BMI: body mass index.
* A sharp rise in BMI refers to an upward deflection on the BMI curve that is substantially steeper than the nearby centile curves over 6 to 12 months.
¶ For weight management counseling, the timing of follow-up depends on the clinician's level of concern and the patient and family's engagement. A typical interval between visits is 1 to 3 months.
Δ Severe obesity is ideally defined as BMI ≥120% of the 95th percentile or ≥35 kg/m2 (whichever is lower). This corresponds to approximately the 99th percentile or BMI Z-score ≥2.33 (ie, 2.33 standard deviations above the mean).
◊ Pharmacotherapy is typically managed by clinicians with special expertise in weight management (eg, a multidisciplinary weight management program) but may be appropriate for management of obesity in a primary care setting if the clinician learns the limitations and potential adverse effects of the available options and follows the patient closely. Refer to UpToDate content on obesity management in the primary care setting and on pharmacotherapy for obesity.
§ Weight loss surgery is an appropriate consideration for adolescents with severe obesity and with medical comorbidities who have failed to lose weight through conventional dietary interventions and behavioral modification. It should only be performed in the context of a multidisciplinary program with expertise in adolescent medicine and extensive expertise in bariatric surgery. Early surgical intervention may improve outcomes compared with intervention at an older age or higher BMI. Refer to UpToDate content on surgical management of severe obesity in adolescents.