authors explained one reason for the discrepancy is that some question whether adolescents who are still in the process of growing can benefit from diets. However, they said a meta-analysis from 2019 concluded that such diets can be effective, though the analysis also cautioned that more research with longer-term follow-up periods is needed.³

In terms of therapeutic goals of weight loss, the authors found that 2 sets of guidelines for children recommend a gradual reduction in BMI.¹ For adults, the guidelines suggest a more concrete goal of losing 5% to 10% of weight in the first 6 months. Additionally, while the involvement of a family support system is treated as an important component of weight loss for pediatric patients, guidelines for adult patients tend to emphasize self-management and health literacy, the authors found.

“In adolescents, as in adults, the improvement of health literacy might be considered a relevant health objective in order to promote healthy eating and nutritional behavior and a healthy lifestyle,” the authors wrote, noting that adolescents will soon be transitioning to life as independent adults.

There are also gaps in terms of recommendations for metabolic and bariatric surgery (MBS). Such procedures are recommended for adolescents if they have a BMI above 50 kg/m², but the bar is lower—a BMI of at least 40 kg/m²—if the patient is an adult. However, the authors added that there are few recommendations related to adolescents and MBS in general, owing to a lack of research into this patient population. That may soon change, though, they noted.

“Due to the fact that obesity, including severe obesity and the associated comorbidities, is increasingly occurring in adolescents worldwide, it is likely that the necessary data basis for bariatric interventions will also emerge for this age group within the next decade,” they wrote.

The investigators did find a number of similarities in the recommendations between the 2 groups. They said both sets of recommendations encouraged annual BMI assessments and screening for eating disorders and obesity-related comorbidities. Cognitive behavioral therapy is listed as a potential therapeutic intervention in both populations. Lastly, both sets of guidelines urge a multidisciplinary approach to decisions about potential surgeries.

The authors concluded that the lack of specificity in the guidelines regarding the transition period between childhood and adulthood is problematic. They said it might be helpful to utilize counseling or therapy sessions to help support adolescents as they prepare to become adult patients.

References

1. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95-107. doi:10.1111/obr.12334

2. Brauchmann J, Laudenbach L, Kapp P, et al. Discrepancies between recommendations in evidence-based guidelines for the management of obesity in adolescents and adults: an evidence map. Obes Rev. Published online May 27, 2025. doi:10.1111/obr.13945

3. Andela S, Burrows TL, Baur LA, Coyle DH, Collins CE, Gow ML. Efficacy of very low-energy diet programs for weight loss: A systematic review with meta-analysis of intervention studies in children and adolescents with obesity. Obes Rev. 2019;20(6):871-882. doi:10.1111/obr.12830